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Leading improvement

John Øvretveit (The Karolinska Institute Medical Management Centre, Stockholm, Sweden and Bergen University Faculty of Medicine, Bergen, Norway)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 1 December 2005




To provide research‐informed guidance to leaders of quality and safety improvement and evidence‐based materials for education programmes for leaders


Search of databases and hard copy literature since 1985 into managers' and leaders' role in quality and safety improvement. Classification into “eA”: Empirical research strong evidence, “eB”: Empirical research, weak evidence and, “eC”: Conceptual discussion, not based on systematic empirical research. Summary, and synthesis of the best available evidence for a guidance checklist for leaders.


Although most literature emphasises the importance of committed leadership for successful quality and safety improvement, research evidence supporting this is scarce and often scientifically limited. The research shows evidence of the limitations and scope of leader actions for improving health care provision, the need to engage clinicians in this work and ways to do so, as well as the leadership role played by others apart from senior leaders. The ability of managers and other leaders skilfully to tailor Q&SI to the situation may be important but descriptions of how leaders do this and evidence supporting this proposition are lacking.

Research limitations/implications

More research is needed about whether or how the leader role is different according to the stage of quality and safety development of the organisation, the type of organisation, the type of context, the level and type of leader and the type of improvement and improvement method.

Practical implications

Implications for leaders' actions are provided in a “best evidence guidance” checklist. This provides more tangible and research‐informed guidance than the inspirational literature or studies from single organisations.


This paper provides the first overview and synthesis of a wide range of studies which can be used as a basis for future research and materials for educational programmes. It provides the first detailed guidance for leaders about specific actions which research suggests they need to take to improve quality and safety.



Øvretveit, J. (2005), "Leading improvement", Journal of Health Organization and Management, Vol. 19 No. 6, pp. 413-430.



Emerald Group Publishing Limited

Copyright © 2005, Emerald Group Publishing Limited

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