Prof. John Marshall: Clinical Research & Quality Improvement - Bridging the Chasm

We have our differences, but clinicians, administrators, policy-makers, and health care funders share a common core goal: to provide the best possible care to patients and to improve that care continuously. The tools they use differ, and may even appear to be in conflict. Clinical research seeks to determine in as rigorous a manner as possible, which of several options yields better patient-centered clinical results and to disseminate these findings to clinicians. Administrators use quality improvement tools to ensure that accepted best practice approaches are routinely applied in clinical care. Research focuses on a small population of patients, requires their informed consent prior to engagement, is funded from sources outside of the provision of care, and determines whether one of two or more approaches is better. Quality improvement implements conclusions of variable scientific rigour across a broad group of patients, assumes benefit and so does not seek consent, is funded from clinical funds, and focuses on clinician compliance rather than patient benefit. Evolving research designs such as the stepped wedge cluster trial or the platform trial provide a mechanism to bridge the gulf between research and quality improvement and to ensure that new knowledge that benefits patients is incorporated rapidly into clinical care.