Context Of Quality Improvement Research Articles

Child Health Nurses' Acceptance and Use of a Novel Telehealth Platform: A Mixed-Method Study.

Telehealth appointments in the healthcare sector have increased since the COVID-19 pandemic, increasing patients' access to services. However, research exploring nurse perceptions of implemented telehealth services in the community sector is limited. Within the context of quality improvement, the current study aimed to understand child health nurses' acceptance and use of a novel telehealth platform using mixed methods. A total of 38 child health nurses completed an online survey that included multiple-choice questions based on an expanded Technology Acceptance Model and open-ended questions exploring barriers and facilitators to use. Results demonstrated that despite 70% of nurse users having completed less than three sessions with parents, perception and acceptance scores were high. Overall, 85% of variance in satisfaction with the platform and 46% of variance in intention to use the platform were predicted by perception scores. Three consistent themes generated from data were facilitators for use and five as barriers, which provided further understanding to findings. To ensure telehealth is adapted into routine clinical care, facilitators and barriers for implementation need to be identified and addressed. Nurses need to be engaged in implementation and ongoing maintenance to ensure the uptake and optimal use of technology within nursing care.

Context in Implementation Science.

Changing health care delivery systems and processes of care to improve health care quality is complex. What is done (intervention) is equally important as how it is done (implementation) and where it is done (context). Furthermore, it has been consistently observed that among groups participating in multisite quality improvement (QI) efforts and implementation studies, significant heterogeneity in the improvements is seen. Our objective is to provide a step-by-step guide to assist both researchers and groups practicing QI on the frontlines in addressing context in planning, implementing, and disseminating their QI and implementation interventions. We discuss in depth a sample of the >60 available dissemination and implementation frameworks that consider context. We then provide an approach to addressing context in QI and implementation initiatives and discuss an application of this approach, using a published study as an example. Finally, we discuss next steps for the field of context and implementation science. Data from networks of health systems working together on QI are needed on both network-wide rates of process and outcome measures. Also needed are segmented/stratified data that inform our understanding of the influence of context on successful implementation in subgroups. Finally, multisite prospective studies are needed to develop an in-depth understanding of how specific context and implementation factors affect the successful spread of proven interventions.

Exploring the Relationship between Window View Quantity, Quality, and Ratings of Care in the Hospital.

Hospital ratings reflect patient satisfaction, consumer perception of care, and create the context for quality improvement in healthcare settings. Despite an abundance of studies on the health benefits of the presence and content of window views, there is a gap in research examining how these features may impact patient satisfaction and consumer perceptions of the quality of care received. A quantitative exploratory study collected data from 652 participants regarding their previous stay in the hospital, their perception of windows in their room, and their perception of their room, the hospital, and the quality of care received. On a scale of 0–10, participants with access to windows gave a 1-unit higher rating for the hospital. Access to window views from their bed provided a 1-unit increase, and having a view to green spaces resulted in a 2-unit increase in hospital ratings. Statistically significant results were also found for room ratings and care ratings. Windows in the patient rooms impact the key patient satisfaction measures and patient experience during the hospital stay. Patient room design, bed set up, and quantity and quality of window views may play an important role in shaping the patient’s experience.

An evaluation of the Course Experience Questionnaire in a Malaysian context for quality improvement in teaching and learning

This study revealed the results of the validation of the Course Experience Questionnaire (CEQ) within the Bachelor degree students who undertook their undergraduate from a Western university with 50% of the classes conducted in Malaysia. The specific instrument has been used extensively in other contexts to investigate the teaching-learning environment in Higher Education Institutions (HEIs). A sample of 368 students from the HEIs participated in this study. The validity and reliability of the CEQ were investigated through exploratory factor analysis and Cronbach alpha coefficient. The overall course satisfaction was used as an external criterion in order to strengthen the instrument’s validity. The exploratory factor analysis identified four constructs reflecting good teaching, generic skills, appropriate assessment and clear goals and standards. The population of the research was limited and data was collected only from students of HEIs so the generalization of findings needs attention from more institutions.

