How do we know?

We know that every improvement is a change—but how do we know that a change is an improvement?1 Improvement experts and patients, each in their own terms, ask this question with appropriate impatience.23 For example, how can valid conclusions be drawn when an improvement initiative employs no control population, or if the study employs predominantly qualitative measures? Indeed, some argue that if the RCT is the gold standard, how can improvement scientists settle for less?4 Others counter that this frame actually constrains the options for knowing.56 Flyvbjerg describes these debates in the larger scientific community—at their most vehement—as the Science Wars.7 That goes far beyond where I intend to take this modest essay. Increasingly there are calls for a rich discussion and appraisal of new ways of knowing while striving to improve existing methodologies in healthcare improvement and patient safety.23 I propose that this journal, given its unique subject matter, provides an appropriate test bed to assess the rigour and utility of scholarly reports in these fields. While doing so, we must also be mindful that there are emerging media that …