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. 2015 Mar;24(3):228-38.
doi: 10.1136/bmjqs-2014-003627. Epub 2015 Jan 23.

Demystifying theory and its use in improvement

Frank Davidoff  1 , Mary Dixon-Woods  2 , Laura Leviton  3 , Susan Michie  4
Affiliations

Demystifying theory and its use in improvement

Frank Davidoff et al. BMJ Qual Saf. 2015 Mar.

Abstract

The role and value of theory in improvement work in healthcare has been seriously underrecognised. We join others in proposing that more informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Many professionals, including improvement practitioners, are unfortunately mystified-and alienated-by theory, which discourages them from using it in their work. In an effort to demystify theory we make the point in this paper that, far from being discretionary or superfluous, theory ('reason-giving'), both informal and formal, is intimately woven into virtually all human endeavour. We explore the special characteristics of grand, mid-range and programme theory; consider the consequences of misusing theory or failing to use it; review the process of developing and applying programme theory; examine some emerging criteria of 'good' theory; and emphasise the value, as well as the challenge, of combining informal experience-based theory with formal, publicly developed theory. We conclude that although informal theory is always at work in improvement, practitioners are often not aware of it or do not make it explicit. The germane issue for improvement practitioners, therefore, is not whether they use theory but whether they make explicit the particular theory or theories, informal and formal, they actually use.

Keywords: Complexity; Evaluation methodology; Implementation science; Quality improvement methodologies; Social sciences.

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Figures

Figure 1
Figure 1
Programme (impact) theory of an intervention to improve care of people with chronic medical conditions.
Figure 2
Figure 2
Ishikawa ‘fishbone’ diagram: explanatory theory of barriers in primary care to the support of health-related patient behaviours.
Figure 3
Figure 3
Programme theory (theory of change) for overcoming barriers to the implementation of behaviour change interventions in primary care.
See this image and copyright information in PMC

References

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