King's College London, London, UK. s'
King's College London, London, UK.
BMC Health Serv Res. 2022 Aug 24;22(1):1083. doi: 10.1186/s12913-022-08171-3.
We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits.
We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed.
We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI.
Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.
我们之前开发了一个用于大型医疗保健质量改进（QI）计划的质量改进（QI）投资回报率（ROI）概念框架。我们将 ROI 定义为从 QI 中获得的任何货币或非货币价值或收益。我们称该框架为 QI-ROI 概念框架。本研究描述了该框架涵盖的不同类别收益，并探讨了这些收益之间的关系。
我们使用 ROI 或投资回报概念（例如，成本效益、成本效果、价值）结合医疗保健和 QI，在 Medline、Embase、全球健康、PsycInfo、EconLit、NHS EED、Web of Science、Google Scholar、组织期刊和引文数据库中进行了检索。鉴于大型 QI 计划的复杂性，我们的分析受到复杂性理论的指导。我们使用框架分析方法，使用基于组织对其利益相关者义务的初步 ROI 概念框架来分析数据。纳入的文章至少讨论了三个组织对这些义务的收益，其中至少有一个是财务或患者收益。我们综合了讨论过的不同 QI 收益。
我们检索到 10428 篇文章。对 102 篇文章进行了全文筛选。其中 34 篇被排除，68 篇被纳入。纳入的文章包括 QI 经济、效果、过程和影响评估以及概念文献。基于这些文献，我们对我们的 QI-ROI 概念框架进行了回顾和更新，该框架是我们第一次研究的结果。我们的 QI-ROI 概念框架包括四个类别：1）组织绩效，2）组织发展，3）外部结果，和 4）意外结果（积极和消极）。我们发现 QI 收益是相互关联的，大规模 QI 的 ROI 不仅仅是最终结果；还有一些组织看重的早期收益，这些收益有助于整体 ROI。组织还发现了意外负面后果的积极方面，例如从失败的 QI 中吸取教训。
我们的分析表明，QI-ROI 概念框架由大型 QI 计划的多方面和相互关联的收益组成。根据每个组织的目标和目的以及发展阶段，这些可能是可取的。因此，组织可以在整个项目生命周期中推断出相关且合理的增量收益或投资回报。
