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Qual Saf Health Care. 2010 Aug;19(4):271-4. doi: 10.1136/qshc.2009.038034. Epub 2010 May 27.

Ethics, oversight and quality improvement initiatives.

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  • 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.



While substantial public and scholarly attention has focused on the ethical review and oversight of quality improvement (QI) initiatives, there are no systematic data regarding the institutional mechanisms currently in place to review the conduct of QI and the ethical considerations guiding this work.


The authors recruited quality improvement practitioners (QIP) affiliated with the Institute for Healthcare Improvement (IHI) '100 000 lives' campaign to participate in a web-based survey. standard statistical methods were used to analyse the data.


Surveys were completed by 132 QIPs (response rate=26%). Most respondents indicated that QI initiatives conducted with their organisation are subject to review prior to implementation. Respondents strongly agreed that ensuring minimal risk to patients, and privacy and confidentiality are relevant ethical considerations for QI initiatives conducted at their institution. A majority of respondents also agreed that assessing established practices, scientifically sound design, transparency, and the identification and minimisation of potential conflicts are relevant ethical considerations for QI initiatives.


Many QI efforts seem to be getting some oversight, and those engaged in the QI initiatives endorse a range of ethical considerations that are suited to this work. Yet most of these reviews are not independent of those conducting the intervention and are not conducted by people trained in ethics. These findings should facilitate the development of a conceptual and policy framework that is informed by the realities of QI.

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