People working in improvement need to be sceptical about health care. They often question and examine longstanding practices. Polly Mitchell, Alan Cribb, and Vikki Entwistle argue that the institutionalisation of improvement can get in the way of this scepticism, allowing costly or even harmful activities to slip under the radar. They explore the role that philosophy can play in upholding an active culture of scepticism in health care improvement.

Following a panel event on Quality Management Systems, we have been talking about ways of introducing QMS into a health care setting. Mirek Skrypak shares an approach that he has developed while working as a director of quality in the NHS.