Table 1.

Quality improvement taxonomy

	QI strategy	Definition	Example methods	Surgical examples
Articles reporting any QI intervention (1–9) must include one additional item (10–11)
1	Provider reminder systems	Any ‘clinical encounter-specific’ information intended to prompt a clinician to recall information or consider a specific process of care	Decision aids Reminders	MEWS The WHO Surgical Safety Checklist
2	Facilitated relay of clinical data to providers	Transfer of clinical information from patients to the provider (not during a patient visit)	Telephone call Postal contact	Relay of BP measurements to the preassessment team
3	Provider education	Dissemination of information	Educational outreach visits Distribution of educational material Clinical guideline information	Component separation, training and recurrence rates Cadaveric training and surgeon confidence
4	Patient education	Dissemination of information	Distribution of educational material Individual or group sessions	Trimodal pre-habilitation programmes compliance and effect on LOS
5	Promotion of self-management	Access to a resource that enhances the patient’s ability to manage their condition	BP devices Patient diaries	Follow-up phone calls with recommended adjustments to care
6	Patient reminders	Any methods of encouraging patient compliance to self-management	Appointment reminders	SMS exercise reminders before bariatric surgery
7	Organisational change	Any change in organisational structure	Multidisciplinary teams Communication Health records	Changes to staff rota to facilitate early patient mobilisation after elective arthroplasty
8	Financial, regulatory, or legislative incentives	Any financial bonus, reimbursement or provider licensure scheme	Positive or negative incentives for providers or patients.	18-week wait target for elective orthopaedic surgery
9	Feedback	Any feedback of clinical performance	Distribution of feedback via staff education sessions or emails. Can occur as part of SPC or audit and feedback	Percentage of patients achieving target LOS
QI techniques (10–11)
10	Audit and feedback	Any feedback of clinical performance summarising percentages of patients who have achieved a target outcome which has been measured at intervals over time	PROMs LOS Morbidity and mortality	Percentage of patients achieving target LOS
11	QI methods	Systematic techniques for identifying defects in clinical systems and making improvements, typically involving process measurement and remeasurement	PDSA, Six Sigma, TQM, CQI, SPC, Lean	Improving processes for acetabular cup placement in minimally invasive hip surgery

Adapted from Shojania et al (2004) Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 1: Volume 1—Series Overview and Methodology). Technical Reviews, Rockville (Maryland): Agency for Healthcare Research and Quality (USA).

BP, Blood Pressure; CQI, Continuous Quality Improvement; LOS, Length of Stay; MEWS, Modified Early Warning System; PDSA, Plan-Do-Study-Act; PROM, Patient Reported Outcome Measure; QI, quality improvement; SMS, Short Message Service; SPC, Statistical Process Control; TQM, total quality management.