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The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review

Mia Bierbaum, Stephanie Best, Sharon Williams, Zoe Fehlberg, Susan Hillier, Louise A. Ellis, Angie Goodrich, Robert Padbury, Peter Hibbert

BMC Health Services Research, Volume: 25, Issue: 1

Swansea University Author: Sharon Williams

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DOI (Published version): 10.1186/s12913-025-12730-9

Abstract

ObjectivesQuality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies ar...

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Published in: BMC Health Services Research
ISSN: 1472-6963
Published: Springer Science and Business Media LLC 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69282
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Duplicates, studies published prior to 2014, systematic and scoping reviews, and study protocols were removed. The retrieved title abstracts were screened, and the full texts of eligible studies were reviewed in pairs using Covidence software. Of the included studies, data were extracted using a predefined template, and studies were critically appraised using the QI Minimum Quality Criteria Set. Frequency analysis of the use of QI or IS tools was conducted, as well as a narrative analysis of the integration of QI and IS in each study.ResultsThe database search returned 3,407 title abstracts, of which 1,618 were screened. Assessment for eligibility resulted in the identification of 149 studies, of which the full texts were reviewed, and 12 studies included in the final analysis. These 12 studies integrated QI and IS methods to implement an intervention in tertiary healthcare. The Plan-Do-Study-Act (PDSA) cycle was the most frequently used QI tool and the Theoretical Domains Framework, Behaviour Change Wheel (including Capabilities, Opportunity and Motivation) and the Consolidated Framework for Implementation Research were the most frequently used IS frameworks.ConclusionThe study highlights a lack of consistent terminology across the QI and IS fields, as well as opportunities for greater integration of the two fields to enhance study design, implementation and sustainability, and to improve healthcare performance.</abstract><type>Journal Article</type><journal>BMC Health Services Research</journal><volume>25</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1472-6963</issnElectronic><keywords>Implementation science, Quality improvement, Systematic review, Narrative synthesis, Tertiary healthcare, Hospitals, Integration, Quality of healthcare</keywords><publishedDay>16</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-04-16</publishedDate><doi>10.1186/s12913-025-12730-9</doi><url/><notes/><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This research was funded by The Flinders Foundation (MB).</funders><projectreference/><lastEdited>2025-05-22T17:12:20.2280943</lastEdited><Created>2025-04-12T17:00:33.3252963</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>Mia</firstname><surname>Bierbaum</surname><order>1</order></author><author><firstname>Stephanie</firstname><surname>Best</surname><order>2</order></author><author><firstname>Sharon</firstname><surname>Williams</surname><order>3</order></author><author><firstname>Zoe</firstname><surname>Fehlberg</surname><order>4</order></author><author><firstname>Susan</firstname><surname>Hillier</surname><order>5</order></author><author><firstname>Louise A.</firstname><surname>Ellis</surname><order>6</order></author><author><firstname>Angie</firstname><surname>Goodrich</surname><order>7</order></author><author><firstname>Robert</firstname><surname>Padbury</surname><order>8</order></author><author><firstname>Peter</firstname><surname>Hibbert</surname><order>9</order></author></authors><documents><document><filename>69282__34338__b0e50bae4cb8458eabf77e79c87fc113.pdf</filename><originalFilename>69282.VoR.pdf</originalFilename><uploaded>2025-05-22T17:04:46.4595234</uploaded><type>Output</type><contentLength>1721736</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2025. 