title: Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory.
abstract: BACKGROUND
  The identification and articulation of programme theory can support effective design, execution and evaluation of quality improvement (QI) initiatives. Programme theory includes an agreed aim, potential interventions to achieve this aim, anticipated cause/effect relationships between the interventions and the aim and measures to monitor improvement. This paper outlines the approach used in a research and improvement programme to support QI initiatives in identifying and articulating programme theory: the action effect method.
  Building on a previously used QI method, the driver diagram, the action effect method was developed using co-design and iteration over four annual rounds of improvement initiatives. This resulted in a specification of the elements required to fully articulate the programme theory of a QI initiative.
  The action effect method is a systematic and structured process to identify and articulate a QI initiative's programme theory. The method connects potential interventions and implementation activities with an overall improvement aim through a diagrammatic representation of hypothesised and evidenced cause/effect relationships. Measure concepts, in terms of service delivery and patient and system outcomes, are identified to support evaluation.
  
  
  CONCLUSIONS
  The action effect method provides a framework to guide the execution and evaluation of a QI initiative, a focal point for other QI methods and a communication tool to engage stakeholders. A clear definition of what constitutes a well-articulated programme theory is provided to guide the use of the method and assessment of the fidelity of its application.
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Reed
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: McNicholas
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Woodcock
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Laurel
authors.identifier: http://orcid.org/0000-0001-8592-4322
authors.initials: L
authors.lastname: Issen
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D008962:Models, Theoretical; D058996:Quality Improvement
keywords: Communication; Evaluation methodology; Implementation science; Quality improvement methodologies; Quality measurement