Engaging with theory: from theoretically informed to theoretically informative improvement research

Repeated calls have been made for the increased use of theory in designing and evaluating improvement and implementation interventions.1–4 The benefits are argued to include identifying contextual influences on quality improvement (QI), supporting the generalisability of findings and anticipating how future phenomena might unfold.2 5 Most importantly, the ability of theories to provide robust explanations is invaluable for understanding how, why and in what circumstances interventions work (or do not work),6 thus addressing crucial questions relating, for example, to variation in improvement outcomes.4 7

Although the use of theory in improvement and implementation research appears to be increasing over time,8 the emphasis largely remains on adopting a theoretically informed approach, that is, applying theory to design an intervention or to systematise and explain evaluation findings. Despite the recognised need...

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