Health Care Analysis

, Volume 26, Issue 2, pp 189–205 | Cite as

Valuing Healthcare Improvement: Implicit Norms, Explicit Normativity, and Human Agency

  • Stacy M. Carter
Original Article


I argue that greater attention to human agency and normativity in both researching and practicing service improvement may be one strategy for enhancing improvement science, illustrating with examples from cancer screening. Improvement science tends to deliberately avoid explicit normativity, for paradigmatically coherent reasons. But there are good reasons to consider including explicit normativity in thinking about improvement. Values and moral judgements are central to social life, so an adequate account of social life must include these elements. And improvement itself is unavoidably normative: it assumes that things could and should be better than they are. I seek to show that normativity will always be implicated in the creation of evidence, the design of programs, the practice of healthcare, and in citizens’ judgements about that care, and to make a case that engaging with this normativity is worthwhile.


Ethics Social values Implementation science Improvement science Knowledge translation Evidence based medicine Cancer screening Early detection of cancer Health policy Community participation 



This study was funded by Australian National Health and Medical Research Council (NHMRC) Grants 1023197 and 1104136.

Compliance with Ethical Standards

Conflict of interest

The author declares that she has no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Sydney Health EthicsThe University of SydneyCamperdownAustralia

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