HEALTHCARE QUALITY PAGE

In the last five years, at least ten journal publications have revisited questions about quality improvement projects (QIPs), their relationship to research, and ethical issues they raise. The main point of confusion appears to be about the differing purposes of research and quality improvement. Research is intended to attempt to derive generalizable or transferable new knowledge. In contrast, a QIP is intended to bring about positive, immediate changes in the delivery of health care. The difficulty is that some QIPs produce knowledge that may be transferable or generalizable to other similar healthcare services or organizations and staff involved in QIPs are encouraged to share and publish information about their projects.

 

The Plan–Do–Study–Act (PDSA) model, widely promoted as a method for carrying out a QIP, can add to the confusion. The model is often described as a scientific approach to achieving improvement. The language used in the model borrows heavily from traditional research terms. In the Plan phase,

hypotheses are developed about changes that may lead to improvement. The Do phase is a trial testing the hypotheses. The Study phase involves analysing and interpreting data from the trial. The Act phase is about drawing conclusions about whether the hypotheses led to improvement.

 

There are three types of QIPs. Many QIPs are routine attempts to implement best clinical practice and can be confused with implementation research. More complex QIPs may involve changing systems that support the care delivery, where the effects of the intervention may not be fully predictable at the start. A further type of QIP involves testing alternative systems or methods for organizing or delivering care. Some of these QIPs clearly raise ethical issues, so appropriate ethical oversight should be in place.