Article Text

Download PDFPDF

Beyond evidence: the micropolitics of improvement
  1. Ann Langley1,
  2. Jean-Louis Denis2
  1. 1HEC Montréal, chemin de la Côte-Ste-Catherine, Montréal, Quebec, Canada
  2. 2École Nationale d'Administration Publique, Montreal, Quebec, Canada
  1. Correspondence to Professor Ann Langley, HEC Montréal, 3000, chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 2A7, Canada; ann.langley{at}


This paper aims to draw attention to the social and micropolitical dimensions of attempting to implement improvements within healthcare organisations. It is argued that quality improvement initiatives, like other forms of organisational innovation, will fail unless they are conceived and implemented in such a way as to take into account the pattern of interests, values and power relationships that surround them. Drawing on examples, it is suggested that innovators can intervene more successfully if they understand how the benefits and costs of interventions are likely to be distributed among stakeholders within their setting, how different but equally legitimate value sets may structure peoples' understanding of them and how the nature of the interventions themselves (and, in particular, the shape of their hard core and soft periphery) might provide scope for redesigning or adapting interventions in ways that are likely to make them both more effective and politically feasible.

  • Evidence-based medicine
  • healthcare quality improvement
  • management
  • organisation

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text

Statistics from


  • Competing interests None.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.