Table 2

Core domains of knowledge for the improvement of health care

Content areaDefinitionExample learning objectives
Modified from Bataldenet al.11
Customer/beneficiary knowledgeIdentification of the person, persons, or groups of persons for whom health care is provided; an understanding of their needs and preferences and the relationship of health care to those needs and preferencesFor a particular health care service:
  • Identify those whom we seek to serve

  • Describe methods to identify their needs

Health care as process, systemThe interdependent people (patients, families, eligible populations, caregivers), procedures, activities, and technologies of health care giving that come together to meet the need(s) of individuals and communities
  • Describe care as a process

  • Analyze data on processes of care

Variation and measurementThe use of measurement to understand the variation across and within systems to improve the design and redesign of health care
  • Collect and analyze data on outcomes of care

  • Use data to identify changes that might decrease unwanted variation in the outcomes of care

Leading, following and making changes in health careThe methods and skills for making change in complex organizations, including the general and strategic management of people and the healthcare work they do. Such activities include a general understanding of healthcare financing, information technology, the roles that individuals of different professions play in daily health care giving, and the development of a supportive internal organizational climate for working, learning and caring
  • Display skill in active listening

  • Describe core concepts for managing change

CollaborationThe knowledge, methods, and skills needed to work effectively in groups, to understand and value the perspectives and responsibilities of others, and the capacity to foster the same in others
  • Work effectively in interdisciplinary teams

  • Describe why an interdisciplinary approach is necessary for improvement in health care

Developing new locally useful knowledgeThe recognition of the need for new knowledge in personal daily health professional practice and the skill to develop new knowledge through empiric testing
  • Conduct serial experiments of improvement (also known as Plan-Do-Study-Act cycles)

  • Apply continuous improvement to personal learning and change

Social context and accountabilityAn understanding of the social contexts (local, regional, national, global) of health care and the way that expectations arising from them are made explicit. This specifically includes an understanding of the financial impact and costs of health care
  • Describe the linkage of quality and cost in health care

  • Apply continuous improvement within the current context of health care delivery

Professional subject matterThe health professional knowledge appropriate for a specific discipline and the ability to apply and connect it to all of the above
  • Identify and evaluate the literature defining best practice