The design of evaluations for continuous quality improvement.

Many health care organizations are modeling continuous quality improvement activities after designs used in business and industry. This has resulted in a somewhat standardized and possibly limited approach to conducting quality improvement activities. In contrast, the evaluation paradigm provides a broader approach because the design of an evaluation may be based on the questions to be examined, or the design may emerge during the process of conducting the evaluation. This article examines the design of evaluations used for continuous quality improvement activities in health care and human service organizations. Through a case example, the benefits of using alternative evaluation designs are explored. In particular, use of alternative approaches to gather and evaluate information about restrictive treatment interventions in a mental health setting are presented.