SQUIRE and the evolving science of healthcare improvement.

To cite: Stevens DP. BMJ Qual Saf Published Online First: [please include Day Month Year] doi:10.1136/ bmjqs-2015-004158 The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines seek to improve the reporting of studies of healthcare improvement work, but are interventions in a field of science that is itself rapidly evolving. SQUIRE differs in this regard from reporting guidelines for studies that are based on more stable methodologies, for example, randomised clinical trials (CONSORT) or systematic reviews (PRISMA). SQUIRE in 2008 probed relatively unfamiliar territory for editors, reviewers and authors, including those associated with journals apparently focused on healthcare improvement. The pilot study reported by Howell et al offers a perspective on that interaction. They counted the number of SQUIRE elements that appeared in four selected journals before (2006–2008) and after (2010– 2012) publication of SQUIRE. Included among the journals were 3 of the 17 journals that suggest using the guidelines. They found no difference in SQUIRE elements in this relatively small study sample. These findings are in contrast with the positive effect that was reported when an early version of CONSORT guidelines for clinical trials was assessed. This different outcome may be related to more articles and higher impact journals examined over a longer study period in the CONSORT evaluation. In any event, a report such as that by Howell et al, raises by implication questions that may apply uniquely to editorial expectations and publication guidelines for an evolving science. Well before manuscript preparation, how do authors use SQUIRE for design of their improvement initiatives—including the planning of the studies and incorporation of appropriate methodologies—that are conveyed in their reports? How does the aspiring author apply publication guidelines when the field itself is actively evolving? Given the dynamic state that characterises the epistemology of healthcare improvement, 9 should editors and reviewers require all items on the guidelines checklist, or are some mandatory only for selected categories of improvement reports?