Designing quality improvement initiatives: the action effect method, a structured approach to identifying and...

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Programme Theory Development

Background:

• Effective quality improvement (QI) initiatives require clear programme theory, encompassing aims, interventions, causal links, and measures.
• Programme theory guides the design, execution, and evaluation of complex healthcare interventions.
• Existing QI methods, like the driver diagram, provided a foundation for developing a more comprehensive approach.

Purpose of the Study:

• To outline and describe the action effect method for identifying and articulating programme theory in QI initiatives.
• To present a structured, systematic process for developing robust programme theory.
• To provide a framework for enhancing the clarity and effectiveness of QI interventions.

Main Methods:

• The action effect method was developed through co-design and iterative refinement over four rounds of QI initiatives.
• It builds upon the driver diagram, incorporating a systematic process to connect interventions and implementation activities to the overall aim.
• The method utilizes diagrammatic representation of hypothesized and evidenced cause-effect relationships and identifies key measure concepts for evaluation.

Main Results:

• The action effect method provides a structured framework for articulating the programme theory of a QI initiative.
• It specifies the necessary elements for a fully articulated programme theory.
• The method facilitates the connection between potential interventions, implementation activities, and the desired improvement aim.

Conclusions:

• The action effect method offers a valuable framework for guiding the execution and evaluation of QI initiatives.
• It serves as a focal point for integrating other QI methodologies and a tool for stakeholder engagement.
• The method promotes a clear definition and consistent application of programme theory in practice.