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. 2025 Apr 16;25(1):558.
doi: 10.1186/s12913-025-12730-9.

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

Mia Bierbaum  1   2 , Stephanie Best  3 , Sharon Williams  4 , Zoe Fehlberg  3 , Susan Hillier  2 , Louise A Ellis  1 , Angie Goodrich  5 , Robert Padbury  5   6 , Peter Hibbert  7   8
Affiliations

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

Mia Bierbaum et al. BMC Health Serv Res. .

Abstract

Objectives: Quality 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.

Methods: A 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.

Results: The 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.

Conclusion: The 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.

Keywords: Hospitals; Implementation science; Integration; Narrative synthesis; Quality improvement; Quality of healthcare; Systematic review; Tertiary healthcare.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: None. Ethical approval to conduct the systematic review was not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
The frequency of reported IS frameworks used in conjunction with QI methods (Note: studies may be counted multiple times)
Fig. 3
Fig. 3
The frequency of use of QI/IS methods/tools/theory across study phases (Note: studies may be counted multiple times)
See this image and copyright information in PMC

References

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    1. Eccles MP, Mittman BS. Welcome to implementation Science. Implement Sci. 2006;1(1). 10.1186/1748-5908-1-1.

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