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Is money spent on quality improvement better spent on clinical care?

TO THE EDITOR: The Journal is to be commended for this important discussion on quality improvement (QI) by Millar1 and Runciman.2 It is important to understand that if doctors are not engaged in changes to health service provision, including QI, such changes will be ineffective.3 Not surprisingly, unengaged doctors can “prove” the lack of an effect of a QI initiative and return to doing what they have always done. Millar comments on the “division between QI and clinicians”.1 Why this division? Why is there a lack of engagement, and a lack of common purpose, values, and beliefs? Professional responsibilities as defined by the American College of Physicians (ACP) in 2002 include “commitments” to, among others, “improving quality of care”, “improving access to care”, and “a just distribution of finite resources”.4 The 2009 Royal Australasian College of Physicians Professional Qualities Curriculum provides a very similar list of responsibilities for all physicians.5 It may be time for many doctors to step onto the common ground and out of the ivory tower. It is time that doctors become able to view themselves as only one part of a larger system that exists solely to provide health care for patients and the population. Teamwork and collaboration with non-medical health professionals (including managers) may often be undervalued from a “doctor-centric”, and often “hospital-centric”, perspective. It is also high time that health organisations and many managers become serious about involving clinicians, initiating “true” clinical leadership, and engaging and communicating in a meaningful way. Clinical leadership, clinical governance and “teamwork” have unfortunately become almost sloganlike, stale entities that appear in health policy plans and strategy documents without much meaning or consequence. One day, clinical care may be better and have more resources because of better implementation of QI that actually engages clinicians.