Improvement is, almost by definition, a good thing. But things done in the name of improvement have costs and ‘side-effects’, and could even lead to harm or involve treating people in unethical ways. A focus on improvement activities might also obscure and neglect things which are crucial to good health care systems.

This online discussion is a chance to explore the possible gaps between the aspirations we all have to make health care better and some of the things that are done in the name of improvement. This might include, for example, the way institutions define or use ‘improvement’; improvement agendas which serve the interests of some people and institutions but not others; and even perhaps some approved methods or techniques being used in ways or contexts that we think are inappropriate. Participants will be encouraged to share (anonymised) examples of the kinds of scenarios and cases that give them cause for concern or worry, and why.

This is the second in a series of online discussion groups which will explore questions about concepts, assumptions, values and ethics in health care quality and improvement. The idea is for participants to informally share and compare insights, perspectives and experiences. Optional pre-reading will be provided but no homework is required – just bring your interest!

Optional pre-reading

There is no required reading but those who are interested might like to look at these two editorials from BMJ Quality and Safety:

• Overcoming the ‘self-limiting’ nature of QI: can we improve the quality of patient care while caring for staff?
• The harms of promoting ‘Zero Harm’

These suggest some possible ways of thinking about the ‘negative side effects’ of improvement, but they are only meant to be indicative and to act as prompts for us to suggest, and discuss, other possible examples and aspects of this question.

Convenors

The philosophy and ethics discussion group events will be hosted by the Special Interest Group (SIG) convenors: Alan Cribb, Vikki Entwistle and Polly Mitchell. The convenors are researchers on a Wellcome-funded project ‘But why is that better?’, an investigation of what applied philosophy and ethics can bring to quality improvement work in health care.

Visit the project website.
Project Twitter: @phil4hcq
This event is organised by the Philosophy and ethics for health care improvement SIG.