HealthSociety
'But why is that better?'
‘But why is that better?’ An investigation of what applied philosophy and ethics can bring to quality improvement work in healthcare is a research project funded by a Wellcome Trust Collaborative Award in Humanities and Social Science. The project runs for five years, from 2018–2023.
Quality improvement (QI) aims to tackle the shortcomings of health services, but QI initiatives do not always work and sometimes create new problems. One of the reasons for these failures is that people do not agree about what counts as good quality, and quality is often interpreted in ways that fail to capture the aspects of healthcare that matter to people.
This project uses the tools of applied philosophy to help deliver on the promise, and avoid the pitfalls, of healthcare QI. We think that applied philosophy can help elucidate and address the conceptual, ethical and practical challenges faced by researchers and quality improvement practitioners, with potentially transformative implications.
Read more about our activity including conferences, workshops, talks and publications by clicking on the 'Activity' tab below
Aims
We will work with QI partners from diverse healthcare settings to address debates about quality and to understand how the potential harms and ethical challenges produced by QI can be better managed. We will pioneer a partnership approach to building applied philosophy into QI.
Methods
We will address these goals by integrating our applied philosophical scholarship with literature-based work; interviews with QI leaders; partnership working with QI sites; knowledge exchange events; and methodological innovation and reflection.
Project team
| Professor Alan Cribb |
Principal Investigator |
School of Education, Communication and Society, King’s College London |
| Professor Vikki Entwistle |
Co-Investigator |
Health Services Research Unit and School of Divinity, History and Philosophy, University of Aberdeen |
| Dr Polly Mitchell | Research Fellow | School of Education, Communication and Society, King’s College London |
Advisory group
| Name | Affiliations |
| Professor Natalie Armstrong |
Department of Health Sciences, University of Leicester |
| Mr Jono Broad | Quality Improvement Patient Involvement (QIπ) |
| Dr Sibylle Erdmann | Ei SMART BMJ Patient Panel and parent carer to two children with healthcare needs |
| Professor Soren Holm | Centre for Social Ethics and Policy, University of Manchester; Manchester Institute for Collaborative Research on Ageing, University of Manchester |
| Professor Christian Munthe | Department of Philosophy, Linguistics and Theory of Science, University of Gothenberg |
| Professor Craig Ramsay |
Health Services Research Unit, University of Aberdeen |
| Professor Rosamund Scott | Centre of Medical Law and Ethics, King’s College London |
| Professor Nick Sevdalis |
Centre for Implementation sciences, King’s College London; NHS National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London |
| Professor Justin Waring | Centre for Health Innovation, Leadership and Learning, Nottingham University Business School |
| Professor James Wilson | Department of Philosophy, University College London; Health Humanities Centre, University College London |
Conferences
- The ethical implications of improvement science research and practice: developing a research agenda.
Conference: University of Liverpool, London campus. In conjunction with Dr Lucy Frith (University of Liverpool) and Professor Stacy Carter (University of Wollongong). Supported by the Institute of Medical Ethics
29 April 2019
- Development of ethical guidance for WHO on person centred approaches to healthcare
Videoconference: Hosted by Centre for Biomedical Ethics, National University of Singapore. In conjunction with WHO Health Ethics and Governance Unit and Integrated Health Services Team, and National University of Singapore Centre for Biomedical Ethics
27 February 2020
- But Why Is That Better?’ A healthcare improvement workshop
Online workshop: King's College London
30 November 2020
- How can we tell if it’s good…without making it worse?
Online workshop: King’s College London. In conjunction with with colleagues in the Centre for Public Policy Research, King's College London.
27 January 2022
- ‘Person-centred healthcare: philosophical and practical perspectives’
Online workshop: for National Clinical Advisers, NHS England and NHS Improvement, London
29 September 2022
- ‘But Why Is That Better? Philosophical issues in healthcare
Improvement’
Online workshop: hosted by The Health Foundation ‘Q’ community
29 November 2022
Talks
- 'Applied philosophy and healthcare quality improvement.'
Alan Cribb
Centre for Biomedical Ethics seminar series, National University of Singapore
30 January 2019
- 'The conversation between healthcare quality improvement and bioethics: where to begin.'
Alan Cribb
The ethical implications of improvement science research and practice: developing a research agenda, University of Liverpool in London
29 April 2019
- 'Equity in healthcare improvement: where and how should it feature?'
Vikki Entwistle.
The ethical implications of improvement science research and practice: developing a research agenda, University of Liverpool in London
29 April 2019
- 'Speaking out in research: ethical and practical challenges of managing disclosure of concerns
Alan Cribb
THIS Space, THIS Institute, University of Cambridge
4 September 2019
- ‘Why healthcare improvement needs philosophers
Polly Mitchell
Polygeia Annual Conference, King's College London
9 November 2019
- 'Equality in healthcare: why socio-relational theorising matters for healthcare improvement.'
Vikki Entwistle
AABHL NZB Conference, University of Orago, Dundin
21 - 23 November 2019
- ‘An introduction to ethical issues in person-centred care’
Polly Mitchell
Development of ethical guidance for WHO on person centred approaches to healthcare, Centre for Biomedical Ethics, National University of Singapore
27 February 2020
- ‘Tackling disrespect in healthcare: the significance of equality within professional-patient relationships’
Vikki Entwistle
Feminist Approaches to Bioethics (FAB) World Congress, virtual conference
18 June 2020
- ‘Values and ethics in healthcare improvement’
Vikki Entwistle
Nordic Conference on Research in Patient Safety and Quality in Health Care, Jönköping, Sweden
29-30 September 2022
- ‘But why is that better? Connecting bioethics with healthcare improvement’
Vikki Entwistle
Berman Institute seminar series, John’s Hopkins University
https://www.youtube.com/watch?v=ErGVJgfjNoc
24 October 2022
- ‘But why is that better?’
Vikki Entwistle
Centre for Biomedical Ethics seminar series, National University of Singapore
11 November 2022
Publications
- Alan Cribb (2019), 'Managing ethical uncertainty: implicit normativity and the sociology of ethics,’ Sociology of Health and Illness. 42(S1):21–34.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2019), ‘Defining What is Good: Pluralism and Healthcare Quality,’ Kennedy Institute of Ethics Journal. 29(4): 367–388
- Alan Cribb, Vikki Entwistle, and Polly Mitchell (2020), 'What does ‘quality’ add? Towards an ethics of healthcare improvement,’ Journal of Medical Ethics. 46(2):118–122.
- Guddi Singh and Alan Cribb (2020), 'Aligning quality improvement with better child health for the 21st century,' Archives of Disease in Childhood - Education and Practice. 106(6):370–377.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2021), 'Made to Measure: The Ethics of Routine Measurement for Healthcare Improvement,' Health Care Analysis 29: 39–58.
- Alan Cribb, Vikki Entwistle and Polly Mitchell (2021), ‘Talking it better: conversations and normative complexity in healthcare improvement,’ Medical Humanities. 48(1):85–93.
- Polly Mitchell, Alan Cribb, Vikki Entwistle and Guddi Singh (2021), ‘Pushing poverty off limits: quality improvement and the architecture of healthcare values,’ BMC Medical Ethics 22:91.
- Alan Cribb and Alf Collins (2021), ‘Strengthening Citizenship: a healthcare improvement priority,’ Future Healthcare Journal. 8(1):e174–e177.
- Alan Cribb and Thomas Woodcock (2021), ‘Measuring with quality: the example of person-centred care,’ Journal of Health Services Research and Policy 27(2):151–156.
- Alan Cribb, Jane K O’Hara, and Justin Waring (2021), ‘Improving responses to safety incidents: we need to talk about justice,’ BMJ Quality & Safety 31(4):327–330.
- Alan Cribb and Graham Pullin (2022), 'Aesthetics for everyday quality: one way to enrich healthcare improvement debates,' Medical Humanities 48(4):480–488.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2022), ‘Vagueness and variety in person-centred care’ [version 1; peer review: 2 approved], Wellcome Open Research 7:170.
