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High Reliability and ‘Cargo Cult QI’: response to Sutcliffe et al. BMJ Qual Saf 2017;26:248–51
  1. Andrew Smaggus1,
  2. Mark Goldszmidt2
  1. 1Department of Medicine, Western University, Schulich School of Medicine and Dentistry, London, Canada
  2. 2Department of Medicine, Western University Schulich School of Medicine and Dentistry, London, Canada
  1. Correspondence to Dr Andrew Smaggus, Medicine, Western University, B9-100, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5; andrew.smaggus{at}

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In their article regarding high-reliability organisations, Sutcliffe et al1 argue that healthcare's failure to understand the fundamental concepts that underlie high reliability has limited their impact on patient safety and healthcare quality. In considering their claims, an important issue arises that extends beyond the pursuit of high reliability: the failure within healthcare to develop a nuanced understanding of the theoretical basis for improvement methodologies. More specifically, the pressure to pursue quality improvement (QI) initiatives may presently exceed our expertise for achieving them successfully. This is an issue that, if not addressed, may compromise future attempts to improve …

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  • Competing interests None declared.

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