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A search was performed in the electronic databases Medline, CINAHL and Embase (see [36] for the search strategy). The search was conducted in December 2015. The search aimed to identify all peer-reviewed original research articles reporting from PDSA projects that applied the PDSA method (see Fig. 1) and included the following search terms: (1) a PDSA cycle of a quality improvement initiative, (2) a PDSA cycle or PDSA, (3) the PDSA method, (4) a quality improvement project, (5) the quality improvement method, (6) quality improvement, (7) QI, (8) quality improvement research, (9) the quality improvement method, (10) the quality improvement, (11) the intervention, (12) the improvement, (13) the improvement method, and (14) the improvement method. The reference lists of all identified articles were screened for additional articles. Additionally, the authors' reference lists and personal files were screened for additional articles.

Although it is challenging to define what rigor in QI is [6], there are attempts to define and operationalize ‘rigor’ in the scientific community [8, 34]. This notion is often related to reproducibility and systematic review, where rigor is considered as the ability to replicate an effect and to detect and explain the reasons for the effect [32]. Even though this definition is valuable, it is not sufficient in the context of QI. In the field of IS, definitions are limited to the ‘credibility’ of an improvement project [4, 8, 34]. The scientific community has recently shifted from solely increasing the methodological complexity of QI research to also building and establishing a strong theoretical foundation [5, 32, 33]. We argue that it is important to combine methodological rigor with scientific rigor in order to ensure the credibility of the method. The scientific rigor is illustrated by the need to report the quality of the data and the design of the study with a transparent and reproducible manner [33]. It is crucial that the evidence generated is of high quality, which is why we emphasize the need for methodological rigor.

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