- Vikki Entwistle, Alan Cribb, Polly Mitchell, and Steve Walter (2022), ‘Unifying and universalizing Personalised Care? An analysis of a national curriculum with implications for policy and education relating to person-centred care,’ Patient Education and Counselling 105(12):3422–3428.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2023), ‘Patient safety and the question of dignitary harms,’ Journal of Medicine and Philosophy.
- Alan Cribb, Vikki Entwistle, and Polly Mitchell (2023), ‘Varieties of Improvement Expertise: knowledge and contestation in healthcare improvement,’ Sociology of Health and Illness.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (forthcoming), ‘A wide vocabulary for person-centred care,’ Future Healthcare Journal.
Media coverage
- Peter Littlejohns. “Improvement science is unavoidably normatively inflected, this is mostly implicit – discuss?!” CLARHC South London blog.
- Vikki Entwistle, Alan Cribb and Polly Mitchell. 'Healthcare Improvement and Healthcare Ethics: Time for the Twain to Meet.' NUS Yong Loo Lin School of Medicine Newsletter 34.
Conferences
- The ethical implications of improvement science research and practice: developing a research agenda.
Conference: University of Liverpool, London campus. In conjunction with Dr Lucy Frith (University of Liverpool) and Professor Stacy Carter (University of Wollongong). Supported by the Institute of Medical Ethics
29 April 2019
- Development of ethical guidance for WHO on person centred approaches to healthcare
Videoconference: Hosted by Centre for Biomedical Ethics, National University of Singapore. In conjunction with WHO Health Ethics and Governance Unit and Integrated Health Services Team, and National University of Singapore Centre for Biomedical Ethics
27 February 2020
- But Why Is That Better?’ A healthcare improvement workshop
Online workshop: King's College London
30 November 2020
- How can we tell if it’s good…without making it worse?
Online workshop: King’s College London. In conjunction with with colleagues in the Centre for Public Policy Research, King's College London.
27 January 2022
- ‘Person-centred healthcare: philosophical and practical perspectives’
Online workshop: for National Clinical Advisers, NHS England and NHS Improvement, London
29 September 2022
- ‘But Why Is That Better? Philosophical issues in healthcare
Improvement’
Online workshop: hosted by The Health Foundation ‘Q’ community
29 November 2022
Talks
- 'Applied philosophy and healthcare quality improvement.'
Alan Cribb
Centre for Biomedical Ethics seminar series, National University of Singapore
30 January 2019
- 'The conversation between healthcare quality improvement and bioethics: where to begin.'
Alan Cribb
The ethical implications of improvement science research and practice: developing a research agenda, University of Liverpool in London
29 April 2019
- 'Equity in healthcare improvement: where and how should it feature?'
Vikki Entwistle.
The ethical implications of improvement science research and practice: developing a research agenda, University of Liverpool in London
29 April 2019
- 'Speaking out in research: ethical and practical challenges of managing disclosure of concerns
Alan Cribb
THIS Space, THIS Institute, University of Cambridge
4 September 2019
- ‘Why healthcare improvement needs philosophers
Polly Mitchell
Polygeia Annual Conference, King's College London
9 November 2019
- 'Equality in healthcare: why socio-relational theorising matters for healthcare improvement.'
Vikki Entwistle
AABHL NZB Conference, University of Orago, Dundin
21 - 23 November 2019
- ‘An introduction to ethical issues in person-centred care’
Polly Mitchell
Development of ethical guidance for WHO on person centred approaches to healthcare, Centre for Biomedical Ethics, National University of Singapore
27 February 2020
- ‘Tackling disrespect in healthcare: the significance of equality within professional-patient relationships’
Vikki Entwistle
Feminist Approaches to Bioethics (FAB) World Congress, virtual conference
18 June 2020
- ‘Values and ethics in healthcare improvement’
Vikki Entwistle
Nordic Conference on Research in Patient Safety and Quality in Health Care, Jönköping, Sweden
29-30 September 2022
- ‘But why is that better? Connecting bioethics with healthcare improvement’
Vikki Entwistle
Berman Institute seminar series, John’s Hopkins University
https://www.youtube.com/watch?v=ErGVJgfjNoc
24 October 2022
- ‘But why is that better?’
