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Title: A scientific approach to improvement : the use of Plan-Do-Study-Act cycles in healthcare
Author: McNicholas, Chris
ISNI:       0000 0004 5994 3791
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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This thesis contributes further understanding on how to pursue improvements in healthcare and informs the academic growth of improvement science. Derived from manufacturing industries, QI methods are common approaches to structure the process of making improvements in healthcare, however, questions over their scientific legitimacy and application have arisen due to their varied effectiveness. A review of how QI methods are associated with science identifies the prominent theoretical role of QI methods in facilitating change and improvement by supporting the local application of the scientific method. The Plan-Do-Study-Act (PDSA) cycle method is identified as playing a central role in this and a theoretical framework is developed to assess the use of the method in published and local team's accounts. This demonstrates that the method is commonly not used with high fidelity; a key novel addition to the research literature. Studies are presented to further understand the reality of PDSA cycle use. These provide a novel identification and empirically grounded description of the social dimensions of applying the PDSA cycle method including negotiating through a single PDSA cycle and navigating the iteration and scale up of change and complexity of learning. A novel association between understanding, intentions and process of applying the PDSA cycle method and the fidelity of the methods use is also presented as well as the views of teams using the method which demonstrate different conceptual views of the PDSA cycle method and the wider social benefits of using the method. Overall, this thesis provides clarity in regards to the technical and social elements of PDSA cycle use. It demonstrates research approaches to open the 'black box' of PDSA cycle use and investigate the use of QI methods more widely. It calls for continued exploration of applying science to improve the quality of healthcare for patients.
Supervisor: Reed, Julie E. ; Bell, Derek Sponsor: National Institute for Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral