It is an interesting read and makes some pertinent arguments but I don’t necessarily agree with all the statements that are made in it.

I do agree that there is often a fundamental misunderstanding of the nature of the iterative change process in QI projects (which often runs counter to traditional ‘task and finish’ methods for implementing change) and that organisations frequently use it as a blunt tool rather than having sophisticated guidelines for when it is appropriate to utilise a QI method and how to do so effectively. I can imagine that this would include considerations of the culture, climate and context in which the project is occurring, relative priority of the issue being targeted, consideration of resourcing, expectations of timeframes/governance/reporting, other conflicting priorities, access to expertise, access to data and systems/processes to support QI activities. There may well be other considerations as well?

QI often requires more time and effort to do well than common change efforts are afforded and that is where people often put unnecessary pressure on QI project teams. For me, QI (when done well) offers a robust, evidence based approach to making change that has the potential to ensure that improvement efforts are focused on the right area (and scale), can demonstrate impact, enable reflective learning and prevent ineffective changes being implemented. In my experience a common approach to change in the NHS is to ‘just get on with it’, often with no measurement, no involvement and no testing of change before large scale implementation. Anyone familiar with change in the NHS will doubtless be able to point to multiple such instances which have resulted in poor outcomes for all.

Perhaps it is just my reading of the paper, but levying the accusation that QI itself causes negative impacts on staff is not justified. I agree that it is the way in which QI is commonly used that can have this impact. However, I would also point out that not trying to adopt some of these principles may be even worse for staff and that isn’t acknowledged in the paper. The idea that all QI projects require additional measurements around socio-behavioural elements is just adding to the measurement burden that QI teams already face. Where appropriate, for sure, identify relevant balancing measures to ensure there are no unintended consequences, but I wouldn’t advocate these measures in all situations. Given that measurement is often the most challenging component of QI projects, adding additional requirements for all project teams is not sensible.

QI done well is very effective. However, our current conditions make it very difficult to do QI well so I would suggest that there is a need for pragmatic guidance for organisations to consider when and how to best deploy it.

Would be keen to hear others thoughts.