The leaders of quality improvement are the ones who are doing the improvement work

Martin Marshall and James Mountford make many important points relating to the development of quality improvement in healthcare. ¹ They rightly say that whereas academic clinical research is well developed the ability to improve how we deliver healthcare is only just beginning to enter clinical practice. However, I think their definitions of ‘visitors’ and ‘residents’ of the emerging business of quality improvement should be reversed and perhaps amended.

Quality improvement is different to academic medicine. It is an iterative approach delivered by those working on the frontline of healthcare using their system knowledge to discover the areas that need attention and then improving the care. The Keystone central line infection project they describe developed in this way. ² These frontline clinicians with their sleeves rolled up and with a bead of sweat on their foreheads are the ‘residents’ of quality improvement. The improvement scientists who evaluate and attempt to understand these improvements are the ‘visitors’ or perhaps ‘supporters’ would be a better word. This is a very important part of the quality improvement world, but as we take this forward we must recognize that the leaders are the frontline clinicians who are both doing their job and seeking to improve their job. ³