TY - JOUR T1 - Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff? JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 857 LP - 859 DO - 10.1136/bmjqs-2022-015272 VL - 31 IS - 12 AU - Rebecca Lawton AU - Eric J Thomas Y1 - 2022/12/01 UR - http://qualitysafety.bmj.com/content/31/12/857.abstract N2 - In this month’s edition, Mandel and Cady draw on organisational change theories to argue that quality improvement (QI), as currently deployed, is self-limiting.1 In other words, if left untamed it will fail to produce valuable change and may have a raft of negative consequences, including stress, reduced engagement and burnout among healthcare staff. While acknowledging that some improvement methods (eg, appreciative inquiry, positive deviance) do address the emotional experience of staff as well as their performance, and focus on socio-behavioural (teamwork, cultures, etc) as well as process-technical design elements, Mandel and Cady call for these to be explicit elements of all healthcare QI initiatives.We argue here that this article represents a theoretical framing for messages that ring loud throughout the QI and safety literature. These linked messages are (1) additive change means asking staff to do more and more, potentially creating safety clutter, and (2) improvement initiatives can have negative as well as positive consequences, including for staff. Unless we address 1 and 2, QI might inadvertently increase staff burnout. In turn, healthcare staff burnout, already rife, has the potential to exacerbate a global shortage of nurses, doctors and other staff and impact directly on the quality and safety of care.2 We set out some recommendations for reducing the potential harm caused by unchecked and uncritical approaches to QI.Questioning the power of QI to improve healthcare is certainly nothing new. Problems with fidelity to method,3 a lack of expertise or time among those tasked with conducting QI, little attention to sharing learning about success and failure and QI interventions that do not account for context4 5 have all been documented. In 2019, Dixon-Woods coined the term ‘lovely-baby syndrome’ to highlight the strong belief in, but lack of robust evidence for, many improvement approaches and … ER -