Development of the Person-Centered Contraceptive Counseling scale (PCCC), a short form of the Interpersonal Quality of Family Planning care scale

ObjectivePerson-centeredness is a critical component of quality in family planning. We previously validated an 11-item Interpersonal Quality of Family Planning (IQFP) scale. We sought to create a parsimonious version of the scale in preparation for testing its appropriateness as a patient-reported outcome performance measure. Study designTo explore clarity and importance of each of the 11 items, we conducted English and Spanish cognitive interviews with patients who received contraceptive counseling (n = 33) at 3 publicly funded California clinics. We triangulated these results with psychometric analysis of previously collected IQFP data (n = 1097) to assess validity and reliability of selected item combinations. ResultsThe 11-item IQFP scale was reduced to a 4-item scale (the Person-Centered Contraceptive Counseling scale, or PCCC) that includes items evaluating provider performance regarding respect for patients, information provision, and eliciting and honoring patient preferences for birth control. Interview participants deemed the items included in the 4-item PCCC important and clear in both English and Spanish versions of the instrument. The 4-item PCCC retained the 11-item IQFP's psychometric properties, including internal consistency (Cronbach's alpha = 0.92 vs 0.97 for the PCCC and IQFP, respectively) and a consistent single factor analysis solution (factor loadings = 0.86–0.92 and 0.81–0.91). The 4-item PCCC additionally retained the construct and predictive validity of the IQFP. ConclusionsThe 4-item PCCC is a valid and reliable as a measure of person-centered contraceptive counseling that reflects patients’ perspectives on contraceptive counseling. ImplicationsPerson-centered measures such as the 4-item PCCC can help inform efforts to improve health care quality. Future work will investigate the validity and reliability of the 4-item PCCC as a performance measure to determine the appropriateness of its use in the quality improvement context.

Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement

ABSTRACT During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.

The influence of contextual factors on healthcare quality improvement initiatives: a realist review

BackgroundRecognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare?MethodsA realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework.ResultsThirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings.ConclusionsThis is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes.Systematic review registrationPROSPERO CRD42017062135

Knowledge identification in medium-sized enterprises under the context of quality improvement – an exploration in manufacturing companies in China

As a fundamental element of knowledge management (KM), knowledge identification is a crucial issue in contemporary business organisations. Evidenced by research, medium sized enterprises (MEs) contribute constructively and significantly to economic development, society stabilisation and employment increase. Their healthy survival and growth are of critical importance to a nation. Among the approaches ensuring the successful development of MEs, quality improvement (QI) is a crucial one. However, what is and how to identify the knowledge most relevant to the MEs’ QI, the drives and sources for identifying the QI knowledge (QIK) as well as the underpinning rationales, are currently lacking of sufficient study. The exploratory research reported by this paper has obtained and prioritised the up-to-date answers to these questions, leading to the enrichment of the theoretical understanding of KM approaches and practical guidance of their implementation in operations, under the context of QI in MEs.

The effect of contextual factors on quality improvement success in a lean-driven New Zealand healthcare environment

