Context shapes the effectiveness of knowledge implementation and influences quality improvement.  When QI efforts fail or achieve mixed results, or when initiatives work in some settings but not in others, ‘context’ is often cited as the cause.  Encompassing a range of interconnecting elements at all levels of the system from policy to organisation to the individual, context can be broadly be defined as anything other than the improvement process itself (clinical intervention + QI methodology).  Understanding contextual barriers and facilitators to implementation is therefore crucial to implementing effective improvement; yet context is still poorly understood.

Research Theme Aims


The aim of the Context theme is to further the understanding of the role of context within quality improvement.  We will fulfil this aim by:

  • synthesising current evidence on context in healthcare quality improvement;
  • disseminating findings to the SISCC improvement programmes and to the wider QI community in an accessible way;
  • producing evidence-based guidance and resources to address contextual issues in implementation planning.

Translating evidence into practice, for application in real-world settings, will inform the planning and implementation of context-sensitive QI programmes that take local knowledge and contextual factors into account.

Within SISCC, the Context theme is closely linked to the Behaviour Change theme, which explores the way in which individual/organisational factors and professional interactions shape improvement activity. The Context theme has also contributed to the Neonatal Evidence-Into-Practice project, disseminating relevant evidence to practitioners to support the development of improvements within neonatal unit settings. 

Examples of how the Context research theme is supporting the SISCC large-scale improvement programmes is summarised within the Context theme examples.

Our Current Focus


We are undertaking a realist review to examine the influence and impact of contextual factors on QI initiatives in healthcare.  Realist reviews explore the interactions between contexts, mechanism of change and outcomes, to provide an explanatory analysis of ‘what works, for whom and in what setting?’ The review ties in with the study of improvement programmes as vehicles of change, and the development of an evidence base around healthcare improvement.

The review will update the evidence base on the contextual conditions for effective improvement, and seek to understand:

  • which contextual factors are important, and how, why, when and for whom they are important, within varied settings;
  • the dynamic nature of context and change over time, and which aspects of context impact at key points in the improvement trajectory;
  • the influence of context on improvement outcomes (provider and patient-level), spread and sustainability.


To date, we have:

  • Published the review protocol in Systematic Reviews.
  • Conducted a scoping exercise: an initial literature scan followed by consultation with a range of stakeholders at local, regional and national (Scotland) levels.
  • Created a theoretical framework and mapped contexts, mechanisms and outcomes based on the findings of the scoping exercise.
  • Reviewed and synthesised a wide range of empirical evidence of context (research-based evidence of contextual factors affecting QI).
  • Held a stakeholder workshop to present emerging findings, to ensure that potential outputs are as informed and relevant as possible.
  • Developed a preliminary evidence-based explanatory model that can be applied to any healthcare setting, to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the various stages of the improvement journey. 

For more detailed information please see The influence of contextual factors on healthcare quality improvement initiatives: what works, for whom and in what setting? Protocol for a realist review

Key People




Outputs from the Context research theme can be accessed on our publications page.

It is anticipated that the findings from the realist review will be available in early 2019.