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
Research report

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

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