How do we learn about improving health care: a call for a new epistemological paradigm. Massoud, M., R., Barry, D., Murphy, A., Albrecht, Y., Sax, S., & Parchman, M. International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, . Published by Oxford University Press in association with the International Society for Quality in Health Care, 4, 2016.
abstract   bibtex   
PURPOSE: The field of improving health care has been achieving more significant results in outcomes at scale in recent years. This has raised legitimate questions regarding the rigor, attribution, generalizability and replicability of the results. This paper describes the issue and outlines questions to be addressed in order to develop an epistemological paradigm that responds to these questions. QUESTIONS: We need to consider the following questions: (i) Did the improvements work? (ii) Why did they work? (iii) How do we know that the results can be attributed to the changes made? (iv) How can we replicate them? (Note, the goal is not to copy what was done, but to affect factors that can yield similar results in a different context.) NEXT STEPS: Answers to these questions will help improvers find ways to increase the rigor of their improvements, attribute the results to the changes made and better understand what is context specific and what is generalizable about the improvement.
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 title = {How do we learn about improving health care: a call for a new epistemological paradigm},
 type = {article},
 year = {2016},
 identifiers = {[object Object]},
 keywords = {complex adaptive systems,delivery,implementation,improvement,learning},
 month = {4},
 publisher = {. Published by Oxford University Press in association with the International Society for Quality in Health Care},
 day = {26},
 city = {University Research Co., LLC., Bethesda, MD, USA.; Harvard Medical School, Boston, MA, USA.; University Research Co., LLC., Bethesda, MD, USA.; Swiss Tropical and Public Health Institute, Basel, Switzerland.; Institute of Public Health, University of Heid},
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 notes = {LR: 20160428; CI: (c) The Author 2016; JID: 9434628; OTO: NOTNLM; 2016/03/10 [accepted]; aheadofprint},
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 abstract = {PURPOSE: The field of improving health care has been achieving more significant results in outcomes at scale in recent years. This has raised legitimate questions regarding the rigor, attribution, generalizability and replicability of the results. This paper describes the issue and outlines questions to be addressed in order to develop an epistemological paradigm that responds to these questions. QUESTIONS: We need to consider the following questions: (i) Did the improvements work? (ii) Why did they work? (iii) How do we know that the results can be attributed to the changes made? (iv) How can we replicate them? (Note, the goal is not to copy what was done, but to affect factors that can yield similar results in a different context.) NEXT STEPS: Answers to these questions will help improvers find ways to increase the rigor of their improvements, attribute the results to the changes made and better understand what is context specific and what is generalizable about the improvement.},
 bibtype = {article},
 author = {Massoud, M R and Barry, D and Murphy, A and Albrecht, Y and Sax, S and Parchman, M},
 journal = {International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua}
}
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