Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm.

Introduction: Little is understood about the role of
quality improvement in enabling health organisations to
survive and thrive in the contemporary context of
financial and economic challenges. We will draw on the
theoretical foundations of the ‘Resource Based View of
the Firm’ (RBV) to develop insights into why health
organisations engage in improvement work, how impacts
are conceptualised, and ‘what works’ in delivering these
impacts. Specifically, RBV theorises that the mix and use
of resources across different organisations may explain
differences in performance. Whether improvement work
influences these resources is unclear.
Methods and analysis: Case study research will be
conducted across health organisations participating in
four approaches to improvement, including: a national
improvement programme; a multiorganisational
partnership around implementation; an organisational
strategy for quality improvement; and a coproduction
project designed to enhance the experience of a clinical
service from the perspective of patients. Data will
comprise in-depth interviews with key informants,
observation of key events and documents; analysed
within and then across cases. Adopting a realist
perspective, the core tenets of RBV will be evaluated as a
programme theory, focusing on the interplay between
organisational conditions and behavioural or resource
responses that are reported through engagement in
improvement.
Ethics and dissemination: The study has been
approved by Bangor University Ethics Committee. The
investigation will not judge the relative merits of different
approaches to healthcare quality improvement. Rather,
we will develop unique insights into the organisational
consequences, and dependencies of quality
improvement, providing an opportunity to add to the
explanatory potential of RBV in this and other contexts.
In addition to scientific and lay reports of the study
findings, research outputs will include a framework for
constructing the economic impacts of quality
improvement and practical guidance for health service
managers that maximises the impacts of investment in
quality improvement.