To the Editor: The Journal is to be commended for this important discussion on quality improvement (QI) by Millar1 and Runciman.2 It is important to understand that if doctors are not engaged in changes to health service provision, including QI, such changes will be ineffective.3 Not surprisingly, unengaged doctors can “prove” the lack of an effect of a QI initiative and return to doing what they have always done.
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