Barbora Krausova, research worker, at King’s Improvement Science (KIS) tells us about the development of the King’s Improvement Science glossary, a collection of terms and definitions from the fields of quality improvement, improvement science and implementation science.
When I joined the King’s Improvement Science (KIS) team in January 2017 I was new to the field of improvement and implementation science and was positively puzzled by all the jargon and terminology. To give you an example, in one of the first meetings I attended, one of our external partners was talking about using “Kanban” and the fact he was a “black belt” and some other people he worked with were “green belt”. I figured he was probably not talking about Karate, but I honestly had no idea what he meant, and I felt too embarrassed to ask.
For those of you who also don’t know: Kanban is a Japanese term for a visual tool, often a card attached to supplies or equipment that signals when more supplies are needed. It comes from the Lean management philosophy, which is an increasingly popular improvement approach in the healthcare sector. Oh, and the belts he was talking about are a certification system in Six Sigma (another management philosophy) that reflect the level of experience and expertise in that field.
Why was the glossary developed?
I’m sure many of you can relate to this story and have attended a meeting or a presentation where you didn’t understand a term (or two or three) but felt too apprehensive or uncomfortable to ask what it meant. It’s not always easy or possible to ask for an explanation or translation. That’s why I started writing down terms that were new to me, that I needed to look up following a meeting or a presentation. I also noted terms I wasn’t familiar with from the literature I was reading as part of my induction and learning in the early days. Not long after this, I had a discussion with colleagues about sharing this learning and acquired terminology with others, and the idea of a glossary was born.
I started adding in terms more systematically. For instance, I tried to think of all the common terms used in quality improvement (based on my own learning as well as the literature) and then I asked other colleagues in the team with specialist knowledge and experience in the area to check that the terms I was including were relevant. They also added other terms.
My colleagues Dr Lucy Goulding and Dr Louise Hull were particularly instrumental in shaping, refining and reviewing the glossary. We held a series of meetings in 2017 and 2018 to review the terms and definitions, to make sure they were not only correct, but also relevant and explained as succinctly as possible. The glossary went through several iterations before we arrived at the current version. The final (very enjoyable) step was having the glossary professionally designed to fit in with a wider suite of resources for improvement and implementation the KIS team has developed.
More about the KIS glossary
The glossary is very much based on our work in KIS and the terminology we have come across in a variety of settings and situations. We can’t (and don’t) claim it to be an exhaustive list, not least because these fields are constantly evolving and expanding, and the list of terminology grows and changes as a result.
The reason we put the glossary together is to help untangle the complex and confusing terminology of healthcare improvement and implementation. This wasn’t the easiest of tasks as formal or universally accepted definitions are often lacking, and the field overlaps with and borrows terminology from other fields. There are also international differences, where some terms might have one meaning in one country (eg USA) and another meaning (or none) in another (eg UK).
There are currently around 200 terms in the glossary, including some terminology from evaluation, research, health economics and patient and public involvement (PPI). In our experience, healthcare improvement and implementation work often includes various elements of these ‘other’ areas, hence their inclusion in the glossary. For instance, we believe it is integral to involve patients and service users in quality improvement projects and so it made sense to us to cover some PPI terms in the glossary. Another example is that improvement and implementation initiatives often include a health economics assessment, which is why we included some common health economics terms.
We believe there isn’t another glossary quite like ours out there. There are numerous glossaries that specifically target quality improvement terminology and a fair number of implementation science glossaries too, but none – as far as we are aware – that combine these fields in one place. Another unique feature is that every term is linked to an online resource, for example, an academic paper, a blog or a website, where readers can find the reference easily and learn more about the topic.
The glossary is written with a broad audience in mind. We hope it will be useful to anyone working or interested in healthcare improvement and implementation – researchers, health professionals, managers, policymakers, students, patients and service users. It was our ambition to make the glossary as accessible as possible by avoiding jargon within our definitions and using examples to explain some of the terms.
Using plain English
Through my work on the glossary, I’ve been reminded of the value of using plain English where possible. It’s so easy for all of us to forget that the jargon and words that are part of our everyday work might be unfamiliar or confusing to others. One of the aims of improvement and implementation science is to identify and help overcome barriers to effective implementation of new approaches to treatment, care or service delivery. It is ironic that improvement and implementation scientists are actively building one such a barrier themselves – the language we use!
One result of working at King’s Improvement Science for two years is that I am now accustomed to using improvement and implementation jargon myself. However, I try to remember that the people I may be speaking with or writing to may not be so familiar with it. I’d urge all of us to consider our audience carefully and adjust our language accordingly. Even better, wouldn’t it be wonderful if we could all simply avoid using overly technical language? Of course, specialist terms are sometimes unavoidable, and people are unlikely to stop inventing or re-inventing terminology in their specialist fields. But don’t panic – if you find yourself in doubt, keep calm and look it up in the new KIS glossary.
The glossary can be viewed and downloaded for free at www.kingsimprovementscience.org/KIS-glossary. Let us know what you think.
When you have done that, why not test your knowledge with our KIS glossary quiz?
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