What influences improvement processes in healthcare?

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:


  • Leadership
  • 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.