Putting improvement at the heart of health care

The need to improve the quality and safety of health care has never been greater. 1 2 Two notions are central to good medical practice. Firstly, doctors continually monitor the care they offer, checking this against what they actually do and learning what they need to do differently.3 Secondly, in the words of the NHS Modernisation Agency, best care wraps around the patient, rather than the patient fitting the care that is offered. Therefore it seems paradoxical that resistance by doctors towards activities promoting quality assurance and improvement is claimed to be found across all countries and health systems.4 Many reasons for such opposition have been suggested. One conclusion is that this will continue until role models emerge that are shown to work.4 In fact, such models already exist, for both improvement practice and medical practice. The recent increase in reported improvement activity using the principles and methods of continuous quality improvement offers evidence of one approach that may deliver lasting changes. 5 6 Continuous quality improvement can be …