"Understanding the rising tide phenomenon is important for a more nuanced interpretation of null results arising in the context of system-wide improvement. Recognition that a rising tide may have predisposed to a null result in one health system cautions against generalising the result to another health system where strong secular trends are absent."
Secular trends and evaluation of complex interventions: the rising tide phenomenon
YF Chen, K Hemming, AJ Stevens, RJ Lilford
BMJ Quality and Safety 2016;25:303-310 doi:10.1136/bmjqs-2015-004372
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