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Doing ‘something’ does not guarantee improvement – it has to be the ‘right’ thing

Doing ‘something’ does not guarantee improvement – it has to be the ‘right’ thing

Too often, seemingly simple improvement interventions are implemented without fully considering how the intervention might achieve the desired results, whether it can cause harm, or whether a different intervention should be considered. The tendency to favour rapid solutions and implementation over longer-term analysis and measurement represents a common pitfall in quality and safety studies.  

Quality improvement and patient safety (QIPS) studies often omit the critical details underlying the success - or lack thereof - of improvement interventions. In part due to the perception that simple interventions do not require rigorous measurement. Reported measures often solely focus on the outcomes rather than the mechanisms and processes that led to the outcomes.

It is not uncommon in human services to see ‘solutions’ implemented in the name of ‘improvement’, that are based on little more than what staff think will work (often without apparent knowledge of how such an intervention might work), what other elements of the intervention might be needed and what unintended downsides might be incurred.

Without an understanding of why and how an intervention might be successful, even apparently simple interventions may prove difficult to implement and ineffective at improving patient care. Thus wasting time and resources, and adding fuel to the fire of staff claims that ‘we tried it and it didn’t work.’

The authors suggest ‘five golden rules for measurement to get improvement started in the right direction:

Rule 1:

Know why your change might achieve the desired results

Rule 2:

Identify process measures to measure uptake of the change – are staff/consumers doing things in the new, ‘improved’ way?

Rule 3:

Measure the impact of the change – is it fixing the problem?

Rule 4:

Identify a meaningful and practical lag time between intervention and effect —how long will it take before the change improves outcomes?

Rule 5:

Anticipate unintended consequences—what can go wrong?

All accessed 17/8/23:

Etchells E, Trbovich PFive golden rules for successful measurement of improvement.  BMJ Quality & Safety Published Online First: 23 June 2023. doi: 10.1136/bmjqs-2023-016129.