In lieu of an abstract, here is a brief excerpt of the content:

  • The Ethics of Using QI Methods to Improve Health Care Quality and Safety
  • Mary Ann Baily (bio), Melissa Bottrell (bio), Joanne Lynn (bio), and Bruce Jennings (bio)

PROJECT PARTICIPANTS Organizational affiliations for identification purposes only; affiliations current as of 2006

George J. Agich, PhD
Bowling Green State University
Bowling Green, OH

Mary Ann Baily, PhD
The Hastings Center
Garrison, NY

Paul Batalden, MD
Dartmouth Medical School
Hanover, NH

Nancy Berlinger, PhD, MDiv
The Hastings Center
Garrison, NY

*Melissa Bottrell, MPH, PhD
National Center for Ethics in Health Care, Veterans Health Administration
Seattle, WA

*Michael Carome, MD
DHHS Office for Human Research Protections
Rockville, MD

David Casarett, MD, MA
Center for Health Equity Research and Promotion
Philadelphia VA Medical Center
Philadelphia, PA

Janet Corrigan, PhD
National Quality Forum
Washington, DC

Linda Cronenwett, PhD, RN, FAAN
University of North Carolina at Chapel Hill, School of Nursing
Chapel Hill, NC

Frank Davidoff, MD, MACP
Institute for Healthcare Improvement
Wethersfield, CT

Nancy Neveloff Dubler, LLB
Montefiore Medical Center
Bronx, NY

*Arnold Farley, PhD
Centers for Medicare and Medicaid Services
Baltimore, MD

*J. Michael Fitzmaurice, PhD
Agency for Healthcare Research and Quality
Rockville, MD

*Ellen Fox, MD
National Center for Ethics in Health Care, Veterans Health Administration
Washington, DC

Brent James, MD, MSTAT
Intermountain Institute for Health Care Delivery Research
Salt Lake City, UT

*Stephen F. Jencks, MD, MPH
Centers for Medicare and Medicaid Services
Baltimore, MD

Bruce Jennings, MA
Center for Humans and Nature
New York, NY

Robert J. Levine, MD
Yale University
New Haven, CT

Joanne Lynn, MD, MA, MS
The RAND Corporation
Arlington, VA

Karen Maschke, PhD
The Hastings Center
Garrison, NY

Ethel Mitty, EdD, RN
New York University
College of Nursing
New York, NY

Robyn Y. Nishimi, PhD
National Quality Forum
Washington, DC

Margaret O'Kane, MHA
National Committee for Quality Assurance
Washington, DC

Paul Schyve, MD
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, IL

Theodore Speroff, PhD
Vanderbilt University Medical Center
Nashville, TN

Sean Tunis, MD, MSc
San Francisco, CA

Matthew K. Wynia, MD, MPH
American Medical Association Institute for Ethics
Chicago, IL

*Note: The authors of this report are responsible for its content. Statements in this report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S Department of Health and Human Services.

The federal government employees listed above participated in the meeting discussions in an advisory capacity. However, in addition to the preceding disclaimer, it should be further emphasized that the statements in this report should not be construed as endorsement by the Department of Veterans Affairs or any other department of the U.S. government, nor do they represent the policies of any federal departments, agencies, or offiices. [End Page S2]


Powerful forces of change are at work within the American health care system. The public debate concerning health care financing and access to insurance coverage is intensifying. But below the surface of the media and policy debate about cost and access, a quieter but perhaps more significant process of change is under way: the transformation of health care management and delivery-indeed, health professional work itself-through health care quality improvement.

The innovative, interdisciplinary quality improvement (QI) movement has begun to significantly upgrade delivery of health care in the United States. Taking its cue from reform approaches in other industries, and driven especially by studies indicating a shockingly widespread incidence of medical errors and a striking lack of consistency in the standard of care patients receive in different facilities and from different practitioners, the QI movement has arrived in health care. Using knowledge gained from the disciplines of medicine, nursing, health care management, and medical and health services research, it attempts to mobilize people within the health care system to work together in a systematic way to improve the care they provide. In this work, discipline-specific knowledge is combined with experiential learning and discovery to make improvements.

Ethical issues arise in QI because attempts to improve the quality of care for some patients may sometimes inadvertently cause harm, or may benefit some at the expense of others, or may waste scarce health care resources. Ethical issues also arise because some activities aimed at...