Abstract

Although quality improvement (QI) is frequently advocated as a way of addressing quality and safety in healthcare, evidence of its effectiveness has remained very mixed. This lecture will help to explain why. It will show that QI has evolved through a separate genealogy from clinical science, and consequently suffers problems of credibility in some of the target audiences. There is insufficient attention to rigorous evaluation of improvement and to sharing the lessons of successes and failures. Too many QI interventions are under-specified, and treated as ‘magic bullets’ that will produce improvement in any situation, regardless of context. Fidelity in the application of QI methods is often mixed. QI work is often pursued through time-limited, small-scale projects, led by professionals who may lack the expertise, power or resources to instigate the changes required. Too much improvement work is undertaken in isolation at a local level, failing to pool resources and develop collective solutions, and introducing new hazards in the process. The lecture concludes by offering suggestions on how to improve improvement.

 

Biography

 

A fellow of both the Academy of Social Sciences and the Academy of Medical Sciences, Mary Dixon-Woods leads a programme of research focused on patient safety and healthcare improvement, healthcare ethics, and methodological innovation in studying healthcare.

She is Deputy Editor-in-Chief of BMJ Quality and Safety. She holds honorary positions as an adjunct professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University and a visiting adjunct professor at Dartmouth College. She was, in 2012, one of the first recipients of a Wellcome Trust Senior Investigator Award. She served on the National Advisory Group on the Safety of Patients in England, which produced the Berwick report in 2013.

Mary is a member of the advisory board for the 2016 review of information technology in the NHS led by Professor Bob Wachter.