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The epistemology of quality improvement: it's all Greek
  1. Rocco J Perla1,2,
  2. Gareth J Parry3,4
  1. 1Center for Innovation and Transformational Change, UMass Memorial Health Care, Worcester, Massachusetts, USA
  2. 2UMass Medical School, Worcester, Massachusetts, USA
  3. 3Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  4. 4Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Gareth J Parry, Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138, USA; gparry{at}


In Plato's Theaetetus, knowledge is defined as the intersection of truth and belief, where knowledge cannot be claimed if something is true but not believed or believed but not true. Using an example from neonatal intensive care, this paper adapts Plato's definition of the concept ‘knowledge’ and applies it to the field of quality improvement in order to explore and understand where current tensions may lie for both practitioners and decision makers. To increase the uptake of effective interventions, not only does there need to be scientific evidence, there also needs to be an understanding of how people's beliefs are changed in order to increase adoption more rapidly. Understanding how best to maximise the overlap between actual and best practice is where quality improvement needs to employ educational and social sciences' methodologies and techniques.

  • Decision analysis
  • evidence-based medicine
  • health care quality
  • research

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Funding Health Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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