To the Editor: I found the Commentary by Dr Berwick1 to be disappointing. The failure to demonstrate the benefit of some quality-improvement activities in clinical trials has led him to propose that we adopt some other means of testing hypotheses concerning quality-improvement interventions.
It is true that underpowered trials should not be used to either dismiss or accept a new intervention. However, if a properly designed and executed clinical trial showed a lack of effect, the first thought should not be to search for another method that might produce a more desired result.
The Science of Quality Improvement. JAMA. 2008;300(4):390-392. doi:10.1001/jama.300.4.391-b