PurposeThis paper aims to theorise and test a causal model of predominantly lean-driven quality improvement (QI) in the context of health-care clinical microsystems, examining the effects contextual factors in this setting have on improvement activity.Design/methodology/approachQI practitioners at a New Zealand District Health Board were surveyed on a range of contextual factors hypothesised to influence improvement outcomes. Survey responses were analysed via partial least squares path modelling to test the causal model that was designed to be consistent with the “model for understanding success in quality” (MUSIQ) model (Kaplan et al., 2012) adopted in health-care QI.FindingsDefined variables for teamwork, respect for people, lean actions and negative motivating factors all demonstrated significant effects. These findings support the representation of the microsystem layer within the MUSIQ model. The final model predicted and explained perceived success well (adjusted R2 = 0.58).Research limitations/implicationsThe sample was a non-probability sample and the sample size was small (n = 105), although power analysis indicated that we exceeded the minimum sample size (97 cases). Even though health-care processes have universality, this study was conducted in only one district in New Zealand.Practical implicationsThe results support highly functional teamwork as the critical contextual factor in health-care QI outcomes and suggest lean-driven process improvement can be a valid mediating mechanism. The key recommendation for practitioners is to increase focus on human resource capability when initiating and supporting QI.Originality/valueThe originality is testing the robustness of the MUSIQ model specifically in a lean environment, which provides the context for QI. The paper provides a more detailed specification of contextual factors acting as exogenous variables that moderate the cause (lean actions) and the effect (perceived success).

Healthcare leaders’ views on successful quality improvement initiatives and context

PurposeThe purpose of this paper is to investigate the contextual factors contributing to the sustainability of healthcare quality improvement (QI) initiatives.Design/methodology/approachThemes from semi-structured interviews with international healthcare leaders are compared with Kaplan and Provost et al.’s (2012) model for understanding success in quality (MUSIQ). Critical success factors within these themes are shown in detail.FindingsThe interviews provide a rich source of information on critical success factors. The themes largely correspond with MUSIQ, reinforcing its robustness. An important factor emerging from the interviews was the importance of engagement with patients and families in QI, and this needs consideration in seeking to understand context in QI.Research limitations/implicationsInterview participants represent a limited set of western countries and health systems. Their experiences may not hold true in other settings.Practical implicationsThe detail on critical success factors provides QI practitioners with guidance on designing and implementing sustainable initiatives.Originality/valueIncluding consideration of contextual factors for engagement with patients and families in frameworks for context in QI appears to be an original idea that will add value to such frameworks. Researchers in patient engagement are starting to address contextual factors and connections should be made with this work.

Assessing content validity and user perspectives on the Team Check-up Tool: expert survey and user focus groups

ObjectiveThis study assesses content validity and user feedback on the Team Check-up Tool (TCT), an instrument used for measuring dynamic context of quality improvement (QI) teams and their implementation of...

THE GENERAL METHODOLOGICAL PRINCIPLES OF COMBINED OPTIONAL ONLINE ENGLISH LANGUAGE TRAINING OF PRIMARY SCHOOL STUDENTS

The aim of the publication is to demonstrate the implementation of general methodological principles of optional elementary school online foreign languages learning on an example of a virtual course for students of the second and third grades. Methods . The methods involve pedagogical modeling and projecting; the experience of foreign and Russian methodists, teachers and researchers is analysed, generalized and adjusted to the modern realias. Results and scientific novelty. On the basis of the requirements of the state educational standard and interest of pupils in computer games, the author’s technique of the combined facultative educational activities integrated to training in English at elementary school is developed. Online training in the form of games (additional to the major classroom activities) gives a possibility of the choice of tasks interesting to children, studying the material at optimum comfortable and individual speed; it is possible to perform the tasks at home excluding the stressful situations that are specific to school examination, and allows pupils to master most effectively personal, metasubject and object competences. In general context of quality improvement of the general education, the modernization of educational process assumes not only justification of its new maintenance, but also restructuring of scientific and methodical support which has to meet essential needs of teachers and pupils, to facilitate access to necessary specific information. The lack of methodical base of creation of electronic distance resources for foreign-language education of younger school students has motivated the author to create own methodical concept of online training taking into account age of pupils. The complex of the general methodical principles is thoroughly considered; based on the general methodical principles, the proposed modular technique of the organization of an online class is created and implemented. Interactive blocks are described; these blocks are the component units of each module in the educational space of the educational portal LearningApps.org – technological base of an online course of a foreign language. Practical significance. The results of the diagnostic studies, showed in the article, suggest that the use of the proposed general methodological principles increase the percentage of the knowledge quality, promote the development of initial linguistic representations required to master at the elementary level of oral and written skills in a foreign language, enrich linguistic horizons of students. It contributes to the development of motivation to learn foreign Language, as well as the formation of such metasubject result as the ability to learn and plan their activities. Online environment gives the chance to synchronize the problem solution of providing the trainee with information and methodical material; facilitates search by a teacher of an optimum way of achievement of the practical pedagogical purposes. As a consequence of flexibility and usability of educational means on the LearningApps.org portal, the teacher can quickly change blocks and create additional ones according to the needs of pupils and new thesis. It gives the grounds for a conclusion about prospects of online courses accompanying the main educational programs and lessons at school.

