title: The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement.
abstract: BACKGROUND Quality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen.
  
  
  OBJECTIVE
  To develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project.
  
  
  METHODS
  10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model.
  
  
  RESULTS
  The Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly.
  
  
  CONCLUSIONS
  The MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.
authors.affiliation: Cincinnati Children's Hospital Medical Centre, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH 45229, USA. heather.kaplan@cchmc.org
authors.forename: Heather C
authors.initials: HC
authors.lastname: Kaplan
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Provost
authors.forename: Craig M
authors.initials: CM
authors.lastname: Froehle
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
mesh_terms: D006801:Humans; D017146:Models, Organizational; D008962:Models, Theoretical; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards