Three Questions … A Quick Glimpse Into WHO is Using SQUIRE and WHY

Sarah Frazer, BA, BSc, MIHM, FRSA

Dr. Frazer is well known in healthcare for her work on how good practice spreads, how improvements can be made at practitioner level and how organizations and teams can best work together. She is a speaker and workshop presenter and has written numerous papers, articles and guides around the topics of the spread of better practice, complex systems, culture and behavior in organizations, breakthrough collaborative and improvement methodologies, and is the author of "Undressing the Elephant; Why Good Practice Doesn't Spread in Healthcare"

1. What have you found most interesting about SQUIRE
SQUIRE is perhaps not only for writing up completed improvement work. We've been using the guidelines in two proactive ways. One method is at the start of a project to use SQUIRE like a meeting agenda and to work through the topics. The headings enable a comprehensive discussion and more detailed planning than before. They work as excellent reminders for all aspects of improvement project implementation. Another way is to use them as a midway project review. In this case we use them to draft a case study as though the project was completed and we are writing some time after the end. In this way we check progress and do future planning that is more implementation orientated. The process provides insight into work still to be completed if the intended
outcomes are to be achieved.

2. How have the guidelines been helpful in writing about your improvement work?
They provide a comprehensive list of what can be covered. We do have a fair amount of discussion on some items and disagreement as to whether they should be included in the write-up. This is interesting in itself and we usually end up adding the section in after the debate! Where context, history and funding is concerned the guidelines are an excellent step forward in helping those who read the write-ups to understand how applicable the results may be to their own situation. There is some evidence of some projects not wishing to use the guidelines because they appear too onerous. My feeling is this is precisely what the guidelines are intending to resolve - the quick write up that lacks fidelity.

3. Have the SQUIRE guidelines influenced how you plan for future work?
Yes. We use them as a guidelines for improvement project planning. It can be frustrating to get to the end of the project and realize some effort at the start on, for example, addressing ethical issues, would have meant a more efficient and effective process and better outcome. For me personally I am a lot more critical of what I read. I use the guidelines as my benchmark. If improvement reports leave out many of the headings then I ask myself, and others, why the omission and what impact does this have on the result and its generalizability.