BMJ Qual Saf 20:i87-i91 doi:10.1136/bmjqs.2010.046342
  • Rethinking methods of inference

Increasing the generalisability of improvement research with an improvement replication programme

Open Access
  1. Gareth Parry3,4
  1. 1Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden
  2. 2The Robert Wood Johnson Foundation, New Jersey, USA
  3. 3Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Gareth J Parry, Research Scientist, Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138, USA; gparry{at}
  • Accepted 12 October 2010


If a quality improvement is found effective in one setting, would the same effects be found elsewhere? Could the same change be implemented in another setting? These are just two of the ‘generalisation questions’ which decision-makers face in considering whether to act on reported improvement. In this paper, some of the issues are considered and a programme of research for testing improvements in different settings is proposed to build theory and practical guidance about implementation and results in different settings.


  • Funding The Health Foundation.

  • Competing interests None declared.

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

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