Quality management and perceptions of teamwork and safety climate in European hospitals

This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. Perceived teamwork and safety climate. Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate.

Needs assessment to improve neonatal intensive care in Mexico

Background At the time of the research, Dr Weiss was a clinical fellow in neonatal-perinatal medicine at Baylor College of Medicine, Texas Children's Hospital. Dr Profit was on faculty at Baylor College of Medicine, Texas Children's Hospital, Department of Pediatrics, Section of Neonatology. He held a secondary appointment in the Department of Medicine, Section of Health Services Research and conducted his research at the VA Health Services Research and Development Center of Excellence where he collaborated with Dr Kowalkowski.: Improving the quality of neonatal intensive care is an important health policy priority in Mexico. A formal assessment of barriers and priorities for quality improvement has not been undertaken.Aim:To provide guidance to providers and policy makers with regard to addressing opportunities for better care delivery in Mexican neonatal intensive care units.Objective:To conduct a needs assessment regarding improvement of quality of neonatal intensive care delivery in Mexico.Methods:Spanish-language survey administered to a volunteer sample of Mexican neonatal care providers attending a large paediatric conference in Mexico in June 2011. Survey domains included institutional context of quality improvement, barriers, priorities, safety culture, and respondents' characteristics. Results were analysed using descriptive analyses of frequencies, proportions and percentage positive response (PPR) rates.Results:Of 91 respondents, the majority identified neonatology as their primary specialty (n = 48, 65%) and were physicians (n = 55, 73%). Generally, providers expressed a desire to improve quality of care (PPR 69%) but reported notable deterrents. Respondents (n, %) identified family inability to pay (38, 48%), overcrowded work areas (38, 44%), insufficient financial reimbursement (25, 36%), lack of availability of nurses (26, 30%), ancillary staff (25, 29%), and subspecialists (22, 25%) as the principal barriers. Respiratory care (27, 39%) – reduction of mechanical ventilation and initiation of nasal continuous positive airway pressure – and reduction in frequency of late-onset infections (19, 28%) were selected as top clinical priorities. There were substantial opportunities for improving safety (PPR 48%) and teamwork climate (PPR 58%).Conclusion:These findings may guide efforts to improving quality of care delivery in Mexican neonatal intensive care units.

An exploratory analysis of the Model for Understanding Success in Quality

Experience suggests that differences in context produce variability in the effectiveness of quality improvement (QI) interventions. However, little is known about which contextual factors affect success or how they exert influence. Using the Model for Understanding Success in Quality (MUSIQ), we perform exploratory quantitative tests of the role of context in QI success. We used a cross-sectional design to survey individuals participating in QI projects in three settings: a pediatric hospital, hospitals affiliated with a state QI collaborative, and organizations sponsoring participants in an improvement advisor training program. Individuals participating in QI projects completed a questionnaire assessing contextual factors included in MUSIQ and measures of perceived success. Path analysis was used to test the direct, indirect, and total effects of context variables on QI success as hypothesized in MUSIQ. In the 74 projects studied, most contextual factors in MUSIQ were found to be significantly related to at least one QI project performance outcome. Contextual factors exhibiting significant effects on two measures of perceived QI success included resource availability, QI team leadership, team QI skills, microsystem motivation, microsystem QI culture, and microsystem QI capability. There was weaker evidence for effects of senior leader project sponsors, organizational QI culture, QI team decision-making, and microsystem QI leadership. These initial tests add to the validity of MUSIQ as a tool for identifying which contextual factors affect improvement success and understanding how they exert influence. Using MUSIQ, managers and QI practitioners can begin to identify aspects of context that must be addressed before or during the execution of QI projects and plan strategies to modify context for increased success. Additional work by QI researchers to improve the theory, refine measurement approaches, and validate MUSIQ as a predictive tool in a wider range of QI efforts is necessary.

