title: Healthcare quality improvement -- policy implications and practicalities.
abstract: OBJECTIVE
  This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention.
  
  
  METHODS
  Learning events combined with work-based projects, focusing on individual and group responses are evaluated. A total of 11 multi-disciplinary groups drawn from NHS England healthcare Trusts (self-governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used.
  
  
  RESULTS
  The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient-centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged.
  
  
  CONCLUSIONS
  The authors revise the Plan, Do, Study; Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution-focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes.
  
  
  CONCLUSIONS
  - Although UK-centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.
authors.affiliation: Cardiff Business School, Cardiff University, UK. esain@cardiff.ac.uk
authors.forename: Ann Elizabeth
authors.initials: AE
authors.lastname: Esain
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gakhal
authors.forename: Lynne
authors.initials: L
authors.lastname: Caley
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Cooke
mesh_terms: D004739:England; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000379:methods / Q000458:organization & administration / Q000592:standards; D006291:Health Policy; D006801:Humans; D011340:Problem Solving; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D013192:Staff Development / Q000379:methods; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards