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BMJ Open. 2019 Jul 24;9(7):e030269. doi: 10.1136/bmjopen-2019-030269.

Why is reporting quality improvement so hard? A qualitative study in perioperative care.

Author information

Clinical Trials Unit, University of Warwick, Coventry, UK.
Orthopaedic Directorate, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge Primary Care Unit, Cambridge, UK.
Health Sciences, University of Leicester, Leicester, UK.



Quality improvement (QI) may help to avert or mitigate the risks of suboptimal care, but it is often poorly reported in the healthcare literature. We aimed to identify the influences on reporting QI in the area of perioperative care, with a view to informing improvements in reporting QI across healthcare.


Qualitative interview study.


Healthcare and academic organisations in Australia, Europe and North America.


Stakeholders involved in or influencing the publication, writing or consumption of reports of QI studies in perioperative care.


Forty-two participants from six countries took part in the study. Participants included 15 authors (those who write QI reports), 12 consumers of QI reports (practitioners who apply QI research in practice), 11 journal editors and 4 authors of reporting guidelines. Participants identified three principal challenges in achieving high-quality QI reporting. First, the broad scope of QI reporting-ranging from small local projects to multisite research across different disciplines-causes uncertainty about where QI work should be published. Second, context is fundamental to the success of a QI intervention but is difficult to report in ways that support replication and development. Third, reporting is adversely affected by both proximal influences (such as lack of time to write up QI) and more distal, structural influences (such as norms about the format and content of biomedical research reporting), leading to incomplete reporting of QI findings.


Divergent terminology and understandings of QI, along with existing reporting norms and the challenges of capturing context adequately yet succinctly, make for challenges in reporting QI. We offer suggestions for improvement.


publishing; qualitative; quality improvement; reporting

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