Editor's Choice

Improving on improvement

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7549.0-f (Published 04 May 2006) Cite this as: BMJ 2006;332:0-f
  1. Fiona Godlee (fgodlee{at}bmj.com), editor

    Last week, members of a small but increasingly confident tribe of healthcare enthusiasts gathered in Prague for their annual meeting, the Forum on Quality Improvement in Health Care. Run jointly by the BMJ Publishing Group and the Institute for Healthcare Improvement (www.ihi.org/ihi), the forum is in its 11th year and, according to the feedback we've received, its best year yet.

    Discussions in the sessions and over lunch—and through the evening in Prague's many bars—were wide ranging: what has happened to clinical leadership, what can happen when you learn to think like a designer, the importance of directly observing what goes on in hospitals and primary care, how to achieve sustainable change within a complex adaptive system, and whether quality improvement should be seen as research. There was also some eye opening gossip on who's on the way up and who's on the way out, or should be.

    Participants talked alot about the problem of getting their work published. Journals treat quality improvement as research and wonder why there's no ethics committee approval. But often the work began simply as an effort to improve health care locally; the fact that it came up with a generalisable message that might merit publication is a bonus. And many, perhaps most, ethics committees are still unclear what to do with quality improvement proposals (“unclear” is a euphemism for “ill informed” and “in disarray”—the words I scribbled down at the time).

    Over lunch I talked to Frank Davidoff, former editor of Annals of Internal Medicine and now working with IHI, about why so little of this work gets published. The Quality Improvement Report format, pioneered by Quality and Safety in Health Care and adopted by the BMJ, has helped, but there are still significant barriers. Last year in an effort to tackle the problem, he and Paul Batalden developed draft publication guidelines (Quality and Safety in Health Care 2005;14: 319-25). But they don't think quality improvement should be seen as research or subjected to the bureaucracy of review by ethics committees or institutional review boards. From conversations I heard in Prague, this is still a live debate and one on which we would welcome your views.

    The meeting was judged a success by the 1000 delegates who attended, including me and our two bloggers, Jane Smith and Jenny Kowalczuk whose accounts you can read on bmj.com. But the real test will be how much of the enthusiasm filters through to normal practice. The improvement scientists will have to work hard to dispel the notion that improving health care locally means you have to join a club and get a badge—conferring special skills, privileged knowledge, and expert blessing. That'll be a challenge for next year's forum: Barcelona, 18-20 April 2007. Book your place now.


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