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Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities
  1. Samuel Pannick1,
  2. Nick Sevdalis2,
  3. Thanos Athanasiou3
  1. 1NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
  2. 2Centre for Implementation Science, King's College London, London, UK
  3. 3Department of Surgery & Cancer, Imperial College London, London, UK
  1. Correspondence to Dr Samuel Pannick, NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, Room 503, Medical School Building, Norfolk Place, London W2 1PG, UK; s.pannick{at}


Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers—particularly middle managers—also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.

  • Healthcare quality improvement
  • Implementation science
  • Management
  • Quality improvement methodologies

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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