Selected Issues > Quality Improvement
Quality Improvement

qi imageAmericans have long assumed that their health care is the best in the world, but recent evidence has shown otherwise. Unnecessary surgery, inappropriate use of medications, and other medical errors are commonplace. One-third of American patients in a 2005 survey reported being victims of medical errors--more than patients in Australia, Canada, German, New Zealand, and the United Kingdom. There are also significant inequities, with the quality of care varying according to a patient’s socioeconomic status, ethnicity, and geographic location.

In response, many health care professionals have recently launched systematic efforts to upgrade the quality of care by making changes and monitoring their effects on an ongoing basis. That is good news and, on the surface, would seem to pose no ethical dilemmas. But there are several areas of concern.

From the Hastings Center


The Ethics of Improving Health Care Quality & Safety

Lead Investigators Mary Ann Baily, Bruce Jennings (Center for Humans and Nature) Project Consultants Joanne Lynn (The RAND Corporation), Melissa Bottrell (National Center for Ethics in


Professional Chaplains and Health Care Quality Improvement

The Hastings Center has convened a one-year research project to explore how quality of care is understood within the “professionalizing” profession of chaplaincy; the challenges inherent in defining, measuring, and improving quality in less-standardized areas of health care delivery; and the current and potential role of chaplaincy in improving the quality of health care in the United States.

Hastings Center Report

Tipping Point, Over the Top, or Just Noncompliance as Usual?

By Greg Koski 
As soon as I read the headline, I thought, here we go again. As a former director of the Office for Human Research Protections at the Department of Health and Human Services, I was hardly surprised when several colleagues sent me the op-ed by Atul Gawande in the New York  Times last December called “A Lifesaving Checklist.” 


Accountability: Patient Safety and Policy Reform

Edited by Virginia A. Sharpe According to a recent Institute of Medicine report, as many as 98,000 Americans die each year as a result of medical error – more than from

Hastings Center Report

How Turning a QI Project into “Research” Almost Sank a Great Program

By Lucy M. Candib
Somewhere along the line, someone asked if I had IRB approval. IRB approval? Well, no, that hadn’t occurred to me. I had started a program, and I was evaluating it on our own terms at the health center. It was a kind of quality improvement project—could we make open access to exercise available to our multiethnic, low-income patients? I wasn’t recruiting people into an experiment; I was making a service accessible to them.

Hastings Center Report

Making Up Is Hard to Do

By Summer Johnson
In a time when issues of patient safety, hospital care quality, and tort reform for medical liability are front-page news and hot topics in the halls of Congress, Nancy Berlinger’s After Harm: Medical Error and the Ethics of Forgiveness presents an opportune and refreshing perspective on medical error. Medical errors present particular challenges for maintaining or restoring the physician-patient relationship. Berlinger argues that the responsibility for maintaining or restoring the integrity of that relationship is the health care provider’s.

Hastings Center Report

The Problem with Single-Payer Plans

By Ezekiel J. Emanuel
Even in theory, single payer is not the best reform option. Here’s the problem: while it proposes the most radical reform of the health care financing system, it is conservative, even nostalgic, when it comes to the broken delivery system. It retains and solidifies the nineteenth century, fragmented, fee-for-service delivery system that provides profligate and bad quality care.
A commentary on “Single Payer Meets Managed Competition.”

Hastings Center Report

Far Afield

By Nancy Berlinger
One Friday last February, there I was, venturing out into the field, courtesy of the Acela service to Boston. I’d persuaded two sociologists—Ray de Vries, a sociologist of medicine, and Wendy Cadge, a sociologist of religion—to meet me at Brandeis. Wendy studies chaplains in the field. Ray and I were working on a Hastings Center project that has looks at chaplains, a health care profession in the process of “professionalizing.”

Hastings Center Report

Unrest about Research

By Gregory Kaebnick
An ongoing series of articles and essays in the Report have noted that human subjects research ethics, a sometimes intricate and arcane set of discussions that are virtually a discrete subfield within bioethics, is the site of growing and multiplying controversies.

Bioethics Forum

Evidence, Technology, and Cost Control

Daniel Callahan