We identified and reviewed 38 academic and 16 grey literature publications covering diverse improvement approaches. Some examples include Six Sigma, Lean, Business Process Reengineering, Plan-Do-Study-Act, clinical audits and feedback, quality improvement collaboratives and peer-learning communities, training and education interventions, and patient engagement and feedback-related interventions. Based on the reviewed literature, six key factors influence the implementation of improvement efforts:
- Relationships and interactions that support an improvement culture
- Skills and competencies
- Use of data
- Patient and public involvement, engagement and participation
- Working as an interconnected system of individuals and organisations, influenced by internal and external contexts
This review also attempted to go beyond identifying these high-level influences by explaining what specific aspects of the influencing factors are important for quality improvement. The report provides a detailed analysis of influencing factors across the six categories outlined above, as well as summary tables for each.