On the trail of quality and safety in health care

BMJ 2008; 336 doi: (Published 10 January 2008) Cite this as: BMJ 2008;336:74
  1. Richard Grol, director1,
  2. Donald M Berwick, president 2,
  3. Michel Wensing, senior researcher1
  1. 1Centre for Quality of Care Research (WOK), PO Box 9101, 114, 6500 HB Nijmegen, Netherlands
  2. 2Institute for Healthcare Improvement, Cambridge, MA 02138, USA
  1. Correspondence to: R Grol r.grol{at}
  • Accepted 11 November 2007

Initiatives to improve patient care have had only limited success. Richard Grol, Donald Berwick, and Michel Wensing call for steps to encourage a new generation of researchers to investigate how to speed up progress

Despite many years of effort and numerous programmes to improve the quality and safety of health care, major problems persist.1234567 Various reasons for the slow pace of improvement have been identified, such as resistance to change among health professionals, organisational structures that block improvement of care, and dysfunctional financial incentives.7891011 Many different approaches have been tried to speed up improvement, such as medical audit, evidence based guidelines, accreditation, disease management, public reporting of performance indicators, financial incentives, revalidation of professionals, and breakthrough collaboratives. Research on the effect of these approaches is scarce, but the evidence shows that even well developed improvement programmes are often only partially effective.8910 Despite substantial scientific development of this field, research on quality and safety in health care is not yet fully developed.11 We examine the reasons for the poverty of research in this field, and present the key challenges.

Research agenda

To help choose the best approach for improving care we need well designed studies on quality and safety of care using a variety of research methods. Decision makers at all levels of health care need information from such research. Programmes aimed at monitoring and improving health care are often expensive, and it is important to know if they will yield value for money.12 13 Several authors have outlined the research agenda for such research and have described the methods to be used.6 7 1415161718 The research should focus on understanding why the provision and outcomes of care vary …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to to receive unlimited access to all content on for 14 days.
Sign up for a free trial