Quality improvement and implementation science: Different fields with aligned goals

One hundred years ago, Massachusetts surgeon Ernest Codman advocated the unpopular idea that physicians and hospitals should track patient outcomes to determine the effectiveness of the care rendered to these patients. This heretical concept caused friction with his contemporaries and administrators at the Massachusetts General Hospital, from which he resigned to start a private hospital where he could practice his End Result System that tracked patients and outcomes.

Now, Codman’s idea is accepted dogma. We recognize that patients’ outcomes often fall short of our collective expectations. One important reason for this failure is that scientific evidence about patient care (including diagnosis and management) is unevenly and inconsistently applied. This phenomenon is known as the evidence-to-practice performance gap.

The evidence-practice performance gap is a natural target for health care improvement efforts. In this issue of Anesthesiology Clinics, we present articles addressing two distinct but complementary approaches to narrowing the performance gap: quality improvement (QI) and implementation science (IS).