Intended for healthcare professionals

Education And Debate Improving the quality of health care

Using research to inform quality programmes

BMJ 2003; 326 doi: (Published 05 April 2003) Cite this as: BMJ 2003;326:759
  1. John Øvretveit, director of research (,
  2. David Gustafson, Robert Ratner professor of industrial engineering and preventive medicineb
  1. a Medical Management Centre, Karolinska Institute, Stockholm Sweden S-40242
  2. b University of Wisconsin, 610 Walnut Street, University of Wisconsin, Madison WI 53705, USA
  1. Correspondence to: J Øvretveit
  • Accepted 6 February 2003

Quality programmes consume more resources than any treatment and have potentially greater consequences for patient safety and other clinical outcomes. So why do we know so little about whether they are effective?

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.

Summary points

Quality programmes are large scale interventions to improve health care

Little research is available to show if they work or are cost effective

Such research is difficult because the programmes involve dynamic organisations and change over time

Research can identify the factors needed for successful implementation

What is a quality programme?

Quality programmes are planned activities carried out by an organisation or health system to prove and improve the quality of health care. The programmes cover a range of interventions that are more complex than a project carried out by a single team (box 1).

Use of quality programmes is increasing worldwide. One recent study noted 11 different types of quality programmes in the NHS over three years.1 Many countries are embarking on accreditation programmes without any evidence that they are the best use of resources for improving quality and …

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