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What does 'quality' add? Towards an ethics of healthcare improvement

Cribb, A; Entwistle, V; Mitchell, P; (2020) What does 'quality' add? Towards an ethics of healthcare improvement. Journal of Medical Ethics , 46 (2) pp. 118-122. 10.1136/medethics-2019-105635. Green open access

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Abstract

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’ (QI), and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, be treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality.

Type: Article
Title: What does 'quality' add? Towards an ethics of healthcare improvement
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/medethics-2019-105635
Publisher version: https://doi.org/10.1136/medethics-2019-105635
Language: English
Additional information: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: ethics, ethics quality, healthcare improvement, quality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of Arts and Humanities
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of Arts and Humanities > Dept of Philosophy
URI: https://discovery.ucl.ac.uk/id/eprint/10093180
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