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Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Of these 34 were excluded and 68 included.
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One hundred and two (102) articles were selected for full text screening.
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We synthesized the different QI benefits discussed. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost–benefit, cost-effectiveness, value) combined with healthcare and QI. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. We called the framework the QI-ROI conceptual framework. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes.