Programme evaluation is important to advancing the science of improvement.
Because of the temporal nature of improvement, the theory and methods for analytical studies are a critical component of the science of improvement.
Part of building this knowledge and the science of improvement is discovering whether context affects the implementation and outcomes of some or of all types of QI.
These disagreements may be simply due to evolution in the field, but may also be due to a lack of knowledge of the science of improvement.
In addition to these classifications of studies, Deming 5 defined a distinction between analytical and enumerative studies which has proven to be fundamental to the science of improvement.
The emergence of a science of improvement within medicine in the last few decades has amplified the differences between the two epistemologies.
Sensitivity to these issues will be critical in spreading and sustaining this, or any other, approach to adapting the science of improvement to real-world settings.
There is an urgent need for greater scientific rigour in the application and reporting of these methods to advance the understanding of the science of improvement and efficacy of the PDSA method.
To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness.
The science of improvement can also be used to refer to a broad church of research grounded in health services research, social science, evaluation studies and psychology and other disciplines.
However, many of the comments and discussions around particular items illustrated broader issues, which we hypothesise are related to skill in writing, knowledge of the science of improvement and the evolution of the field.
