From local change to scholarly contribution: lessons from a scoping review of the gaps and pitfalls of QI reports.

Abstract

Quality improvement reports (QIRs) are important for disseminating real-world interventions in healthcare. However, as a relatively new genre of scholarly writing, QIRs vary widely in clarity, methodological rigour and scholarly contribution. Despite the availability of reporting frameworks such as Standards for Quality Improvement Reporting Excellence (SQUIRE) V.2.0, key elements-such as methodological rigour, contextual detail and rationale for interventions-are often under-reported or poorly articulated. This study aimed to (1) identify best practices in publishing QIRs and (2) examine common methodological strengths and weaknesses in project design and execution. We conducted a scoping review using the six-stage framework by Arksey and O'Malley. A purposeful sample of 71 QIRs published in 2019 across three leading quality improvement (QI) journals-<i>BMJ Quality & Safety, BMJ Open Quality</i> and <i>Joint Commission Journal on Quality and Patient Safety</i>-was analysed. Data extraction was guided by SQUIRE V.2.0 and supplemented by additional best practices. Return-of-findings sessions with QI scholars, journal editors, frontline practitioners and an international QI conference audience refined the findings and ensured practical relevance. Most QIRs described a local problem and intervention but only 22% articulated strong aim statements with measurable targets. Two-thirds referenced a QI methodology but many descriptions of common QI tools lacked rigour. Process and balancing measures were often missing or inadequately justified. While Plan-Do-Study-Act cycles were commonly reported, few met criteria for 'authenticity'. Data analysis and display methods varied, with several common weaknesses. Discussion sections frequently lacked depth and contextual factors-critical for reproducibility-were inconsistently described. Eight core lessons emerged to support more rigorous, transparent and impactful reporting. As an emerging genre of scholarly communication, many QIRs still fall short in conveying methodological rigour and transferable insights. This review provides practical recommendations, illustrated by strong examples, to help authors and educators improve the clarity and impact of QIRs across healthcare settings.