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So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare
  1. Paul Batalden1,
  2. Frank Davidoff2,
  3. Martin Marshall3,
  4. Jo Bibby3,
  5. Colin Pink3
  1. 1The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  3. 3The Health Foundation, London, UK
  1. Correspondence to Professor Paul Batalden, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA; paul.batalden{at}

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How we assembled this supplement

Our interactions during the Colloquium led to an outpouring of creative and innovative thought about improving healthcare. We re-explored and reframed old ideas, and came up with new ones. The process reminded many of us of the way Native American elders were said to go about reaching decisions: ‘Talk and talk until the talk begins.’1 And importantly, we recognised both explicit and implicit invitations to take action, as we probed the various ways in which people could build on and use such knowledge.

In putting together this supplement, we decided, in general, not to follow the traditional procedure of publishing the inputs: the scripted material participants prepared beforehand, and presented in the initial days of the meeting. Instead, with a few exceptions, it seemed closer to the spirit of the meeting to assemble the outputs: the collective explorations, insights and syntheses that emerged from our intense and productive week together. Accordingly, we invited participants, as individuals or in small groups, to write about the ideas from the meeting that changed their thinking the most and that they felt would be important to share. Many chose to do so in a longer (∼2500-word) format: serious, scholarly, well-documented articles written to be as accessible as possible to a general readership. Several opted for a shorter (∼800-word) format that captured ‘ideas in evolution’: thinking that seemed too interesting and important to lose, even though it was not yet fully worked out. All of the submitted manuscripts were peer-reviewed.

Collective wisdom that emerged in the course of the meeting

The resulting papers fell naturally into six structural groups:

  1. structure of improvement knowledge;

  2. discovering and defining sources of evidence;

  3. social determinants of action;

  4. importance of cross-disciplinary work;

  5. challenges of professional education;

  6. rethinking methods of inference.

What follows is a summary of the key elements expressed in the cluster of papers that came together in …

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