Table 1

Integrated evaluation framework

Model components	Definitions
External environment	External motivators	External factors that stimulate the organisation to focus on the QI project.
External environment	Project sponsorship	External entities contributing personnel, expertise, equipment, facilities or other resources for the project.
Organisation	QI leadership	Senior leadership commitment to champion and support QI project.
	Senior leader project sponsor
	Culture supportive of QI	Values, beliefs and norms of an organisation that shape the behaviours of staff in pursuing QI.
	Maturity of organisational QI	Sophistication of the organisation’s QI programmes.
	Staff engagement	Steps taken by the organisation for continued staff engagement in QI.
QI support and capacity	Data infrastructure	Extent to which a system exists to collect, manage and facilitate the use of data. Effective use of technology.
	Resource availability	Support for QI, including allocation of resources, finances and staff time.
	Workforce focus on QI	Workforce development through training and engagement in QI.
QI team and microsystem	Team diversity	Diversity of team members with respect to professional discipline, personality, motivation and perspective.
	Physician involvement	Contribution of physicians to the QI team efforts.
	Subject matter expert	Team member/members knowledgeable about measurement.
	Prior QI experience	Prior experience with QI.
	Team leadership	Team leader’s ability to accomplish the goals of the improvement project by guiding the QI team.
	Team norms	Team establishes strong norms of behaviour about QI goal achievement.
	Team QI skill/capability for improvement	Team’s ability to use improvement methods to make changes.
	Motivation to change	Extent to which team members have a desire and willingness to improve.
	QI accountability	Clearly stated and communicated responsibility and accountability in the project.
Trigger (training event)	Participation and reaction (Kirkpatrick level 1)	Overall satisfaction with the programme, content, delivery, logistics, facilitators, etc.
Trigger (training event)	Knowledge, skills and attitudes (Kirkpatrick level 2)	Improvement in knowledge and skills reported by participants immediately after the intervention.
Outcomes/process and system changes	Behaviour change (Kirkpatrick level 3)	Confidence in measurement skills. Maintaining and advancing the skills learnt. Continued spread and involvement in QI.
	Learning networks	Development of QI networks among postintervention.
	QI capacity development	Ability of participants to initiate and lead other projects. Ability of participants to train/help other staff.
	Change in organisational practice and/or patient outcomes (Kirkpatrick level 4)	Sustainability in outcomes achieved. Sustainability in practices. Process changes as a result of the training event.
	Dissemination/spread	Spread of knowledge and improved practices to non-intervention units.
	Unintended consequences	Negative or positive unanticipated outcomes.

QI, quality improvement.