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Published on: February 16, 2011
No respect: research in quality, safety, and process improvement
Ilan S Rubinfeld1, H Mathilda Horst
1Ilan S Rubinfeld, MD, MBA, is an Attending Physician in Trauma and Critical Care and Acute Care Surgery at Henry Ford Hospital in Detroit, MI. He is also Assistant Professor of Surgery, Wayne State University School of Medicine; Associate Program Director, General Surgery Residency, Henry Ford Hospital; and Associate Medical Director, Surgical Intensive Care, Henry Ford Hospital.
The Permanente Journal
|August 27, 2010
Summary
Healthcare quality improvement research is crucial but faces institutional barriers. Applying pure science standards to practical clinical settings can hinder essential, on-the-ground improvement efforts.
Area of Science:
- Healthcare research
- Clinical practice
- Quality improvement
Background:
- High-quality research in healthcare is essential for patient safety and effective treatment.
- Despite the recognized need, institutional bias and inertia often impede quality improvement initiatives.
- The healthcare culture exhibits a complex, ambivalent attitude towards quality improvement (QI) work.
Purpose of the Study:
- To examine the challenges and implications of applying rigorous scientific standards to practical, frontline clinical improvement efforts.
- To explore the conflict between the demand for high-quality research and the realities of implementing QI in healthcare settings.
Main Methods:
- Commentary based on expert analysis and reflection.
- Exploration of the "sharp end" of clinical practice where QI occurs.
- Discussion of the application of "pure science" standards in applied healthcare settings.
Main Results:
- Institutional bias and inertia create significant obstacles for quality improvement research and implementation.
- The strict application of pure science standards may not always be appropriate or feasible for frontline clinical improvement work.
- A "love-hate" relationship exists within healthcare regarding quality improvement efforts.
Conclusions:
- There is a critical need to reconcile the demands for rigorous research with the practicalities of clinical quality improvement.
- Addressing institutional barriers is vital to foster and support essential frontline improvement work.
- Rethinking the application of scientific standards in clinical practice is necessary to facilitate effective quality improvement.
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