Why empiricism is not enough.

Those involved in the improvement science community have much to celebrate as more resources become available to improve patient safety. Professor Kathleen Steven’s letter in this issue reminds us there is still much to do and that progress depends on building the scientific basis for improved patient safety and health outcomes. Professor Stevens’ letter builds on Professor Pearson’s promotion of the Improvement Science Research Network (ISRN) in a recent editorial.1 For Professor Stevens the further development of improvement science requires better opportunities to collect data from broader populations and to test findings more broadly. Clearly, Professor Stevens intends the ISRN to lead by enabling access to research instruments and bibliographies organised around key concepts in improvement science and by providing media supports – newsletters, online interaction and webcasts. The ISRN structure has similarities with the Joanna Briggs Institute (JBI), which has brought to the clinical and research community resources that are now widely used and appreciated. With access to online databases, the Cochrane Library, JBI resources, the Physicians’ Information and Education Resource (PIER), BMJ Clinical Evidence, emedicine, UpToDate, quantitative and qualitative research methods of increasing sophistication, and now the ISRN, as well as other resources, the improvement science community has a wealth of supports to call on in the quest for patient safety and better healthcare outcomes. Yet, the achievement of improved patient care will continue to elude us until the ethics of healthcare are taken more seriously, by which I mean that there is a challenge in healthcare delivery that cannot be resolved by empirical methods alone, even those that rely on inductive reasoning. The lack of compassion in the care of the elderly in National Health Service (NHS) hospitals requires far more critical reflection on the realities of everyday practice than is possible based on information science alone. Whereas it is possible to benchmark performance across healthcare systems using quantitative and qualitative indicators, and to show improved facility or system performance against baseline measures, what appears to be an erosion of compassion cannot be solved by more and better data, higher-level aggregations of data or collaboration within the quality improvement industry. According to a popular UK newspaper, the Daily Mail, millions of elderly patients suffer pressure ulcers, hip fractures following falls or malnutrition during NHS hospital stays and most of these cases could be avoided.2 The reporter goes on to mention that there have been complaints for years of nurses not bothering to help elderly people eat their meals; of food placed out of the reach of patients and thrown away uneaten; of failure to identify 70% of patients with malnutrition, of 200 000 falls a year on NHS property; and of a 10% incidence rate of pressure ulcers. In response to these figures, NHS managers have reminded nurses of what they should be doing: