The Hastings Center has just issued a report entitled "The Ethics of Using Quality Improvement Methods to Improve Health Care Quality and Safety" (June 2006). The report is the product of a project funded by the Agency for Healthcare Research and Quality, in the Department of Health and Human Services. I am pleased to say that Growth House helped out by providing a special electronic mailing list for use by the multidisciplinary team of experts that has been studying these issues for the past two years. The authors of the summary report are Mary Ann Baily, Melissa Bottrell, Joanne Lynn, and Bruce Jennings.
You may download the report as a PDF file from either of the following web locations:
Ethical issues arise in QI because attempts to improve the quality of care for some patients may inadvertently cause harm, or may benefit some at the expense of others, or may waste scarce health care resources. Ethical issues also arise because some QI activities might be interpreted as a form of medical research in which patients are used as subjects.
This new, free report from The Hastings Center explores the ethical dimensions of the quality improvement (QI) movement in health care, with special attention to the relationship between everyday QI activities and Institutional Review Boards (IRBs). Discussion of ethical issues raised by QI has tended to center around the legal question, "Is this QI project human subjects research as defined by federal regulations and therefore subject to IRB review and the regulatory requirements for informed consent?" The study experts consider that to be too narrow a question. Instead, they step back and ask the broader questions of "What is the place of QI in the operation of the health care system?," "What makes a QI activity ethical?," and "What institutional arrangements should be in place to ensure that specific QI activities meet ethical requirements?"
It offers QI professionals, human subjects research professionals, and health policymakers:
- A clear, concise overview of a complex issue, supplemented by examples, definitions, charts, and summaries of regulations.
- Descriptions of QI activities and the ethical requirements for protecting patients and other participants in these activities, as distinct from the ethical requirements for protecting human research subjects.
- Practical and policy recommendations for ensuring the ethical conduct of QI.