The four main domains of the concept of return-on-investment from healthcare quality improvement programmes

BACKGROUND: This paper synthesises a series of four studies in the exploration of the concept of Return on Investment (ROI) in relation to healthcare Quality Improvement (QI) programmes (QI-ROI). METHODS: We followed a multi-stage mixed-methods integration approach where four studies were first conducted and reported separately. The four study designs were linked to enable us to build a cohesive understanding of QI-ROI. Collective findings were then analysed and interpreted to identify the main QI-ROI concept domains. Two studies were based on an extensive global interdisciplinary systematic literature review N = 68; one a qualitative study N = 16, and last, a Delphi study N = 23. For the latter two studies, participants were from the UK National Health Service and included 24 board members, 15 service and clinical directors, and QI leaders. RESULTS: Several benefits were seen to represent ROI from QI programmes. These encompassed internal (e.g., development) and external (e.g., service user socio-economic benefits), intervention outcomes (e.g., clinical benefits) and implementation outcomes (e.g., spread). Further, the benefits included lessons from 'failed' QI programmes. Together, these benefits encompass monetary and non-monetary value of QI along a programme's journey. We view these benefits as four main domains: development, improvement, savings, and sustainability or DISS. CONCLUSION: QI has several organisational and health system benefits contained within the DISS construct. These benefits support various organisational goals such as quality improvement, organisational development, performance and resilience. We posit that the collective findings are applicable to many organisations that provide interdisciplinary healthcare services globally.