{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:08:02Z","timestamp":1788847682935,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/P000703\/1"],"award-info":[{"award-number":["ES\/P000703\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This paper synthesizes 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009=\u200968; one a qualitative study N\u2009=\u200916, and last, a Delphi study N\u2009=\u200923. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u2018failed\u2019 QI programmes. Together, these benefits encompass monetary and non-monetary value of QI along a programme\u2019s journey. We view these benefits as four main domains: development, improvement, savings, and sustainability or DISS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>QI has several organizational and health system benefits contained within the DISS construct. These benefits support various organizational goals such as quality improvement, organizational development, performance and resilience. We posit that the collective findings are applicable to many organizations that provide interdisciplinary healthcare services globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag089","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:36:41Z","timestamp":1781627801000},"source":"Crossref","is-referenced-by-count":0,"title":["The four main domains of the concept of return-on-investment from healthcare quality improvement programmes"],"prefix":"10.1093","volume":"38","author":[{"given":"S\u2019thembile","family":"Thusini","sequence":"first","affiliation":[{"name":"Health Services and Population Research Department, King\u2019s College London, Institute of Psychiatry, Psychology and Neuroscience , London, SE5 8AF,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayana","family":"Soukup","sequence":"additional","affiliation":[{"name":"Imperial College London , Department of Surgery and Cancer , London, W12 0NN,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Henderson","sequence":"additional","affiliation":[{"name":"Centre for Implementation Science, King\u2019s College London , London, SE5 8AF,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026090801413491300_mzag089-B1","volume-title":"Making the Investment Case for Mental Health: A WHO\/UNDP Methodological Guidance Note","author":"World Health Organisation (WHO)","year":"2019"},{"key":"2026090801413491300_mzag089-B2","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1136\/jech-2016-208141","article-title":"Return on investment of public health interventions: a systematic review","volume":"71","author":"Masters","year":"2017","journal-title":"J Epidemiol Community Health"},{"key":"2026090801413491300_mzag089-B3","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/PTS.0b013e3182753e33","article-title":"The business case for health-care quality improvement","volume":"9","author":"Swensen","year":"2013","journal-title":"J Patient Saf"},{"key":"2026090801413491300_mzag089-B4","author":"Solid","year":"2020"},{"key":"2026090801413491300_mzag089-B5","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/j.socscimed.2009.09.051","article-title":"Studying large-scale programmes to improve patient safety in whole care systems: challenges for research","volume":"69","author":"Benn","year":"2009","journal-title":"Soc Sci Med"},{"key":"2026090801413491300_mzag089-B6","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1108\/IJHG-04-2024-0045","article-title":"What influences perceptions about the concept of return on investment from healthcare quality improvement programmes? 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