title: Assessing quality improvement in health care: theory for practice.
abstract: OBJECTIVE
  To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care.
  
  
  METHODS
  Conceptual model, informed by literature review.
  
  
  RESULTS
  To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care.
  
  
  CONCLUSIONS
  Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement.
authors: Mount Sinai School of Medicine, Department of Health Evidence and Policy, One Gustave Levy Place, Box 1077, New York, NY 10029, USA. lawrence.kleinman@mountsinai.org
authors: Lawrence C
authors: LC
authors: Kleinman
authors: Denise
authors: D
authors: Dougherty
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D017146:Models, Organizational; D015279:Organizational Culture; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement