What’s the difference between research and quality improvement?

James Moses, MD, MPH; Medical Director of Quality Improvement, Boston Medical Center

I think research has its space, and it’s very, very important. But if we were trying to improve our health care system through research, we would be here for eternity.

People have a sense that it’s only through research that we can prove effectiveness of an intervention. And, so, a lot of times, even though an intervention is designed to improve something, a lot of times people will set up their intervention to have a pre-assessment and a post-assessment. To say, “Hey, did our measure of interest actually improve based on this intervention?” And the problem with that frame is you’re actually prioritizing the proof of effectiveness over actually realizing sustained improvement. Improvement is actually something that’s little bit more organic. It’s the concept that improvement should be never ending.

Improvement, as we know, is about cycles of testing — not for proof of effectiveness — but, in essence, cycles of testing to learn what’s going to improve. And, so, your measurement framework is not about “pre“ and “post.” It’s about continually measuring your metric of interest that you want to move, and coming up with not just one intervention, but multiple interventions, based on learning from prior cycles so that you can actually get to the point of realizing sustained improvement through a series of interventions that were informed by testing in the actual system that you want to improve.

So they’re similar, and they’re both very important. I think that a lot of times the sustained improvement realized in quality improvement helps to be justified and validated through good research assessment of its effectiveness. But I don’t think that we should have improvement prioritize proof of effectiveness over sustained improvement.