Research in the sciences of improvement, implementation, and pediatric patient safety

The imperative for the provision of safe care and the continuous improvement of care is now a central part of health-care delivery. Pediatric Research journal has recognized this development with the introduction of a new section on Quality and Patient Safety. Quality and safety were once thought to be the inevitable consequences of the professional responsibility of clinicians. It is now understood that one cannot rely on the good intention of professionals to be safe or to deliver high-quality care. The complexity of health-care delivery has changed the way evidence-based care can be implemented. Health-care delivery relies on the integration of many different processes, all prone to potential failure. Over the past 20 years, the theoretical basis underpinning the delivery of high-quality safe and effective care has evolved, with the development of the sciences of improvement, implementation, and patient safety.

Improvement Science is the study of how to improve different aspects of care, whether it be safety, processes, or effectiveness. The theories are based on the integration of different streams of research on systems, psychology, behavior, and manufacturing processes. Improvement Science can be defined as developing an understanding of the factors and processes that lead to the continual improvement of care, usually developing the solution locally or adapting a solution to the local context. The challenge to know how to bring what we know into everyday work is studied by Implementation Science, which considers what it takes to implement what is already known at scale. The study of Patient Safety considers a wide range of different areas of inquiry, such as ergonomics or human factors, safety culture and team work, mechanisms of different harms, and the interventions required to mitigate against harm, including reliability theory, microsystem theory, and the study of complex adaptive systems and human behavior.

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