BMJ Qual Saf 20:453-459 doi:10.1136/bmjqs.2010.047993
  • Original viewpoint

The role of theory in research to develop and evaluate the implementation of patient safety practices

  1. Robert M Wachter7
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2Medical Management Centre, The Karolinska Institute, Stockholm, Sweden
  3. 3RAND Corporation, Santa Monica, California, USA
  4. 4VA Greater Los Angeles, Los Angeles, California, USA
  5. 5The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  6. 6Stanford University, Stanford, California, USA
  7. 7University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Professor Robbie Foy, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK; r.foy{at}
  1. Contributors PS, PP and BW were chief co-investigators for the AHRQ-funded project, and all other authors were members of the project team. RF, JO and PS wrote the first draft of the manuscript, to which all other authors contributed substantial comments. All authors approved the final version of the manuscript.

  • Accepted 19 January 2011
  • Published Online First 11 February 2011


Theories provide a way of understanding and predicting the effects of patient safety practices (PSPs), interventions intended to prevent or mitigate harm caused by healthcare or risks of such harm. Yet most published evaluations make little or no explicit reference to theory, thereby hindering efforts to generalise findings from one context to another. Theories from a wide range of disciplines are potentially relevant to research on PSPs. Theory can be used in research to explain clinical and organisational behaviour, to guide the development and selection of PSPs, and in evaluating their implementation and mechanisms of action. One key recommendation from an expert consensus process is that researchers should describe the theoretical basis for chosen intervention components or provide an explicit logic model for ‘why this PSP should work.’ Future theory-driven evaluations would enhance generalisability and help build a cumulative understanding of the nature of change.


  • Linked articles 047035.

  • Funding AHRQ.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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