Partnership Makes Performance: Integrating Quality Improvement and Implementation Science to Advance Healthcare

December 1, 2025

A new paper in BMJ Quality & Safety from Northwestern University Feinberg School of Medicine researchers Rinad S. Beidas, PhD; Cynthia Barnard, PhD, MBA; Lisa R. Hirschhorn, MD, MPH; Miriam R. Rafferty, DPT, PhD; Kelli Scott, PhD; Sara J. Becker, PhD; and Patricia D. Franklin, MD, MBA, MPH — representing the Department of Medical Social Sciences (MSS) and the Center for Dissemination and Implementation Science (CDIS) — highlights the power of partnership between two disciplines that share a common goal: improving the quality, safety, and equity of healthcare. In “Partnership Makes Performance: Integration Approaches to Optimize Implementation Science and Quality Improvement Collaboration,” the authors call for uniting the complementary strengths of Quality Improvement (QI) and Implementation Science (IS) to accelerate progress toward more effective and sustainable health system change.

QI and IS each aim to improve healthcare delivery but take different approaches. QI focuses on solving immediate, local challenges such as reducing wait times or improving care coordination, while IS studies how to apply evidence-based practices across unique clinical and community settings. The authors assert that integrating these complementary perspectives can produce faster, more pragmatic, and more generalizable results—ultimately improving outcomes for patients and healthcare teams alike.

While QI is deeply embedded within health systems, IS may be less familiar to many clinicians and administrators. The authors recommend expanding IS education within medical training and embedding IS experts into healthcare teams to ensure research methods inform real-world problem solving. They also call for developing a shared vocabulary between the two fields to enhance collaboration.

The paper outlines a new framework for considering three models for integration:

QI/is – QI leads, using IS tools to strengthen rigor and strategy.
QI+IS – Both fields work in full partnership as equals.
IS/qi – IS leads, drawing on QI methods to enhance real-world feasibility and adoption.

The authors emphasize that uniting QI and IS can make healthcare improvement efforts more reliable, replicable, and equitable—advancing what is known as the “quintuple aim”: better health, better patient and clinician experiences, lower costs, and greater equity.

A Proactive Physical Therapy Program

Rafferty, Assistant Professor of Physical Medicine and Rehabilitation, leads implementation research at the Shirley Ryan Ability Lab and is faculty in MSS and CDIS. A key example featured in the paper is her team’s proactive physical therapy program for people with mild Parkinson’s disease. In the past, patients were referred to physical therapy only after balance problems or falls, which limited opportunities for improvement. Rafferty worked closely with Northwestern neurologists to understand why early referrals were rare and identified barriers from both the physician and patient perspectives. That blend of quality improvement and implementation science, beginning with a clinical problem and gathering perspectives, allowed her team to build a proactive physical therapy program that has now been sustained for ten years. She has since built a broader portfolio of implementation research based on this model and is expanding it across Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital and the University of Chicago through an R01 grant.

Patient-Centered Outcomes Research Institute (PCORI)

For Scott, Assistant Professor in MSS and CDIS and the Director of the Northwestern University Clinical and Translational Sciences (NUCATS) Dissemination and Implementation Science Consult Service, the growing partnership between implementation science and quality improvement at Northwestern Medicine represents a new frontier. With Franklin, Scott is co-leading efforts to bridge these disciplines through the Patient-Centered Outcomes Research Institute (PCORI) Health Systems Implementation Initiative (HSII), a national program that funds health systems to implement evidence-based practices. Northwestern Medicine was selected as one of the participating health systems, and the application was developed by a cross-institutional team. During the first year of the initiative, the team focused on building system wide capacity to integrate implementation science and quality improvement. This effort produced the Integrated QI IS Playbook, a practical step by step resource that combines Northwestern Medicine’s internal Lean Six Sigma QI training materials with implementation science frameworks. The playbook is currently being piloted in several projects.

One pilot effort, which Scott is leading with CDIS Assistant Professor Zabin Patel, PhD, MPH, is a partnership with Northwestern Medicine Kishwaukee Hospital in DeKalb. The goal is to reduce the number of patients who return to the hospital within 30 days for emergency or inpatient care. The Kishwaukee team is using Northwestern Medicine’s DMAIC model while also incorporating implementation science methods to understand context, select targeted strategies, and evaluate how well those strategies are carried out.

According to Teresa Pollack, MS, CPHQ, Quality Director at Northwestern Memorial Hospital, the HSII PCORI capacity building work allowed both groups to learn from one another, including how implementation strategies could be integrated into the QI framework in unexpected ways. “The implementation science framework was really rich in helping us understand how to adapt successes to other environments instead of duplicating or replicating,” said Pollack.

Kevin O’Leary, MD, Vice President for Quality at Northwestern Medicine and Chief of Hospital Medicine, notes, “Both approaches have served research and performance improvement really well on their own, but together they can serve us all even better.”

Across these efforts, MSS, CDIS, and Northwestern Medicine are advancing the use of implementation science to support system level priorities. Scott highlights that the work with HSII is laying the foundation for more sustainable, evidence-based change and providing tools that can support teams across the health system and eventually beyond. “The end result is strengthening and infusing improvement methodology in the health system and enculturating implementation science,” notes Pollack. Rinad Beidas, PhD, Chair of the department of Medical Social Sciences, said, “It is so exciting to see what is possible when our leading scientists partner with our world-class healthcare system to trailblaze new ways that connect research and practice to transform the quality of care. This partnership inspired our commentary, and we look forward to seeing what comes next.”