Forbedringsvidenskaben kan få inspiration fra implementering og Lean

‘Comparison is the thief of joy’; Improvement Science and…

Af Simon Tulloch, psykolog, chefkonsulent, Dansk Selskab for Patientsikkerhed

In 2014, Richard Scoville and colleagues wrote an IHI white paper ‘Comparing Lean and Quality Improvement’ which, as the title suggests, explored the relationship between IHI’s approach to quality improvement and Lean management approach. In the paper, the authors explore how to utilize one or both approaches to improve care systems, they discuss the key conceptual foundations, and the tools that characterize them in practice. Essentially, they point out the congruence between the two approaches, as well as key differences.

Per Nilsen and colleagues recently published an article – Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science – which follows a similar approach. The authors set out to characterise and contrast the two approaches, as well as emphasise aspects of implementation science that could potentially inform improvement science, and vice versa.

The authors state that although “the two fields have disparate origins and draw on mostly different sources of knowledge”, “apply a range of analytical tools to understand problems and inform effective solutions” they both “have a shared goal of using scientific methods to understand and explain how health care services can be improved for better patient and population outcomes.”

Interestingly, the authors underline that both approaches describe a problem in terms of a “gap or chasm between current and optimal care and treatment.” On this issue, I’m reminded of an excellent article by Trenholme Junghan – “Don’t Mind the Gap!” Reflections on Improvement Science as a Paradigm – in which he explores the phrase in some detail.

In conclusion, the authors suggest that for both implementation science and improvement science to move forward and ‘bridge the silos’, it is necessary for greater collaboration between scholars and practitioners, greater scientific application and evaluation, and a more coherent use of theory.

Theodore Roosevelt’s maxim that “comparison is the thief of joy”, may well hold true for individuals, however, for models and methods, these papers indicate comparison can be a deeply rewarding process.


Nilsen Per, Thor Johan, Bender Miriam, Leeman Jennifer, Andersson-Gäre Boel, Sevdalis Nick. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. Frontiers in Health Services, vol. 1, 2022. DOI=10.3389/frhs.2021.817750


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