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Demystifying theory and its use in improvement.

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journal contribution
posted on 30.10.2015, 14:50 by Frank Davidoff, Mary Dixon-Woods, Laura Leviton, Susan Michie
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.

History

Citation

BMJ Quality and Safety, 2015, 24 (3), pp. 228-238

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

VoR (Version of Record)

Published in

BMJ Quality and Safety

Publisher

BMJ Publishing Group

issn

2044-5415

eissn

2044-5423

Acceptance date

06/01/2015

Copyright date

2015

Available date

30/10/2015

Publisher version

http://qualitysafety.bmj.com/content/24/3/228

Language

en