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Ethics, oversight and quality improvement initiatives
Holly A Taylor1, Peter J Pronovost, Jeremy Sugarman
1Department of Health Policy and Management, Bloomberg School of Public Health and Berman Institute of Bioethics, Johns Hopkins University, Hampton House 353, 624 N, Broadway, Baltimore, MD 21205, USA. htaylor@jhsph.edu
Quality & Safety in Health Care
|June 1, 2010
Summary
Quality improvement (QI) initiatives often receive some oversight, with practitioners endorsing relevant ethical considerations. However, reviews lack independence and ethics expertise, highlighting a need for improved frameworks.
Area of Science:
- Healthcare Ethics
- Quality Improvement Science
- Health Services Research
Background:
- Limited systematic data exists on institutional mechanisms for reviewing quality improvement (QI) initiatives.
- Ethical review and oversight of QI remain areas of significant public and scholarly interest.
- Understanding current practices in QI ethical review is crucial for policy development.
Purpose of the Study:
- To investigate the current institutional mechanisms for ethical review of QI initiatives.
- To identify the ethical considerations guiding QI practices.
- To assess the independence and expertise of ethical review processes for QI.
Main Methods:
- A web-based survey was administered to quality improvement practitioners (QIPs) from the Institute for Healthcare Improvement (IHI) '100 000 lives' campaign.
- Data from 132 QIPs (26% response rate) were analyzed using standard statistical methods.
Main Results:
- Most surveyed QIPs reported that their organizations subject QI initiatives to review before implementation.
- Respondents strongly agreed on the importance of patient minimal risk, privacy, and confidentiality in QI.
- A majority also recognized the relevance of scientifically sound design, transparency, and conflict of interest management in QI.
Conclusions:
- While many QI efforts undergo some form of oversight, reviews are often not independent or conducted by ethics experts.
- Practitioners endorse a range of appropriate ethical considerations for QI.
- Findings suggest a need for developing policy and conceptual frameworks informed by practical QI realities.
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