Strengthening the contribution of quality improvement research to evidence based health care
- Correspondence to: G Ross Baker PhD Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada M5T 3M6;
Better reporting of quality improvement efforts could assist in the design of effectiveness research
The suggestions by Davidoff and Batalden1 for strengthening reports on quality improvement offer useful guidance for those wishing to publish such work. Their rationale for providing this guidance stems from their perception that the failure to provide better information about local improvement efforts slows the spread of successful changes, limits the scrutiny of quality improvement work, and reduces the incentives to participate in such efforts. They are not the first to lament the variable quality of such reports on improvement. Yet Davidoff and Batalden focus primarily on the impact of enhancements in the reporting of quality improvement efforts on quality improvement practice. These efforts will also have an important impact on quality improvement research. And the benefits between research and practice are likely to be synergistic.
GOALS OF QUALITY IMPROVEMENT RESEARCH
More thorough reporting of quality improvement is a first step toward greater academic respectability for these efforts. But a fuller dialogue about these methods and their epistemology is also critical. The goals of quality improvement practice are to enhance performance by setting aims, examining processes of care, testing changes in these processes, and implementing those changes that improve results.2,3 Nolan has characterized quality improvement as “pragmatic science”, referring to its emphasis on using knowledge about how care is delivered to identify improvements and build better systems though the accretion of small changes.4 While the selected changes derive from relevant research as well as the knowledge that clinicians gain in treating their patients, there is a level of discomfort created among those who view this approach from the standards of evidence based health care.5,6 However, valuing local knowledge does not negate the importance of research because quality improvement goals differ. Quality improvement efforts use evidence …