Quality Improvement Articles: Maximizing the Impact Through Adoption of the Standards for Quality Improvement Reporting Excellence Guidelines

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Today, clinicians are called upon to challenge the status quo and continually improve clinical practice. Quality improvement activities are one way that we do this. Quality improvement activities are “systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings” (Lynn et al., 2007, p. 667). Although the focus of quality improvement is local practice change, these activities serve as important sources of practice-based evidence for both our own and other organizations. Although traditional hierarchies of evidence rank quality improvement as low-level evidence, it is critical to recognize that there is little or no evidence supporting many aspects of clinical practice. Quality improvement may therefore be the best available evidence. In addition, evidence generated through quality improvement may serve as the foundation for future research. As we increasingly recognize the value of the evidence generated through quality improvement activities, we are increasingly likely to see such activities presented at conferences and published in professional journals. Although this presents the evidence to a broader audience, it also increases concern about the ethical conduct and reporting of quality improvement activities. Because quality improvement activities are a routine and necessary part of clinical practice, we may be tempted to give less consideration to the ethics of conducting and reporting quality improvement activities than we would to research projects. However, the routine nature of quality improvement activities does not absolve us of the requirement to conduct and report the activities in an ethical manner. In addition, there is considerable variation across the country for review processes for quality improvement, including no review, review by a quality improvement management team, and review by an institutional review board for research (Taylor, Pronovost, & Sugarman, 2010).

In recognition of the importance of quality improvement activities to the evidence base for clinical practice, the Journal of Pediatric Nursing is actively seeking articles that report on the process and outcomes of quality improvement activities. In recognition of the wide variation in approval processes and the need for guidance for the ethical reporting of quality improvement, our Editorial Board is adopting the Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines (Davidoff et al., 2008, SQUIRE Standards for Quality Improvement Reporting Excellence, n.d.). The guidelines are broadly grounded in the ethical principles of autonomy, beneficence, nonmaleficence, justice, and duty (Ogrinc et al., 2008). In particular, the guidelines call us to address the protection of participant privacy and physical well-being, conflicts of interest, and management of ethical issues. Importantly, the guidelines also recognize that quality improvement activities exist on a continuum across a number of key issues including intent, generalizability, and risk to participants (Ogrinc).

By publishing quality improvement articles, we seek to make the evidence available to clinicians for clinical practice improvement and to researchers for development of research questions. By adopting the SQUIRE guidelines, we seek to provide a tool to authors for the development of high-quality articles and to reviewers and editors a framework for the evaluation of such articles, thereby maximizing the clinical impact of quality improvement articles published in the Journal of Pediatric Nursing.

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References 

1. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S. Publication guidelines for quality improvement in health care: Evolution of the SQUIRE project. Quality and Safety in Health Care. 2008;17(Supplement 1):i3–i9
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2. Lynn J, Baily MA, Bottrell M, Jennings B, Levine RJ, Davidoff F, et al. The ethics of using quality improvement methods in healthcare. Annals of Internal Medicine. 2007;146:666–673Retrieved from http://www.annals.org/content/146/9/666.long
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3. Ogrinc G, Mooney S, Estrada C, Foster T, Goldmann D, Hall LW, et al. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: Explanation and elaboration. Quality and Safety in Health Care. 2008;17(Supplement 1):i13–i32
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4. SQUIRE Standards for Quality Improvement Reporting Excellence. (n.d.). Retrieved August 10, 2010 from, http://squire-statement.org/.
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5. Taylor HA, Pronovost PJ, Sugarman J. Ethics, oversight and quality improvement initiatives. Quality and Safety in Health Care. 2010;19:271–274
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