Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal

File Description SizeFormat 
mzy063.pdfPublished version282.59 kBAdobe PDFDownload
Title: Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal
Author(s): Issen, L
Woodcock, T
McNicholas, C
Lennox, L
Reed, JE
Item Type: Journal Article
Abstract: Background: Despite criticisms that many Quality Improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of, scoring criteria to evaluate programme theory diagrams. Methods: Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. 63 programme theory diagrams (42 driver diagrams and 21 action effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Results: Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause/effect relationships, evidence, and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; Action-Effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over Driver Diagrams; no significant differences were observed based on the setting in which Driver Diagrams were developed. Conclusions: The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams, and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed.
Publication Date: 1-Aug-2018
Date of Acceptance: 27-Feb-2018
ISSN: 1353-4505
Publisher: Oxford University Press (OUP)
Start Page: 508
End Page: 513
Journal / Book Title: International Journal for Quality in Health Care
Volume: 30
Issue: 7
Sponsor/Funder: Chelsea & Westminster Hospital NHS Foundation Trust
The Health Foundation
Funder's Grant Number: N/A
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
quality improvement
quality management
measurement of quality
programme theory
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Health Policy & Services
Publication Status: Published
Online Publication Date: 2018-04-09
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

Items in Spiral are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons