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Quality Improvement techniques and the transformation of organizational practices: a review of health sector and generic management literature.
Bérard, E., Denis, J.L., Saulpic, O., Zarlowski, P.

Healthcare systems are under constant pressures to improve their performance and to better respond to population needs and expectations. New doctrines or techniques are continuously proposed to improve the delivery of care and services. A family of techniques that we label Quality Improvement (QI) techniques have been promoted across various systems and jurisdictions to impact on quality, efficiency and safety of care. QI are a specific case of a broader contemporary trend in organizations which sees in the adoption and implementation of managerial tools and techniques a way to overcome obstacles to improvements and to enable practice changes. In this paper, based on a meta-narrative synthesis of the literature (Greenhalgh et al. 2005), we analyze the benefits/potential and limits of this family of managerial tools and the role of organizational context and agency in the determination of expected benefits. Our aim here is twofold. First, we want to investigate the conditions of effectiveness of QI techniques: how and why they can yield successful results. Then, we wish to propose an integrative framework for the implementation of managerial techniques that could apply and potentially benefit to the understanding of QI implementation within healthcare settings.

Why is such a perspective of any interest for our research question? Despite the broad diffusion of QI in healthcare, there is still a lack of scientific evidence concerning the conditions of effectiveness of such programs. First, the nature and characteristics of QI components and their mode of implementation are not well documented in most of the studies (Nadeem 2013). Second, the change process associated with the diffusion of QI across systems and organizations remains largely under documented. More precisely, how do procedural improvements translate into better patient care, and how to get insight into QI's critical features for improvement? Such concerns are largely shared among the healthcare management community : during the last decade, many studies have stressed that too little is known in healthcare management about "how and why" QI shall work in practice (Dixon-Woods et al. 2011; Hulscher et al. 2013; Stoopendaal y Bal 2013; Walshe y Freeman 2002; Dainty et al. 2013; KAPLAN et al. 2010; GREENHALGH et al. 2012).
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