Demystifying theory and its use in improvement

By Frank Davidoff, M. Dixon-Woods, L. Leviton, Susan Michie. BMJ Quality & Safety, 2015

656 citations recorded by the source corpus.

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.

Subfields: General Health Professions

View Paper: https://www.semanticscholar.org/paper/666e5fad9cf6ff44d86b27a167c4565857e1d151

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In General Health Professions

Citations in the corpus

Clarity out of chaos: Use of theory in implementation research. (2020, background): “But what is theory and how is it encapsulated and tested? Theory may be less formal prospective statements of “if I do a, then b will happen” or retrospective “reason-giving” explanations for observed outcomes (Davidoff et al., 2015).”
A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40 (2016, methodology): “Embedding research studies in a theoretical or conceptual framework Moving forward, we should embed research studies more explicitly in a theoretical or conceptual framework and utilize theory in the interpretation of our results (Davidoff et al. 2015).”
The problem with Plan-Do-Study-Act cycles (2015, background): “…collection plan; specify how the intervention will be implemented (Do), evaluated (Study) and sustained (if successful) No theory of change/programme theory connecting the intervention to its intended outcomes 28 – 31 Poorly targeted interventions that may be inefficient or may fail altogether.”
Realist review (2021, background): “Finally, Davidoff et al. (2015) published a criteria to help researchers determine whether or not their chosen theories are ‘good’ ones.”
A systematic review of the use of the Consolidated Framework for Implementation Research (2015, background): “Better integration of the CFIR (or other theoretical framework) into empirical studies would help to address gaps in use of theory and advance implementation science [4, 31, 32].”
How to study improvement interventions: a brief overview of possible study types (2015, neutral): “61”
An introduction to implementation science for the non-specialist (2015, background): “Use of the term theory in this paper refers to any proposal about meaningful relationships between constructs (variables) or how a mechanism or construct may change the behavior of another construct or outcome [41, 42].”
The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects (2020, methodology): “Logic models can also be used in the context of program theory, an explicit statement of how a project/strategy/intervention/program/policy is understood to contribute to a chain of intermediate results that eventually produce the intended/observed impacts [18].”