Ethical considerations in quality improvement: key questions and a practical guide

doi:10.1136/bmjoq-2021-001497

. 2021 Aug;10(3):e001497.

doi: 10.1136/bmjoq-2021-001497.

Ethical considerations in quality improvement: key questions and a practical guide

David Francis Hunt^{1

2}, Michael Dunn³, Guy Harrison⁴, Jill Bailey^{5

6}

Affiliations

¹ Department of Experimental Psychology, University of Oxford Medical Sciences Division, Oxford, UK david.hunt@psy.ox.ac.uk.
² Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
³ The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, UK.
⁴ Department of Spiritual and Pastoral Care, Oxford Health NHS Foundation Trust, Oxford, UK.
⁵ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK.
⁶ Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.

PMID: 34404685
PMCID: PMC8372876
DOI: 10.1136/bmjoq-2021-001497

Ethical considerations in quality improvement: key questions and a practical guide

David Francis Hunt et al. BMJ Open Qual. 2021 Aug.

. 2021 Aug;10(3):e001497.

doi: 10.1136/bmjoq-2021-001497.

Authors

David Francis Hunt^{1

2}, Michael Dunn³, Guy Harrison⁴, Jill Bailey^{5

6}

Affiliations

¹ Department of Experimental Psychology, University of Oxford Medical Sciences Division, Oxford, UK david.hunt@psy.ox.ac.uk.
² Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, UK.
³ The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, Oxfordshire, UK.
⁴ Department of Spiritual and Pastoral Care, Oxford Health NHS Foundation Trust, Oxford, UK.
⁵ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK.
⁶ Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.

PMID: 34404685
PMCID: PMC8372876
DOI: 10.1136/bmjoq-2021-001497

Abstract

Quality improvement (QI) provides a rigorous and innovative approach to improving patient's lives in the healthcare system. Still, it can pose challenges in understanding what ethical considerations apply to some projects to minimise the possibility of patient harm or prevent other ethical wrongs and potential staff burden. While many commentaries discuss the extent to which QI ethics should match research ethics, there is minimal literature regarding what QI project teams should do when considering ethics at the planning stage. This paper provides a practical walkthrough of some of the ethical considerations across the breadth of QI projects, starting from some of the key questions when planning a QI project and a guide for the different ethical considerations that may apply.

Keywords: healthcare quality improvement; patient safety; quality improvement methodologies; safety culture.

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Conflict of interest statement

Competing interests: None declared.

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References

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1. Baily MA, Bottrell MM, Lynn J, et al. . Special report: the ethics of using Qi methods to improve health care quality and safety. Hastings Cent Rep 2006;36:S1–40. 10.1353/hcr.2006.0054 - DOI - PubMed
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[1] Health Foundation (Great Britain) . Quality improvement made simple: what everyone should know about healthcare quality improvement: quick guide. Health Foundation, 2013.

[2] Health Foundation (Great Britain) . Quality improvement made simple: what everyone should know about healthcare quality improvement: quick guide. Health Foundation, 2013.

[3] Langley GJ, Moen RD, Nolan KM. The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons, 2009.

[4] Langley GJ, Moen RD, Nolan KM. The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons, 2009.

[5] Baily MA, Bottrell MM, Lynn J, et al. . Special report: the ethics of using Qi methods to improve health care quality and safety. Hastings Cent Rep 2006;36:S1–40. 10.1353/hcr.2006.0054 - DOI - PubMed

[6] Baily MA, Bottrell MM, Lynn J, et al. . Special report: the ethics of using Qi methods to improve health care quality and safety. Hastings Cent Rep 2006;36:S1–40. 10.1353/hcr.2006.0054 - DOI - PubMed

[7] Lynn J, Baily MA, Bottrell M, et al. . The ethics of using quality improvement methods in health care. Ann Intern Med 2007;146:666–73. 10.7326/0003-4819-146-9-200705010-00155 - DOI - PubMed

[8] Lynn J, Baily MA, Bottrell M, et al. . The ethics of using quality improvement methods in health care. Ann Intern Med 2007;146:666–73. 10.7326/0003-4819-146-9-200705010-00155 - DOI - PubMed

[9] Bellin E, Dubler NN. The quality improvement-research divide and the need for external oversight. Am J Public Health 2001;91:1512–7. 10.2105/AJPH.91.9.1512 - DOI - PMC - PubMed

[10] Bellin E, Dubler NN. The quality improvement-research divide and the need for external oversight. Am J Public Health 2001;91:1512–7. 10.2105/AJPH.91.9.1512 - DOI - PMC - PubMed

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Ethical considerations in quality improvement: key questions and a practical guide

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Ethical considerations in quality improvement: key questions and a practical guide

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