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Research and reporting methodology
Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature
  1. Daisy Goodman1,
  2. Greg Ogrinc2,
  3. Louise Davies3,
  4. G Ross Baker4,
  5. Jane Barnsteiner5,
  6. Tina C Foster1,
  7. Kari Gali6,
  8. Joanne Hilden7,
  9. Leora Horwitz8,
  10. Heather C Kaplan9,
  11. Jerome Leis10,
  12. John C Matulis11,
  13. Susan Michie12,
  14. Rebecca Miltner13,
  15. Julia Neily14,
  16. William A Nelson15,
  17. Matthew Niedner16,
  18. Brant Oliver17,
  19. Lori Rutman18,
  20. Richard Thomson19,
  21. Johan Thor20
    1. 1Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
    2. 2Department of Education, Veterans Health Administration, White River Jct, Vermont, USA
    3. 3Department of Surgery, Veterans Health Administration, White River Jct, Vermont, USA
    4. 4Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    5. 5Department of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    6. 6Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
    7. 7Department of Pediatrics, Colorado Children's Hospital, Aurora, Colorado, USA
    8. 8Division of Healthcare Delivery Science, New York University, New York, USA
    9. 9Perinatal Institute and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    10. 10Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    11. 11Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
    12. 12Department of Clinical, Educational and Health Psychology, University College, London, UK
    13. 13Department of Nursing, University of Alabama, Birmingham, Alabama, USA
    14. 14National Center for Patient Safety, Veterans Health Administration, White River Junction, NH USA
    15. 15Department of Psychiatry and Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire, USA
    16. 16Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan, USA
    17. 17Department of Nursing, MGH Institute of Health Professions, Boston, Massachusetts, USA
    18. 18Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
    19. 19Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
    20. 20Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
    1. Correspondence to Dr Daisy Goodman, Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, 1 Hospital drive, Lebanon, New Hampshire 03766, USA; daisy.j.goodman{at}


    Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at

    • Health services research
    • Implementation science
    • Quality improvement
    • Quality improvement methodologies
    • Statistical process control

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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    • Correction notice This article has been updated since it published Online First. The names of two authors have been revised.

    • Twitter Follow Leora Horwitz at @leorahorwitzmd and Johan Thor at @johanthor1

    • Collaborators Frank Davidoff, MD Editor Emeritus, Annals of Internal Medicine, and Adjunct Professor at The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA,; Paul Batalden, MD Active Emeritus Professor, Pediatrics and Community and Family Medicine, Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice Hanover, New Hampshire, USA,; David Stevens, MD Adjunct Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA, Editor Emeritus, BMJ Quality and Safety, London, UK Senior Fellow, Institute for Healthcare Improvement, Cambridge, MA, USA, Dr. Davidoff contributed substantially to the editing of the paper but did not serve as an author. Drs. Davidoff, Stevens and Batalden all contributed substantially to the final version of the SQUIRE 2.0 Guidelines, which provides the framework for this manuscript, and offered comments and guidance during the writing process.

    • Contributors All listed authors contributed substantially to the writing of the manuscript. Each author was assigned a specific section, and was the primary author for that section, with one exception: TCF and JCM coauthored the section entitled ‘Summary.’ Each author also had an opportunity to review the final manuscript prior to its submission. The corresponding author and guarantor of this project, DG, was responsible for coordinating submissions and for the primary structuring and editing of this manuscript. GO and LD contributed substantially to both editing and to the conceptualization of the manuscript, and to the purpose and structure of included sections. LD also authored the section entitled ‘Study of the Intervention.’

    • Funding The revision of the SQUIRE guidelines was supported by funding from the Robert Wood Johnson Foundation and the Health Foundation. Robert Wood Johnson Foundation (grant number 70024) Health Foundation (grant number 7099).

    • Competing interests None declared.

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

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