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Seven Propositions of the Science of Improvement: Exploring Foundations

Perla, Rocco J. EdD; Provost, Lloyd P. MS; Parry, Gareth J. PhD

doi: 10.1097/QMH.0b013e31829a6a15
Original Articles

Context: The phrase “Science of Improvement” or “Improvement Science” is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of “improvement” as a science.

Methods: We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming's System of Profound Knowledge. We suggest that Deming's system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement.

Findings: A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase “science of improvement” represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts.

Conclusions: The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of improvement.

University of Massachusetts Medical School, Worcester, Massachusetts (Dr Perla); Associates in Process Improvement, Austin, Texas (Mr Provost); Institute for Healthcare Improvement, Cambridge, and Harvard Medical School, Boston, Massachusetts (Dr Parry).

Correspondence: Rocco J. Perla, EdD, University of Massachusetts Medical School, Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, 55 Lake Avenue North, ACC Bldg, 7th Floor, Worcester, MA 01655 (

The authors declare no conflicts of interest.

An earlier draft of this manuscript was reviewed by the Fellowship Alumni of the Institute for Healthcare Improvement. The authors thank the Fellows for their numerous comments and suggestions. The authors also thank Ms Maureen Bisognano and Drs Thomas Nolan, Donald Goldmann, Martin Marshall, Frank Davidoff, Jason Leitch, and Peter Lachman for their valuable and critical feedback of previous versions of this manuscript.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins