Designing national quality reforms: a framework for action.
Healthcare systems worldwide strive to improve the quality of care they provide. Securing predictable systemic improvement is, however, a complex task. The imperative to be evidence-based is often constrained by the literature, which is of uneven scientific rigour and neither well-synthesized nor contextualised. This article provides a conceptual framework to guide the translation of the available evidence into policy and managerial decisions for improving quality. The framework has three aspects: a taxonomy to organize the available evidence of potential quality-enhancing interventions; a multi-tier approach to selecting and implementing interventions in a healthcare system; and a model to guide the adoption of professional, governmental and market levers for change.
Leatherman
Sheila
S
School of Public Health, University of North Carolina, NC, USA. sheilaleatherman@aol.com
Sutherland
Kim
K
D019317:Evidence-Based Medicine; D018166:Health Care Reform; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006302:Health Services Research / Q000145:classification / Q000458:organization & administration; D006801:Humans; D011050:Policy Making; D011785:Quality Assurance, Health Care / Q000145:classification / Q000379:methods* / Q000592:standards; D014481:United States