Quality Improvement Initiatives Raise Ethics Questions

A majority of respondents said that they also agreed that assessing established practices (67%), scientifically sound design (62%), transparency (62%), and the identification and minimization of potential conflicts (57%) were ethical considerations for quality improvement initiatives conducted at their institution.

The authors also sought out the opinions of hospital CEOs through a survey conducted last November. About 71% of the CEO respondents indicated that quality improvement initiatives conducted by faculty and staff affiliated with their organization always were reviewed by some entity within their organization prior to implementation; 26% said that quality improvement initiatives sometimes were reviewed prior to implementation.

A larger proportion of hospital CEO respondents (56%) reported that an oversight mechanism pays attention to ethical issues "well"—compared with the IHI group at 45%. And, nearly twice as many hospital CEOs (70%) as IHI quality improvement professionals (40%) indicated that QI initiatives at their institution are funded by internal sources.

Overall, this means that according to the authors' data, quality improvement initiatives are being routinely reviewed by a variety of internal mechanisms prior to implementation—although rarely through the institutional review board or any other independent body charged specifically with ethical oversight.

This is turn raises more questions about whether an independent review board could provide a more independent assessment of quality initiatives? Or, whether activities that pose little if any risks or burdens even require such a review?