A Framework for Quality Improvement Translation: Understanding the Conditionality of Interventions

Background

A large literature on health care organizations’ experiences with quality and safety improvement methods and strategies is now available. Although sometimes the effort is made to immediately apply others’ experiences, more often the question is asked, “would it work for us?”

Quality Improvement Translation (QIT)

In a framework for valid and more systematic cross-organizational and cross-national learning, one assesses the conditions that may have been important for success elsewhere so as to replicate the essential conditions for local adaptation. For example, resource limitations may prevent the transfer of a computerized physician order entry (CPOE) system to a developing country as a method of improving safety, but there may be elements of others’ CPOE systems, such as protocols for manual checking, that can be translated with success.

How to Translate Improvements and Strategies to Our Setting

How then do we decide which approaches are easily transfered, and how do we go about translating other approaches that need adapting to “our” (or any) setting? A simple method is to follow five steps for QIT: define our subject and question, search for others’ experiences, assess likely context dependence, identify critical conditions, and plan implementation.

Conclusion

We can improve our methods for learning from others by creating our own systems for seeking out reports that describe the context of the improvement, by deciding which facilities to visit and which conferences and networking events to attend, and by developing our skills in judging transferability and in translating others’ strategies.