Introduction Research in healthcare has long been very well regulated, but this is rarely the case for improvement activities. Improvement activities are activities which use data to assess the current situation to identify areas for improvement. Solutions are then developed and implemented, and later evaluated to measure their success and sustainability. There has been much discussion in the literature as to whether, like research activities, improvement activities should undergo independent ethical review. In fact, most healthcare organisations in Australia struggle with how best to manage improvement activities, despite the 2003 publication of the National Health and Medical Research Council guidelines on this subject.

Discussion At The Children's Hospital at Westmead, the authors take the view supported by others that ethical review is necessary and so have developed a process which utilises the unique skills available in the Clinical Governance Unit to ensure improvement activities are reviewed for ethical considerations in an effective and efficient manner and implemented a database to approve, monitor and report on improvement activities. This has resulted in staff being increasingly satisfied with the turnaround time for approval of improvement activities they are undertaking as well as for the methodological support provided. The authors have experienced a dramatic increase in the number of improvement activities being recorded and ethically reviewed.