Ethical guidelines for schools and quality improvement

In my previous two posts I have argued

• There would appear to be a lack of understanding of the difference between research, quality improvement and evidence-based practice.
• Much of the 'so-called' research or evidence-informed practice being undertaken in schools, could be classified as quality improvement
• However, ethical considerations are just as relevant to quality improvement as to research
• The current use of the notion of 'equipoise'  - we do not know for certain what works best - provides insufficient ethical protection for students - particularly when testing the withdrawal of an intervention.
• In these circumstances, it would be unethical to create a control group, where students were now denied access to a provision (such a 'research-design' would almost certainly not pass the scrutiny of a higher education provider's ethics committee)
• Schools need to give extremely careful consideration to the ethical considerations when conducting their own evaluations of interventions.
• More guidance is required for schools in how to go thinking through ethical considerations. 

In this post, I hope to provide some guidance - based on the health care sector - as to schools can undertake ethically robust quality improvement interventions.

Ethical quality improvement

So what advice can we give school leaders and others who are interested in ethical quality improvement.

1. Permission - have pupils and parents given consent for anonymised data relating to themselves being used for quality improvement processes.
2. The school should produce a set of internal guidelines which clearly distinguish between research, quality improvement and evidence-based practice.
3. These guidelines should also consider the ethical implications of conducting  - research, quality improvement and evidence-based practice - within a school-setting
4. A  senior member of staff should be the point of contact and advice for any member of staff who is looking to undertake a quality improvement project, and which has the potential to be classified as research.
5. If individual members of staff and departments are seeking to undertaken quality improvement projects, where at all possible, these should be included in performance reviews and appraisals and departmental developments plans, and which have been subject to discussion with senior staff.
6. If individual members of staff, departments or the school as a whole wish to undertake any form of randomised control trial, with control groups, this should be subject to a formal review by an appropriate body within the school, possibly even the Governing Body.
7. An appropriate programme of CPD should be put in place so that staff and others involved in these activities have the knowledge and understanding of how to address the ethical issues identified.

Note

Please remember, that this advice is very provisional, and is designed to raise ethical issues associated with schools engaging in quality improvement activities.  If in any kind of doubt, please seek guidance from a HEI

For information -Background material on quality improvement and ethical requirements in the health sector.

Lynn et al (2007) identify seven ethical requirements for the protection of human participants in quality improvement activities.  Table 2 based on the work of Lynn et al seeks to illustrate these requirements in the context of a school, college or multi-academy trust.

Table 1 Ethical Requirements for the Protection of Human Participants in Quality Improvement Activities

Requirement	Explanation
Education, social or scientific values	The gains from a QI activity should justify the resources and risk imposed on the participants (pupils or staff)
Scientific validity	A QI should be methodologically sound( i.e properly structured to achieve its’ goals
Fair participant selection	Pupils/staff should be selected to achieve a fair distribution of the burdens and benefits of the Q1 activity
Favorable risk-benefit ratio	A QI activity should be designed to limit risks while maximising potential benefits and to ensure the risks to an individual participant are balanced by expected benefits to the participant and to society
Respect for participants	A QI activity should be designed to protect the privacy and the confidentiality of personal information Participants in a QI activity should receive information about the findings of the activity that are relevant to their personal development All pupils and school staff should receive basic information about the programme of QI activities The QI results should be freely shared with others in the education system, but participant confidentiality should be protected by putting results into non-identifiable form or obtain specific consents for sharing
Informed consent	Consent to inclusion in minimal-risk QI activities is part of pupils and staff’s commitment to the school Pupils/staff should be asked for informed consent in a specific QI activity if the activity imposes more than a minimal risk The risk to pupils/staff should be measured relative to the risks associated with receiving the existing or normal provision Teachers and other staff should participate in in minimal risk QI activities as part of their job responsibilities Teachers and other staff should be asked for their informed consent  to be included in a QI activity that imposes more than minimal risk The risk to teachers and staff should be measured relative to the risk associated with the usual work situation.
Independent review	Accountability for the ethical conduct of the QI should be be integrated into practice that ensure accountability for the school’s operations.   Each QI activity should receive the kind of ethical review and supervision that is appropriate to its levels of potential risk and project worth

References

LYNN, J., BAILY, M. A., BOTTRELL, M., JENNINGS, B., LEVINE, R. J., DAVIDOFF, F., CASARETT, D., CORRIGAN, J., FOX, E. & WYNIA, M. K. 2007. The ethics of using quality improvement methods in health care. Annals of internal medicine, 146, 666-673.