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

March 2014

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

Research report

The four health systems of the United Kingdom

April 2014

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

You might also like...

Newsletter feature

Bringing an improvement mindset to COVID-19

Dominique Allwood is Assistant Director of Improvement at the Health Foundation, and was recently...

Blog

Digital and data-driven innovation: supporting it to thrive

Arne Wolters explores how digital and data-driven innovation can be used in ways that maximise the...

Blog

How the NHS can use anchor strategies to build a healthy and sustainable post-COVID-19 recovery

We look at how the NHS as an anchor institution has an essential role to play in recovering from the...

Kjell-bubble-diagramArtboard 101 copy

Get social

The latest blog in our COVID-19, health and health inequalities series explores impacts on the #mentalhealth of hea… https://t.co/mPuuMJzQXF

Follow us on Twitter
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