Abstract
I read Hockey and Marshall's essay on quality improvement with great enthusiasm. 1 I agree with the authors about the change in the nature of medicine from a ‘one-to-one relationship behind closed doors’ to one where an appreciation for the wider context in which we practice is essential. Doctors must engage with quality improvement as part of good medical practice. 2 Quality in healthcare is not just concerned with outcome targets (of which there are many); quality is primarily concerned with healthcare processes – including education, patient safety, decision-making, partnership with patients and others. While I am a fan of evidence-based medicine (EBM), EBM typically does not offer guidance on what processes one must adopt in order to achieve the goals set out by EBM. Trials often try to define the best medical treatment or surgical intervention. However, the processes that clinicians go through to incorporate evidence into care are equally as critical – so that eventually, evidence is translated into patient outcomes. Quality in healthcare should matter to doctors. Grand technology, like the da Vinci robot 3 is great, but reaching a good quality decision about the right treatment for a specific patient, teamwork in theatre, patient safety and the patient's experience are all equally as crucial in achieving a good outcome. 4
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