Quality Improvement and Ethics

In a recent Healthcare Improvement Scotland blog, Karen Ritchie asked: “Do we need perfect evidence when making decisions?”

I posted this response on the 26th September 2017:

Dear Karen,
What a carefully considered and thoughtful blog. Thank you for sharing.

I do so agree with this approach: “our underpinning philosophy is that we need to ensure that decisions are evidence informed, rather than evidence based”.

You ask in your blog “Do we need perfect evidence when making decisions?”.

I am of the view that there is no such a thing as perfect evidence, however I do think that science requires philosophy and ethics. That is why I welcome your inclusion of philosophy in the above organisational approach to evidence.

However I am concerned, as I have explained to Dame Denise Coia, Robbie Pearson and Dr Brian Robson, that there is no consideration – or even mention of – ethics as necessary for science by Healthcare Improvement Scotland.

Ethics do not appear in the matrix/diagram that you include as representative of  the “many parts but one purpose” of Healthcare Improvement Scotland:

Some Quality Improvement (QI) proponents have suggested that to address the “perceived slowness” of science – and to “improve” science – we take shortcuts with ethics. I am afraid I could not disagree more. Especially when “pilots” are being scaled-up nationally as part of “good practice”.

I submitted this response on ethics and improvement science (QI) to the BMJ a few months ago.

If you have any thoughts on this subject it would be great if you could post them here.

Kindest wishes,

Dr Peter J Gordon
NHS Scotland
(writing in a personal capacity and in my own time)

A film that considers how we may go about improving health and wellbeing:

By living we learn from omphalos

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