How do we learn about improving health care: a call for a new epistemological paradigm.
OBJECTIVE
The field of improving health care has been achieving more significant results in outcomes at scale in recent years. This has raised legitimate questions regarding the rigor, attribution, generalizability and replicability of the results. This paper describes the issue and outlines questions to be addressed in order to develop an epistemological paradigm that responds to these questions.


OBJECTIVE
We need to consider the following questions: (i) Did the improvements work? (ii) Why did they work? (iii) How do we know that the results can be attributed to the changes made? (iv) How can we replicate them? (Note, the goal is not to copy what was done, but to affect factors that can yield similar results in a different context.)


CONCLUSIONS
Answers to these questions will help improvers find ways to increase the rigor of their improvements, attribute the results to the changes made and better understand what is context specific and what is generalizable about the improvement.
University Research Co., LLC., Bethesda, MD, USA.
M Rashad
MR
Massoud
Harvard Medical School, Boston, MA, USA.
Danika
D
Barry
University Research Co., LLC., Bethesda, MD, USA.
Andrew
A
Murphy
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Yvonne
Y
Albrecht
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Sylvia
S
Sax
MacColl Center for Health Care Innovation, Group Health Research Institute, Seattle, WA, USA.
Michael
M
Parchman
D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D015279:Organizational Culture; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards
complex adaptive systems; delivery; implementation; improvement; learning