ArticleBMJ quality & safety2016
Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.
Article in BMJ quality & safety, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Pooled it
- Middle managers' role in implementing evidence-based practices in healthcare: a systematic review.Implementation science : IS · 2018Pooled it
- Multiple Suggested Care Alternatives and Decision-Making of Primary Care Physicians: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Improving care at scale: process evaluation of a multi-component quality improvement intervention to reduce mortality after emergency abdominal surgery (EPOCH trial).Implementation science : IS · 2018Trial
- Health professionals' perceptions about their clinical performance and the influence of audit and feedback on their intentions to improve practice: a theory-based study in Dutch intensive care units.Implementation science : IS · 2018Trial
- Value operating system: a practical framework to measure outcomes-per-cost at the episode level.BMJ open quality · 2026Article
- Uncovering the informal learning of patient safety in undergraduate clinical clerkships: a qualitative study of patient safety specialists' perspectives.BMC medical education · 2026Article
- Applying FRAME-IS to characterize provider-led adaptations to a cervical cancer prevention intervention in Kenya.Implementation science communications · 2026Article
- Review
- Implementing quality improvement in vascular services: a qualitative study.BMJ open quality · 2026Article
- Health workers' perspectives on barriers and opportunities to optimising quality improvement implementation in urban health facilities in Lilongwe, Malawi.BMJ open quality · 2025Article
- Strategies for optimising health system managers' engagement in quality improvement projects: lessons learnt from the COMPAS+ project.BMJ open quality · 2025Article
- Agile Implementation of a Digital Cognitive Assessment for Dementia in Primary Care.Annals of family medicine · 2025Article
- Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system.BMJ open quality · 2024Article
- Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial.JMIR formative research · 2024Article
- Decision-maker roles in healthcare quality improvement projects: a scoping review.BMJ open quality · 2024Article
- Exploring physician engagement in health care organizations: a scoping review.BMC health services research · 2023Article
- A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability.Implementation science : IS · 2023Article
- Hurdles of innovation-insights from a new healthcare delivery innovation program.Learning health systems · 2023Article
- Impact of externally facilitated continuous quality improvement cohorts on Advanced Access to support primary healthcare teams: protocol for a quasi-randomized cluster trial.BMC primary care · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.