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Who has not attended an organisational meeting focused on some quality problem and not groaned in response to a suggestion of the type ‘We should just …have a new policy’, ‘…send out performance reports’, ‘… create a checklist’, ‘go after the low-hanging fruit’, or any of a number of other commonly suggested strategies for dealing with quality-related problems. Whether the groan occurs audibly or just internally depends on one's self-control and role in the organisation. Following the groan, one may even launch into a short speech beginning with the phrase ‘The problem with… new policies [or checklists or whatever the case may be] is…’ Whether this monologue occurs internally or externally again depends on one's self-control and willingness to risk alienating others at the meeting.
With this editorial, we announce the launch of a new series of articles in BMJ Quality & Safety giving voice to these groans and monologues in response to frequently espoused but problematic improvement strategies, as well as problems that seem never to go away. Entitled ‘The problem with…’, each article will discuss controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement (‘problematic solutions’) and pervasive problems that seem to resist solution.
Table 1 lists some example topics and briefly outlines the motivations for including them. We have commissioned some articles already, but encourage uninvited submissions as well (ideally in discussion with one of the editors before embarking on writing the full article).
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What makes any improvement (or its targeted problem) ‘problematic’?
Something can be difficult without being ‘problematic’. When we know what work needs to be done to achieve a goal, we knuckle down and do the work. That is not problematic. If we do not have the time or resources to invest in this work, we walk …