eLetters

110 e-Letters

published between 2014 and 2017

  • Re: Important practical limitations for decision support
    Alan H Morris

    Dear Editor

    Dr Shojania raises important issues that must be solved before widespread implementation of many decision-support tools is possible. I appreciate his letter. Dr Shojania and I, however, have been addressing different kinds of decision-support. The tools my colleagues and I have implemented, both locally and at external sites, are explicit tools that generate specific instructions, in contrast to...

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  • GRiP and the decline in surgery for glue ear
    Ruairidh Milne

    Dear Editor

    Black and Hutchings present an intriguing account of the rise and fall of glue ear surgery in two English regions.[1] They speculate that the acceleration of the decline from 1992 may have been due to the Effective Health Care bulletin on glue ear, helped by five "contextual features". One of these was the concurrent structural change to the NHS, arising from the introduction of health care commis...

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  • Incident Reporting - Let's Decentralise
    Merilyn A. Rees

    The Editor, BMJ Quality and Safety,

    Mitchell, Schuster, Smith et al (1) present the results of semi-structured interviews with 11 international patient safety experts, 15 years after publication of the US Institute of Medicine's landmark report 'To Err Is Human'.(2) One of the Institute's recommendations was the introduction of healthcare incident reporting.

    Qualitative analysis of the interviews by Mitchel...

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  • Response to Milne and Hill
    Nick A Black

    Dear Editor

    Milne and Hill raise an interesting hypothesis - that the decline in surgical rates may have been due to a programme of Getting Research Into Practice. We intend to test this hypothesis by comparing our data with that for the whole of England and, within the area of our study, to compare the two Berkshire districts with districts in the former East Anglian region. We will report the results on this site...

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  • Making sense of the story - the true value of incident reporting
    Tara J Lamont

    I was interested to read the thoughtful article by Imogen Mitchell and colleagues, echoing longstanding criticisms by Kaveh Shojania, Charles Vincent and others on the low value of high volume incident reporting. There is little learning from categorical data, repeated many times, around falls or minor medication errors. However, there was a time at the National Patient Safety Agency, where we experimented with a multi...

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  • Quality improvement programmes: time for a rethink?
    Kath H Checkland

    Dear Editor

    I read the paper by Ovretveit and Gustafsen with interest, as I believe that this is a neglected area. I found their paper admirably clear and concise, and I would agree with many of their points. However, I feel that they have neglected one important area.

    In their discussion of the ways in which this kind of research could be improved, they discuss the need for empirically based explanatory theo...

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  • The Quadruple Aim: Care of the Patient Requires Care of the Providers
    Christine Sinsky

    The paper by Sikka, Morath and Leape is spot on (1). The authors call for adding a fourth aim to the Triple Aim: improving the experience of those providing care--physicians, nurses and others. This builds on our previous work "From Triple to Quadruple Aim: Care of the Patient Requires Care of the Providers" in which we make a similar recommendation (2).

    We also agree with the importance of creating conditions w...

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  • Guidelines can be derived from research into quality programmes
    John A Ovretveit

    Dear Editor

    I would like to thank Dr Checkland for her thoughtful comments on our paper about evaluating quality programmes. I have some sympathy with her views and for the intriguing proposal about research in this area which she makes. I would agree that insufficient attention has been given to how features of organisations described in organisational theory influences how quality programmes are carried throu...

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  • GRiP: did it have an effect?
    Nick A Black

    Dear Editor

    Milne and Hill suggest the 'Getting Research into Practice' programme may have contributed to the decline in surgery for glue ear that we have reported. We cannot, however provide any evidence to support this suggestion. The rate of decline in surgery throughout England was similar to that observed in 13 former health districts in the Oxford/Anglia region. The ratio of change in rates after 1992 over the...

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  • Fundamental change in our approach to EHR design is needed
    Bruce L. Wilder
    The article by Koppel, The health information technology safety framework: building great structures on vast voids, 11/19/15, seen at http://m.qualitysafety.bmj.com/content/early/2015/11/19/bmjqs-2015-004746.full.pdf, describes an EHR environment that violates just about every principle of safe system design. It is no wonder that there continue to be significant safety issues with EHRs. "Most experts would agree that cornersto...
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