No Respect: Research in Quality, Safety, and Process Improvement

Ilan S Rubinfeld, MD, MBA; H Mathilda Horst, MD

Fall 2009 - Volume 13 Number 4


The need for good quality and safety research has never been more imperative, but even as we encourage and promote such work, we seem to suppress it through institutional bias and inertia. Indeed the culture of health care seems to have a love-hate relationship with quality-improvement work as a whole. In this commentary we explore some of the implications of the application of pure science standards at the sharp end of clinical practice, where the down-and-dirty street-level improvement work happens.

The realm of biomedical publications is an ever-expanding multidisciplinary collection of books, journals, Internet and multimedia resources. The diversity of material and types of authors in that realm has exploded. Concurrently, many of the old guard would say that the number of high-quality projects has diminished commensurate with the increase in competition for dwindling research funds and the widening gap favoring bioscientific staff over physician researchers in awards for scarce National Institutes of Health resources. Additionally, newer kinds of research, mature and well developed in other industries, are now emerging in health care to meet the burning needs associated with behavioral and process issues in our industry.



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