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It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England.\nFINDINGS: Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches.\nORIGINALITY/VALUE: The paper provides an important contribution in furthering our understanding of framing the \"social act\" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.", "publicationTitle": "Journal of health organization and management", "publisher": "", "place": "", "date": "2013", "volume": "27", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "209-224", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Health Organ Manag", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1477-7266", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 23802399", "tags": [ { "tag": "England", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Leadership", "type": 1 }, { "tag": "Organizational Case Studies", "type": 1 }, { "tag": "Organizational Innovation", "type": 1 }, { "tag": "Quality Assurance, Health Care", "type": 1 }, { "tag": "State Medicine", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-08-01T18:18:39Z", "dateModified": "2013-08-01T18:18:39Z" } } ]