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Demystifying theory and its use in improvement.

Frank Davidoff1, Mary Dixon-Woods2, Laura Leviton3

  • 1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.

BMJ Quality & Safety
|January 25, 2015
PubMed
Summary

Theory is crucial for healthcare improvement, yet often overlooked. Making informal and formal theories explicit strengthens programs and evaluation, benefiting practitioners.

Keywords:
ComplexityEvaluation methodologyImplementation scienceQuality improvement methodologiesSocial sciences

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Area of Science:

  • Healthcare Improvement Science
  • Theory in Practice
  • Knowledge Translation

Background:

  • The role and value of theory in healthcare improvement are underrecognized.
  • Professionals often feel alienated by theory, hindering its use in practice.
  • Theory, as 'reason-giving,' is integral to human endeavors, including improvement work.

Purpose of the Study:

  • To demystify theory for healthcare improvement practitioners.
  • To explore the characteristics and application of different theory types (grand, mid-range, programme).
  • To emphasize the importance of making theories explicit for effective improvement.

Main Methods:

  • Exploration of the characteristics of grand, mid-range, and programme theory.
  • Review of the consequences of misusing or omitting theory.
  • Examination of criteria for 'good' theory and the process of developing/applying programme theory.

Main Results:

  • Theory is not discretionary but fundamental to human endeavor.
  • Informal, experience-based theory is always present in improvement work but often implicit.
  • Failure to use or misuse of theory can negatively impact improvement initiatives.

Conclusions:

  • Healthcare improvement practitioners implicitly use theory, but often without awareness.
  • The key is not *whether* theory is used, but *making explicit* the informal and formal theories employed.
  • Explicitly articulating theories enhances the strength and evaluation of improvement programs.