Intended for healthcare professionals


Is quality of care improving in the UK?

BMJ 2011; 342 doi: (Published 03 February 2011) Cite this as: BMJ 2011;342:c6646
  1. Peter J Pronovost, professor1,
  2. Sean M Berenholtz, associate professor1,
  3. Laura L Morlock, professor and deputy chair2
  1. 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
  2. 2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
  1. ppronovo{at}

Yes, but we do not know why

The need to improve the quality of care is well recognised. Yet accomplishing this is complicated, messy, and uncertain, requiring that researchers tackle technical (science) and adaptive (emotional, social, cultural, and political) challenges.1 Tension exists between those who say “just do something” to improve quality and those who say “science should be the guide.”2

The two linked studies (doi:10.1136/bmj.d195; doi:10.1136/bmj.d199) suggest that more science is needed. Benning and colleagues evaluated a large patient safety programme (the Safer Patients Initiative; SPI) in the United Kingdom, led by the Institute for Healthcare Improvement.3 4 The Health Foundation initiated and supported the initiative and, laudably, an independent evaluation, grounded in theory and conducted by experts in epidemiology, biostatistics, medical sociology, health services research, and clinical medicine. They performed a quantitative and qualitative evaluation at organisational and patient levels. The evaluation included five substudies that looked at whether the interventions worked and why. In addition to using a rigorous research design, the authors conducted a state of the art analysis, which included using different approaches to evaluate changes over time in treatment and comparison hospitals. This evaluation will serve as a model for the field. It required, however, an interdisciplinary team of experts and appropriate research funding, both of which are rare …

View Full Text

Log in

Log in through your institution


* For online subscription