Making an Impact? The Emergence of Improvement Science in Healthcare

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Abstract

At an international level, public, political and economic pressures are increasing awareness of the high level of variation in the quality of health care provision. This knowledge has brought with it the realisation that a translational gap exists between the production of evidence-based scientific knowledge and the application of this evidence into everyday practice to improve patient experience, clinical outcomes and quality of care at a population level. Improvement science has emerged as a transdisciplinary effort to address this challenge. Evidence-based care recommendations typically stem from research that is conducted in controlled and artificial settings with additional resource and highly qualified staff. In comparison, real world frontline healthcare settings are complex adaptive social systems, and research from a wide range of academic disciplines suggests that it is a leap of faith to assume that outputs from research will simply translate to improvements in practice. The philosophy of improvement science questions the value of science to society. This paper considers the challenges that the philosophy of improvement science brings to traditional models for thinking about the value of science. The paper uses healthcare and healthcare research as an example to explore these concepts in detail and propose a new model, the Cycle for Improvement, to help reframe the relationship between science and society.