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

March 2014

Paul Bate
Glenn Robert
Naomi Fulop
John Øvretveit
Mary Dixon-Woods
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Key questions addressed

  • How do you define and frame context?
  • What do you see as the key conceptual and empirical literature in the field?
  • How would you identify the main unanswered questions about context and improvement?

The importance of context in the health sector has been recognised by social scientists for some time, starting with the Andrew Pettigrew’s studies of District Health Authorities in the 1980s. But learning from the academic literature seems to have had little impact on practice. The influence of context on effectiveness is one that would benefit from closer cooperation between the academic and service sectors.

The Health Foundation has been eager to explore the role of context in improving the quality of patient care. In 2011, we invited leading academics in the field to discuss key questions – the essays they produced in response are presented in this report and provide a fascinating range of insights into the importance – and challenges – of context.

We are very grateful to all of the authors for their work and insights. The relationship between improvements and context is arguably the most knotty problem in improvement science. We hope these essays will continue to stimulate ideas about how context impacts on the effectiveness of interventions to improve care for patients.

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