Katie Richards (she/her) is a Research Associate in the King’s Improvement Science research group at the Centre for Implementation Science, King’s College London. Currently, she is working across improvement and implementation science project in South London Hospitals, including collaboratively developing a Theory of Change for a quality improvement training programme. Prior to joining King’s Improvement Science, she completed her PhD at King’s College London in 2022. During her PhD, she gained experience in implementation science as she evaluated the national scaling of an early intervention service for eating disorders. She completed her MSc in Human Cognitive Neuroscience at the University of Edinburgh and her BSc in Applied Psychology with Clinical Psychology at the University of Kent. Her research interests include healthcare system change and working environments that foster continuous learning and staff well-being.
Organisation-wide capacity building programmes for quality improvement (QI) have been linked to higher ratings in quality assessments. However, the conditions and mechanisms through which these programmes impact improvement goal(s) at scale have not always been clearly articulated. The aim of this study was to develop a Theory of Change (ToC) outlining the ultimate goals of a QI training programme and the conditions and mechanisms required to reach these goals.
A qualitative study informed by the Aspen Institute’s guide to ToC was conducted. Twenty participants were purposively recruited, including QI team members, hospital staff, and past/present patients. Research evidence, QI training materials, and data gathered during workshops and semi-structured interviews were used to iteratively develop the ToC. Data were analysed using framework analysis.
The ultimate goals identified during the study were improvements in QI infrastructure, a QI culture, and sustained improvements in the quality and experience of care, services and operations for patients, staff, and the wider community. Views on the goals were mixed, but many felt that they should evidence sustained improvements in care.
Key conditions and mechanisms required to reach these goals included:
(1) leadership supporting and enabling QI;
(2) QI perceived as relevant and a priority;
(3) capacity/time for training and QI;
(4) QI governance;
(5) staff awareness of ‘QI offer’;
(6) accessibility of ‘QI offer’;
(7) patients and the public co-producing QI;
(8) listening to and involving staff at all levels and a diverse programme/project team;
(9) appropriately using data; and
(10) sharing, learning and disseminating internally and externally.
Our results suggest that the aims of the training programme should be to improve QI infrastructure, promote a QI culture, and sustain improvements in the quality of care, services and operations. Leadership support emerged as one of the most crucial conditions required to reach these goals.