Table 2 Study definitions

Capacity: refers to having the right number and level of people who are actively engaged and able to conduct improvement [22].

Capability: people having the confidence, knowledge and skills to lead the improvement [22].

Implementation: put in place interventions that can result in true improvements in quality [23].

Lean: A process-improvement methodology articulated as Lean Thinking principles which were developed in the context of elaborately transformed goods such as motor cars. Lean healthcare is the application of “lean” ideas in healthcare facilities to minimize waste in every process, procedure, and task through an ongoing system of improvement [12, 14].

Model for Improvement: The Model for Improvement is made up of a set of fundamental questions that drive all improvement and the Plan-Do-Study-Act (PDSA) Cycle. Combined, the three questions (What are we trying to accomplish?; How will we know that a change is an improvement?; What changes can we make that will result in improvement?) and the PDSA Cycle are the framework called the Model for Improvement [13].

Plan Do Study Act (PDSA): PDSA is a quality improvement method utilizing a framework for an efficient trial-and-learning methodology. The basic concept of which is that an improvement intervention follows four phases: 1. Planning what to do 2. Doing the improvement 3. Studying its impact 4. Acting on the results of that study to revise and improve on what was done. Multiple PDSA cycles are often needed to make successful changes [13].

Quality Improvement (QI): securing understanding of the complex healthcare environment; applying a systematic approach to problem solving; designing, testing, and implementing changes using real-time measurement for improvement; and making a difference to patients by improving safety, effectiveness, and experience of care [6].

Sustainability: Sustainability should be viewed as a characteristic of healthcare which must run through and moderates other domains. Healthcare should be considered not only in terms of what can be delivered to an individual today, but also to the population in general and the patients of the future [24].