Editorial: Conventional evaluations of improvement interventions: more trials or just more tribulations?

open access

......Many of the challenges we regard as unique to QI (quality improvement) in fact exist in clinical research and have been recognised for decades.22 In some cases, we need to choose the right time for an RCT (once the intervention is sufficiently mature). In other cases, we may need to adopt alternative designs, such as step-wedge randomisation, to accommodate the realities of implementing complex interventions in the midst of other institutional activities or adaptive randomisation to minimise the number of sites assigned to the control group. But, we also have to remember that many of the misgivings we feel as providers of healthcare asked to participate in RCTs of improvement interventions echo those made by patients all the time. Our enthusiasm for assignment to active treatment carries no more weight than theirs. Rather than so often avoiding multi-site RCTs in QI, we may just need to find the right spoonful of sugar for ourselves when we end up in the control group.