ABSTRACT
The study of an improvement initiative goes well beyond the description of its implementation. It includes the description of the rationale for undertaking the initiative, the strength of evidence that supports the conclusion that an improvement actually occurred, and a so called ex post assessment of why a particular initiative was (or was not) successfully implemented. The Cystic Fibrosis Care Network provides a case study for reporting rationale. Reporting strength of evidence goes beyond description of the change and explores the measurement that underlies and validates the improvement. Reporting ex post theory analysis is a complicated element that can take advantage of the author's own careful ethnographic observations as the initiative unfolds. Not as simple as it sounds. Two case studies by Dixon-Woods serve to define ex post theory development as applied to the Michigan Keystone Project and the UK Matching Michigan reports for reducing central venous line infections in ICUs. The author's thoughtful reflection on the initiative's implementation and outcomes can lead the reader to important clues to levers as well as hazards for implementing improvement in the reader's setting.
