Beyond Process TO Patient Outcomes: A Comprehensive Scoping Review Exploring THE Evolution, Operationalization, Implementation Challenges, Enabling Factors, AND Demonstrable Impact OF Continuous Quality Improvement IN Complex Healthcare Environments

Abstract

Continuous Quality Improvement (CQI) has emerged as a cornerstone methodology for enhancing healthcare delivery systems globally. Despite its widespread adoption, significant variations exist in how CQI is conceptualized, implemented, and evaluated across healthcare settings. This scoping review synthesizes the existing literature on CQI in healthcare to map its evolution, explore its operationalization frameworks, identify implementation challenges and enablers, and assess its demonstrable impact on patient outcomes and system performance. Using the Arksey and O'Malley framework, supplemented by recent PRISMA-ScR guidelines, this review examines the multifaceted nature of CQI implementation in complex healthcare environments and highlights critical gaps in current understanding. Findings reveal a progressive shift from process-focused metrics toward patient-centered outcome measures, though significant barriers to effective implementation persist. The review identifies key enabling factors that facilitate successful CQI integration and documents evidence of positive impacts on clinical, operational, and experiential dimensions of care. These insights provide a comprehensive foundation for healthcare leaders, practitioners, and policymakers to advance CQI initiatives that genuinely transform healthcare delivery and improve patient outcomes.