This is the first of three articles on research to improve the quality of health care

Health resources that could be used for clinical care are increasingly being devoted to large scale programmes to improve the quality of health care. Examples include national quality initiatives, hospital programmes, and quality accreditation, assessment, and review processes. However, little research has been done into their effectiveness or the conditions needed to implement quality programmes successfully. This is partly because the programmes are difficult to evaluate: they change over time, are applied to changing organisations, and need to be assessed from different perspectives. However, research can produce valid and useful knowledge about how to make such programmes work. We describe what research has shown us so far and highlight how better information can be obtained.