Research and evaluation of quality improvement in health care repeatedly shows that results fall short of expectations; promising interventions shown to be initially successful do not transfer to new settings, or are not sustained. Again and again contextual factors, changing over time or varying between settings, seem to frustrate efforts to improve quality.

Building on a series of thought pieces, this best evidence review combines the ideas of receptive and non-receptive contexts for change, with a psychological perspective and the proposition that social context is the key facilitator of quality improvement. The review also considers context at structural levels within the health care system:

  • macro – the system level
  • meso – the organisation level
  • micro – the clinical team level.

Crucially, the review considers how all of these factors combine to impact upon the success and sustainability of quality improvement efforts.

Additional resources

The authors have summarised all the studies and reviews selected for their review. These summaries are available in the Summary of Findings document (see Downloads section, below).

Further reading

Research report

Perspectives on context

A selection of essays considering the role of context in successful quality improvement.

Research report

The four health systems of the United Kingdom

This report assesses the performance of the NHS on the quality of patient care in all four UK countries since devolution.

You might also like...

Blog

Improving continuity of care in general practice: four lessons from the frontline

How can general practices balance continuity of care with the need to see a GP promptly? Angus Wiltshire explores four early ...

Briefing

The measurement maze

Our briefing suggests there's potential to make better use of quality measurement to improve quality of care.

Invitation to tender

ITT: Summative Evaluation of the Flow Coaching Academy Programme

The deadline for responses is 12.00 on Tuesday 5 November 2019.

Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q Community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more