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What does ‘quality’ add? Towards an ethics of healthcare improvement
  1. Alan Cribb1,
  2. Vikki Entwistle2,
  3. Polly Mitchell1
  1. 1 Centre for Public Policy Research, King’s College London, London, UK
  2. 2 Centre for Biomedical Ethics, National University of Singapore, Singapore
  1. Correspondence to Professor Alan Cribb, Centre for Public Policy Research, London SE1 9NH, UK; alan.cribb{at}


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.

  • healthcare improvement
  • quality
  • ethics
  • ethics quality

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  • Contributors All authors contributed to the development and drafting of this article.

  • Funding This work was supported by the Wellcome Trust (209811).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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