Understanding context for quality improvement: Artefacts, affordances and socio-material infrastructure

Against a backdrop of growing concern for patient safety and service quality, modern health-care systems are witnessing a proliferation of improvement initiatives. The impact is often variable, however, and a key theme to emerge from evaluations of these efforts is a recognition of the effects of local context on the success or otherwise of an intervention. However, the 'context' tends to be understood in terms of higher order issues such as structure, culture and leadership. This article explores a dimension of context not typically taken into account in the health-care improvement literature: the infrastructural context. Many quality improvement interventions hinge on the introduction of artefacts to support behavioural change in the workplace. Despite calls from scholars of technology in practice for a greater acknowledgement of the role of such mundane artefacts in supporting the organisation of health-care work, they are rarely considered in these terms in evaluations of improvement efforts. In this article, I argue that understanding the potential generative effects of artefacts for quality improvement purposes requires an understanding of their 'affordances' and how these relate to the socio-material infrastructure into which they are to be introduced, and/or the technologies they are designed to replace. Integrated care pathway implementation is examined to illustrate this position. Drawing on qualitative case studies of integrated care pathway development processes undertaken in the UK National Health Service and ethnographic research on the international care pathway community, I consider the infrastructural reasons behind the challenges of making pathways work in organising health care, and why, contrary to the aspirations of their proponents, they often appear to increase rather than decrease paperwork.

Statistical Thinking and Methods in Quality Improvement: A Look to the Future

ABSTRACT Much has been written recently concerning the future of statistics in business and industry (e.g., Technometrics 2008). In this expository article, the authors extend this discussion to focus specifically on the future of statistics and statisticians within the context of quality improvement. We argue that though the problems our profession faces are well known and have been repeatedly identified in the literature, the underlying root causes of these problems have remained lurking under the surface of the discussion. In particular, though positive change is certainly taking place, we do not believe that the statistics community has fully accepted and come to grips with the radical changes in our environment over the past 20–40 years. In short, we believe that our environment has changed radically, whereas our own changes have been incremental in nature. One such change that seems particularly difficult for us to swallow is that our society needs us to function, especially in the quality arena, more as an engineering discipline, rather than primarily as a pure science. To the extent that we can make this transition, we believe that we will maintain and grow our vitality as a discipline. To the extent that we refuse to, or are unable to, make this transition, our vitality, influence, and impact may erode, as other disciplines fill the void we leave. We choose to view this situation as half full and therefore offer specific suggestions as to how we feel the profession can make the needed changes in order to secure a brighter future in quality improvement.

Doctor and practice characteristics associated with differences in patient evaluations of general practice

BackgroundVariation in patients' evaluation due to general practitioner (GP) and practice factors may provide information useful in a quality improvement context. However, the extent to which differences in patients' evaluation of the GPs are associated with differences in GP and practice characteristics must also be ascertained in order to facilitate comparison of adjusted patient evaluations between GPs. The aim of this study was to determine such associations in a setting where GPs serve a list of patients and act as gatekeepers.MethodsWe carried out a patient evaluation survey among voluntarily participating GPs using the EUROPEP questionnaire, which produced 28,260 patient evaluations (response rate 77.3%) of 365 GPs. In our analyses we compared the prevalence of positive evaluations in groups of GPs.ResultsOur principal finding was a negative association between the GP's age and the evaluation of all aspects, except accessibility. We also found an association between the way the practice was organised and the patients' evaluation of accessibility, with GPs in single-handed practices getting far the most positive evaluations. Long weekly working hours were associated with more positive evaluations of all dimensions except accessibility, whereas more than 0.5 full-time employees per GP, a higher number of listed patients per GP and working in a training practice were associated with negative evaluation of accessibility.ConclusionGP characteristics are mainly associated with patients' experience of interpersonal aspects of care, while practice characteristics are associated with evaluation of accessibility. These differences need to be accounted for when comparing patient evaluations of different practices.

Evidence-based practice in psychology and behavior analysis.

This paper outlines development of practice (EBP) movement in medicine and psychology and discusses criteria by which a given intervention is deemed evidence-based, in accordance with American Psychological Association's (APA) guidelines. Although EBP movement has its benefits, there are a number of weaknesses that mitigate against implementing these in day-to-day practice. This paper discusses these weaknesses. Readers familiar with Chambless et al.'s (1996, 1998) report on empirically-validated therapies will note that a number of items pertain to behavior analytically-based interventions developed in 1960s and 1970s. Few would argue that these were flawless upon their inception, however, as indicated on list, have not been updated nor improved upon. This paper discusses why this might be so in a general context that suggests that applied behavior analysis has drifted from its empirical roots. This paper concludes by discussing potential usefulness of behavior analytic technologies within context of quality improvement. Keywords: practice, empirically-validated therapies, applied behavior analysis, quality improvement. ********** In an effort to increase use of psychological interventions in United States task forces were formed to define, identify, and disseminate information about extant empirically supported, psychologically based therapies (Chambless & Ollendick, 2001). According to American Psychological Association's (APA) Presidential Task Force on Practice (2006), practice (EBP) in psychology refers to the integration of available with clinical expertise in context of patient characteristics, culture, and preferences (p. 273). What APA means by best available research will be taken up in a moment. Apart from a few modifications, this definition is almost identical to definition adopted by Institute of Medicine (2001): Evidence-Based practice is integration of evidence with clinical expertise and patient values (p. 147). APA's adoption of medicine's definition makes sense from a socio-political standpoint. The medical community and medically oriented administrators are more likely to adopt these guidelines closer they parallel their own guidelines. Before proceeding, a comment about two terms related to concept of EBP warrants mention, as these terms might be confusing. Readers familiar with practice movement have, no doubt, noticed that term has changed over years, from empirically validated therapies (EVT) to empirically supported therapies (EST), to EBP. Generally speaking, these terms are synonymous. Although there are some differences, all of these refer to psychologically based treatments that have undergone scientific evaluation, employing established methodologies, and have proven to be efficacious. EBP, of course, is most current iteration of this concept, and, in keeping with this trend, will at some point likely be supplanted by a newer term. In this paper, we first outline development of practice movement in medicine and psychology. Second, we discuss criteria for EBPs. In particular, we describe what APA defines as well-established treatments and probably efficacious treatments, criteria by which they deem a given therapy evidence-based (Chambless et al., 1996). Although APA's efforts at promoting empirically sound therapies is a step in right direction, there are a number of major weaknesses that mitigate against usefulness of employing these criteria as they bear on day-to-day practice (for which they were intended). The third section of paper discusses these weaknesses. Behavior analysis started as being principle-based and process-oriented (Keller& Schoenfeld, 1950). …

Exploring the academic context for quality improvement: a scientific discipline in need of a career path.

Physician training typically occurs in an academic context. We examine whether improvement should be a central element in academe--specifically medical school. We observe that quality improvement meets the criteria for a discipline, but that there are many obstacles to career development in this field. Whether the research agenda of quality improvement can be accomplished within centers or institutes or whether this discipline needs its own department to ensure the nurturing of new faculty is still an open question. What is not open is the necessity for a career path in this discipline to exist and flourish.