Perla Rocco J, Provost Lloyd P, Parry Gareth J
Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Qual Manag Health Care. 2013 Jul-Sep;22(3):170-86. doi: 10.1097/QMH.0b013e31829a6a15.
The phrase "Science of Improvement" or "Improvement Science" is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of "improvement" as a science.
We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming's System of Profound Knowledge. We suggest that Deming's system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement.
A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase "science of improvement" represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts.
The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of improvement.
如今，“改进科学”或“改善科学”这一表述被众多人士和专业领域用于指代不同事物，这给试图了解改进的人造成了困惑。在本文中，我们简要界定改进和科学的概念，并回顾将“改进”视为一门科学的考量历史。
我们将改进中的关键概念和思想追溯至其哲学和理论基础，重点关注戴明的深刻知识体系。我们认为，戴明的体系与诸多当代及历史哲学和科学辩论及概念有着紧密联系。参照这些辩论和概念，我们确定了7个命题，它们为改进科学提供了科学和哲学基础。
目前不存在基于该领域哲学和理论基础的改进科学的标准观点。此处概述的7个命题展示了审视改进基础的价值。这对于推动该领域发展以及尽量减少对“改进科学”这一表述所代表含义的困惑而言都是必要的。我们认为，像戴明和休哈特这样的高级改进科学家能够整合不同科学学科之间的思想、概念和模型，以开发更强大的改进模型、工具和技术，重点在于实际应用和解决现实世界中的问题。
需要对改进科学的认识论基础、理论基础及其推理方法进行批判性审视，以确保其持续发展和相关性。如果医疗保健领域的改进工作和项目要依据科学准则来界定，那么从事质量改进工作的医疗保健专业人员将受益于一套标准的核心原则、标准词汇以及对改进科学演变的理解。
