Putting improvement at the heart of health care
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7366.670 (Published 28 September 2002) Cite this as: BMJ 2002;325:670
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Wilcox and Lewis seem intent on creating a vast training and guidance
industry to help doctors to overcome their resistance to continuous
quality improvement (CGI). How many millions are currently being put into
training of managers and clinical staff to enable them to embrace the
creed of CGI?
Let us entertain for a moment, the perhaps, outlandish notion that
doctors may have more pressing reasons for their so-called resistance to
CGI, than the absence of investment into CGI training and guidance.
What about starting to fund clinical governance, which to-date, the
DoH has not identified one penny of additional funding to implement. Why
don't we spend some money on employing more clinical staff so that there
are sufficient numbers for them to have dedicated time (real not notional)
to do clinical governance. And lets spend some money improving the
staffing and skills levels of clinical governance support staff who work
directly with the clinical staff. And finally, lets spend money on
clinically relevant information systems instead of trying to make do with
systems still largely tailored to a financial management agenda.
Lets not put more demands on a medical education system that is
already busting at the seams. Instead lets start asking questions about
where all the additional NHS funding is going and where it could best be
used. Do we really need a vast Modernisation agency paying above the going
rate for project managers who might be otherwise employed in the NHS to
support the delivery of service improvements.
Competing interests: No competing interests
approaches to improvement
Editor,
Lewis goes too far in his recommendations on adopting quality
iprovement approaches into medical education. Medical schools should by
all means adopt the principles of quality improvement (which are
essentially those of inductive learning)and certainly put them into
practice in teaching and learning but please no 'academic departments of
health care improvement'. That could be one way to undermine progress.
We are on a long learning curve in health care - improvement is a co-
operative effort in which anyone who has the desire should take part.
Building new annexes in ivory towers whilst undoubtedly well intentioned
seems a distraction.
Competing interests: No competing interests