Finding the Right Balance between Evidence for Judgment and Evidence for Quality Improvement

Abstract

“Evidence for judgment” asks whether healthcare practitioners did what they were supposed to do. “Evidence for improvement” asks whether quality is improving due to the deliberate efforts of managers and care providers The former describes the gap between optimal and actual care, examines peer-to-peer comparisons, is retrospective and often measured only at a single point in time, and identifies problems but not necessarily solutions. Knowledge tends to flow from researchers to practitioners, and knowledge transfer mechanisms are unclear. Evidence for improvement is prospective, focuses on comparisons to self over time, uses longitudinal data, and includes evidence on “how” to improve. Knowledge transfer mechanisms are built into quality improvement projects. Both types of evidence have their role; evidence for judgment helps system leaders identify priorities for improvement, whereas evidence for improvement helps leaders assess whether their implementation strategies have been successful. Currently, however, evidence for judgment predominates. Funding mechanisms, data systems, measurement tools, publication guidelines, and health professional training programs will need to be modified if we want more evidence for improvement.