Intended for healthcare professionals

Letters Improving quality improvement

Quality improvement is complex and contextual

BMJ 2019; 367 doi: (Published 25 October 2019) Cite this as: BMJ 2019;367:l6155
  1. Oliver Groene, honorary senior lecturer1,
  2. Rosa Sunol, president2
  1. 1London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  2. 2Avedis Donabedian Research Institute, 08006 Barcelona, Spain
  1. oliver.groene{at}

Dixon-Woods discusses the current limitations of quality improvement in healthcare and how to deal with them. We would like to add four points.1

First, Dixon-Woods is right that the effectiveness of quality improvement has been subject to evaluation only recently and that many quality improvement studies have methodological flaws.234 A lot of these flaws relate to the complexity of …

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