Furnival Joy, Boaden Ruth, Walshe Kieran
Improvement Directorate, 133-155 Waterloo Rd, Lambeth, London SE1 8UG, UK.
NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Alliance Manchester Business School, Booth Street West, Manchester M15 6PB, UK.
Int J Qual Health Care. 2017 Oct 1;29(5):604-611. doi: 10.1093/intqhc/mzx088.
The literature is reviewed to examine how 'improvement capability' is conceptualized and assessed and to identify future areas for research.
An iterative and systematic search of the literature was carried out across all sectors including healthcare. The search was limited to literature written in English.
The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability. Information about the source of the instruments, the sectors in which they were developed or used, the measurement constructs or domains they employ, and how they were tested was extracted.
The instruments and framework constructs are very heterogeneous, demonstrating the ambiguity of improvement capability as a concept, and the difficulties involved in its operationalisation. Two-thirds of the instruments and frameworks have been subject to tests of reliability and half to tests of validity. Many instruments have little apparent theoretical basis and do not seem to have been used widely.
The assessment and development of improvement capability needs clearer and more consistent conceptual and terminological definition, used consistently across disciplines and sectors. There is scope to learn from existing instruments and frameworks, and this study proposes a synthetic framework of eight dimensions of improvement capability. Future instruments need robust testing for reliability and validity. This study contributes to practice and research by presenting the first review of the literature on improvement capability across all sectors including healthcare.
回顾文献，以研究“改进能力”是如何被概念化和评估的，并确定未来的研究领域。
对包括医疗保健在内的所有领域的文献进行了迭代式系统检索。检索仅限于用英文撰写的文献。
该研究识别并分析了70种用于评估或衡量改进能力的工具和框架。提取了有关这些工具的来源、其开发或使用的领域、它们所采用的测量结构或领域以及它们是如何进行测试的信息。
这些工具和框架结构非常多样化，这表明改进能力作为一个概念具有模糊性，以及在其操作化方面存在困难。三分之二的工具和框架进行了可靠性测试，一半进行了有效性测试。许多工具几乎没有明显的理论基础，似乎也没有得到广泛应用。
改进能力的评估和发展需要更清晰、更一致的概念和术语定义，并在各学科和领域中统一使用。有必要从现有的工具和框架中学习，本研究提出了一个包含改进能力八个维度的综合框架。未来的工具需要进行严格的可靠性和有效性测试。本研究通过对包括医疗保健在内的所有领域的改进能力文献进行首次综述，为实践和研究做出了贡献。
