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      How to build up the actionable knowledge base: the role of ‘best fit’ framework synthesis for studies of improvement in healthcare


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          Increasing recognition of the role and value of theory in improvement work in healthcare offers the prospect of capitalising upon, and consolidating, actionable lessons from synthesis of improvement projects and initiatives. We propose that informed use of theory can (i) provide a mechanism by which to collect and organise data from a body of improvement work, (ii) offer a framework for analysis and identification of lessons learnt and (iii) facilitate an evaluation of the feasibility, effectiveness and acceptability of improvement programmes. Improvement practitioners can benefit from using an underpinning external structure as a lens by which to examine the specific achievements of their own projects alongside comparable initiatives led by others. We demonstrate the utility of a method known as ‘best fit framework synthesis’ (BFFS) in offering a ubiquitous and versatile means by which to collect, analyse and evaluate improvement work in healthcare. First reported in 2011, BFFS represents a pragmatic, flexible approach to integrating theory with findings from practice. A deductive phase, where a review team seeks to accommodate a substantial part of the data, is followed by an inductive phase, in which the team explores data not accommodated by the framework. We explore the potential for BFFS within improvement work by drawing upon the evidence synthesis methodology literature and practical examples of improvement work reported in BMJ Quality and Safety (2011–2015). We suggest four variants of BFFS that may have particular value in synthesising a body of improvement work. We conclude that BFFS, alongside other approaches that seek to optimise the contribution of theory to improvement work, represents one important enabling mechanism by which to establish the rigour and scientific credentials of the emerging discipline of ‘improvement science’.

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          Qualitative research and evaluation methods

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            Rationale and standards for the systematic review of qualitative literature in health services research.

            Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.
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              Should we exclude inadequately reported studies from qualitative systematic reviews? An evaluation of sensitivity analyses in two case study reviews.

              The role of critical appraisal of qualitative studies in systematic reviews remains an ongoing cause for debate. Key to such a debate is whether quality assessment can or should be used to exclude studies. In our study, we extended the use of existing criteria to assess the quality of reporting of studies included in two qualitative systematic reviews. We then excluded studies deemed to be inadequately reported from the subsequent analysis. We tested the impact of these exclusions on the overall findings of the synthesis and its depth or thickness. Exclusion of so-called inadequately reported studies had no meaningful effect on the synthesis. There was a correlation between quality of reporting of a study and its values as a source for the final synthesis. We propose that there is a possible case for excluding inadequately reported studies from qualitative evidence synthesis.

                Author and article information

                BMJ Qual Saf
                BMJ Qual Saf
                BMJ Quality & Safety
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                November 2015
                25 August 2015
                : 24
                : 11
                : 700-708
                School of Health & Related Research (ScHARR), University of Sheffield , Sheffield, South Yorkshire, UK
                Author notes
                [Correspondence to ] Dr Andrew Booth, School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, South Yorkshire S1 4DA, UK; a.booth@ 123456sheffield.ac.uk
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                Research and Reporting Methodology
                Custom metadata

                Public health
                qualitative research,implementation science,health services research,evaluation methodology


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