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Elements of Improving Quality and Safety in Healthcare

Our open-access series brings together critical evidence-based overviews of a diverse range of healthcare improvement approaches.

Mary Dixon-Woods introduces the series
Who is it written by?

We have worked with more than 60 leading academic and clinical experts to develop the series.

Who is it aimed at?

Researchers, people involved in training on healthcare improvement, and those interested in understanding current debates.

What will I learn?

Each Element explores the thinking behind an improvement approach, examines the evidence, and identifies gaps and challenges.

🆕Design Creativity

Gyuchan Thomas Jun, Sue Hignett, P. John Clarkson

This Element examines the role of design creativity within the context of healthcare improvement. It provides an outline of the characteristics of design thinking, shares practical tools to support design creativity and examples of their use, and offers a critique of the approach and the evidence for its application in healthcare improvement.

Two diamonds side by side representing the Double Diamond model.

Explore the series

A round maze with a red dot in the middle

Values and Ethics

Alan Cribb, Vikki Entwistle, Polly Mitchell

This Element demonstrates the ethical considerations and values that underpin both the goals of healthcare improvement and how improvement work is undertaken.

A graph with points going up and down.

Statistical Process Control

Mohammed Amin Mohammed

This Element describes statistical process control methodology, shares case studies to illustrate its application in healthcare, and provides critiques and reflections on its current use and future role in healthcare.

A pink dot in the centre with arrows pointing out to 6 dots round the edge

Approaches to Spread, Scale-Up and Sustainability

Chrysanthi Papoutsi, Trisha Greenhalgh, Sonja Marjanovic

Examines various approaches to spreading, scaling-up, and sustaining improvements in healthcare, noting their strengths and limitations. It shares case studies to highlight how different ways of viewing spread and scale-up can make a difference in practice.

A blue circle with a heart monitor sign and a pound sign inside it.

Health Economics

Andrew Street, Nils Gutacker

Looks at economic approaches that can be used to encourage improvement in healthcare, and explores how economic evaluation can be used to compare the costs and benefits of using healthcare resources in alternative ways.

Three people standing together, one in front of the other two.

Governance and Leadership

Naomi Fulop, Angus Ramsey

Analyses evidence on how governance and leadership influence quality and safety in healthcare at different levels in the health system, and shows how different leadership approaches may contribute to delivering system change.

A cube with four triangles pointing out from it.

Simulation as an Improvement Technique

Victoria Brazil, Eve Purdy, Kamal Bajaj

Reviews the role of simulation as a rapidly emerging tool in improving quality and safety in healthcare, including its current use, potential applications, and challenges.

A person with three pills circling round them..

Reducing Overuse

Caroline Cupit, Carolyn Tarrant, Natalie Armstrong

Examines the successes, promising approaches and challenges in generating and using evidence about overuse, a major issue of healthcare quality, safety and sustainability.

A hospital.

Workplace Conditions

Jill Maben, Jane Ball, Amy C Edmondson

Reviews the evidence for the workplace conditions that are essential for improvement: the right number of staff and skills, psychological safety, and staff wellbeing.

A hexagon shape with a line joining three of its corners.

Operational Research Approaches

Martin Utley, Sonya Crowe, Christina Pagel

Discover key concepts and common approaches in operational research and explore its potential to help analyse and improve healthcare services.

Three adjoining cogs

Making Culture Change Happen

Russell Mannion

Examines the evidence for linking organisational culture to healthcare quality and performance.

A lightbulb with a cog in the centre.

Implementation Science

Paul Wilson, Roman Kislov

Critically explores the theories and strategies of implementation science, and how they are or could be applied in practice.

A bell curve with the positive extreme highlighted

The Positive Deviance Approach

Ruth Baxter, Rebecca Lawton

The potential of positive deviance is largely untapped. Discover how to identify those who demonstrate exceptional performance and investigate how they achieve it.

Abstract icon indicating four people collaborating

Co-Producing and Co-Designing

Glenn Robert, Louise Locock, Oli Williams, Jocelyn Cornwell, Sara Donetto, Joanna Goodrich

Examines the origins and development of co-production and co-design, their application in healthcare, and the opportunities and challenges.

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Collaboration-Based Approaches

Graham Martin, Mary Dixon-Woods

Explores the evidence for collaboration-based approaches to improving healthcare, illustrated by examples and with guidance on the key challenges involved.

Watch the Elements videos

Everything you would expect from THIS

Comprehensive

Covering a wide range of approaches, including models, techniques, major tools and methods, organising structures and strategies.

Evidence-based

Sets out the evidence for how each approach has been used and to what effect, but without advocating for the approach or acting as a how-to guide.

Scholarly

Written by over 60 academic and clinical experts in healthcare improvement from over 40 organisations in the UK, Canada, France, Australia, and the USA.

Robust

Thorough editorial and peer-review process to ensure the content is accurate, accessible, and engaging.

Open access

Freely available online (under a CC-BY-NC-ND licence).

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