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spelling 2025-05-22T17:12:20.2280943 v2 69282 2025-04-12 The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review ab46582012179a28370922a05774d3e3 Sharon Williams Sharon Williams true false 2025-04-12 ObjectivesQuality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies are integrated within healthcare-based studies.MethodsA systematic search was conducted across five databases. Duplicates, studies published prior to 2014, systematic and scoping reviews, and study protocols were removed. The retrieved title abstracts were screened, and the full texts of eligible studies were reviewed in pairs using Covidence software. Of the included studies, data were extracted using a predefined template, and studies were critically appraised using the QI Minimum Quality Criteria Set. Frequency analysis of the use of QI or IS tools was conducted, as well as a narrative analysis of the integration of QI and IS in each study.ResultsThe database search returned 3,407 title abstracts, of which 1,618 were screened. Assessment for eligibility resulted in the identification of 149 studies, of which the full texts were reviewed, and 12 studies included in the final analysis. These 12 studies integrated QI and IS methods to implement an intervention in tertiary healthcare. The Plan-Do-Study-Act (PDSA) cycle was the most frequently used QI tool and the Theoretical Domains Framework, Behaviour Change Wheel (including Capabilities, Opportunity and Motivation) and the Consolidated Framework for Implementation Research were the most frequently used IS frameworks.ConclusionThe study highlights a lack of consistent terminology across the QI and IS fields, as well as opportunities for greater integration of the two fields to enhance study design, implementation and sustainability, and to improve healthcare performance. Journal Article BMC Health Services Research 25 1 Springer Science and Business Media LLC 1472-6963 Implementation science, Quality improvement, Systematic review, Narrative synthesis, Tertiary healthcare, Hospitals, Integration, Quality of healthcare 16 4 2025 2025-04-16 10.1186/s12913-025-12730-9 COLLEGE NANME COLLEGE CODE Swansea University Another institution paid the OA fee This research was funded by The Flinders Foundation (MB). 2025-05-22T17:12:20.2280943 2025-04-12T17:00:33.3252963 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Mia Bierbaum 1 Stephanie Best 2 Sharon Williams 3 Zoe Fehlberg 4 Susan Hillier 5 Louise A. Ellis 6 Angie Goodrich 7 Robert Padbury 8 Peter Hibbert 9 69282__34338__b0e50bae4cb8458eabf77e79c87fc113.pdf 69282.VoR.pdf 2025-05-22T17:04:46.4595234 Output 1721736 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
spellingShingle The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
Sharon Williams
title_short The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
title_full The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
title_fullStr The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
title_full_unstemmed The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
title_sort The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review
author_id_str_mv ab46582012179a28370922a05774d3e3
author_id_fullname_str_mv ab46582012179a28370922a05774d3e3_***_Sharon Williams
author Sharon Williams
author2 Mia Bierbaum
Stephanie Best
Sharon Williams
Zoe Fehlberg
Susan Hillier
Louise A. Ellis
Angie Goodrich
Robert Padbury
Peter Hibbert
format Journal article
container_title BMC Health Services Research
container_volume 25
container_issue 1
publishDate 2025
institution Swansea University
issn 1472-6963
doi_str_mv 10.1186/s12913-025-12730-9
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
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description ObjectivesQuality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies are integrated within healthcare-based studies.MethodsA systematic search was conducted across five databases. Duplicates, studies published prior to 2014, systematic and scoping reviews, and study protocols were removed. The retrieved title abstracts were screened, and the full texts of eligible studies were reviewed in pairs using Covidence software. Of the included studies, data were extracted using a predefined template, and studies were critically appraised using the QI Minimum Quality Criteria Set. Frequency analysis of the use of QI or IS tools was conducted, as well as a narrative analysis of the integration of QI and IS in each study.ResultsThe database search returned 3,407 title abstracts, of which 1,618 were screened. Assessment for eligibility resulted in the identification of 149 studies, of which the full texts were reviewed, and 12 studies included in the final analysis. These 12 studies integrated QI and IS methods to implement an intervention in tertiary healthcare. The Plan-Do-Study-Act (PDSA) cycle was the most frequently used QI tool and the Theoretical Domains Framework, Behaviour Change Wheel (including Capabilities, Opportunity and Motivation) and the Consolidated Framework for Implementation Research were the most frequently used IS frameworks.ConclusionThe study highlights a lack of consistent terminology across the QI and IS fields, as well as opportunities for greater integration of the two fields to enhance study design, implementation and sustainability, and to improve healthcare performance.
published_date 2025-04-16T05:27:46Z
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