Vikki Entwistle
Centre for Biomedical Ethics seminar series, National University of Singapore
11 November 2022
Publications
- Alan Cribb (2019), 'Managing ethical uncertainty: implicit normativity and the sociology of ethics,’ Sociology of Health and Illness. 42(S1):21–34.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2019), ‘Defining What is Good: Pluralism and Healthcare Quality,’ Kennedy Institute of Ethics Journal. 29(4): 367–388
- Alan Cribb, Vikki Entwistle, and Polly Mitchell (2020), 'What does ‘quality’ add? Towards an ethics of healthcare improvement,’ Journal of Medical Ethics. 46(2):118–122.
- Guddi Singh and Alan Cribb (2020), 'Aligning quality improvement with better child health for the 21st century,' Archives of Disease in Childhood - Education and Practice. 106(6):370–377.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2021), 'Made to Measure: The Ethics of Routine Measurement for Healthcare Improvement,' Health Care Analysis 29: 39–58.
- Alan Cribb, Vikki Entwistle and Polly Mitchell (2021), ‘Talking it better: conversations and normative complexity in healthcare improvement,’ Medical Humanities. 48(1):85–93.
- Polly Mitchell, Alan Cribb, Vikki Entwistle and Guddi Singh (2021), ‘Pushing poverty off limits: quality improvement and the architecture of healthcare values,’ BMC Medical Ethics 22:91.
- Alan Cribb and Alf Collins (2021), ‘Strengthening Citizenship: a healthcare improvement priority,’ Future Healthcare Journal. 8(1):e174–e177.
- Alan Cribb and Thomas Woodcock (2021), ‘Measuring with quality: the example of person-centred care,’ Journal of Health Services Research and Policy 27(2):151–156.
- Alan Cribb, Jane K O’Hara, and Justin Waring (2021), ‘Improving responses to safety incidents: we need to talk about justice,’ BMJ Quality & Safety 31(4):327–330.
- Alan Cribb and Graham Pullin (2022), 'Aesthetics for everyday quality: one way to enrich healthcare improvement debates,' Medical Humanities 48(4):480–488.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2022), ‘Vagueness and variety in person-centred care’ [version 1; peer review: 2 approved], Wellcome Open Research 7:170.
- Vikki Entwistle, Alan Cribb, Polly Mitchell, and Steve Walter (2022), ‘Unifying and universalizing Personalised Care? An analysis of a national curriculum with implications for policy and education relating to person-centred care,’ Patient Education and Counselling 105(12):3422–3428.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (2023), ‘Patient safety and the question of dignitary harms,’ Journal of Medicine and Philosophy.
- Alan Cribb, Vikki Entwistle, and Polly Mitchell (2023), ‘Varieties of Improvement Expertise: knowledge and contestation in healthcare improvement,’ Sociology of Health and Illness.
- Polly Mitchell, Alan Cribb, and Vikki Entwistle (forthcoming), ‘A wide vocabulary for person-centred care,’ Future Healthcare Journal.
Media coverage
- Peter Littlejohns. “Improvement science is unavoidably normatively inflected, this is mostly implicit – discuss?!” CLARHC South London blog.
- Vikki Entwistle, Alan Cribb and Polly Mitchell. 'Healthcare Improvement and Healthcare Ethics: Time for the Twain to Meet.' NUS Yong Loo Lin School of Medicine Newsletter 34.
Project status: Ongoing
Principal Investigator
Alan Cribb
Professor of Bioethics and Education
Investigator
Polly Mitchell
Post Doctoral Research Fellow in Bioethics and Public Policy
Affiliations
Funding
Funding Body: Wellcome Trust
Amount: £721,710
Period: December 2018 - December 2023