Incident reporting in primary care: epidemiology or culture change?

As in most other areas of human experience, fashions in healthcare and in healthcare research come and go. They come about because a good idea is articulated, often as a sound bite that makes intrinsic sense, and they go because a few intrepid researchers are prepared to investigate the substance behind the sound bite and they come to realise that the logic is not supported by the reality. The original logic is supplanted.

Over the last 20–30 years, there have been some notable fashions in healthcare that have lit up the globe like a comet and then died. Just as there have been passing fashions in surgery (eg, routine tonsillectomies) and medications (eg, hormone replacement therapy), so also have there been passing fashions in quality improvement (QI) and QI research. Kieran Walshe in his bibliometric research tracked the frequency paths of different QI terms used between 1988 and 2007.1 ‘Patient safety’ was a relatively low frequency term (along with ‘clinical governance’ and ‘six sigma’) from 1988 to 1999, when suddenly it took off following the release of the Institute of Medicine's ‘To Err is Human’2 report, surpassing almost all the other QI terms, along with ‘six sigma’.

The rise in evidence-based medicine, arguably itself a fashion, is largely responsible for deposing fashionable good ideas. Evidence-based medicine, although not immune to criticism,3 is different from other fashions in that it has infiltrated every part of every health system—the idea, at least, if not always the practice—and it has not gone away. It is a concept that has captured health systems globally and become embedded as a value, an aspiration and an expectation of healthcare, even more now than it was when the idea first lit up the world more than 40 years ago. Epidemiological research that measures, compares, tests and …