SQuIRE 3.0 UPDATE

SQuIRE was first published in 2008 and updated to SQuIRE 2.0 in 2015. SQuIRE is seen to have enhanced the quality and rigour of QI publications bringing greater credibility to the field. There is a growing recognition of the challenges unique to reporting QI, such as the iterative nature of QI work, the types of data and analysis used, and the importance of attending to local context, leading to potential misalignments with traditional scientific reporting and creating challenges for those using SQuIRE. Moreover, in the decade since the publication of SQuIRE 2.0, the field of QI has continued to evolve to include more rigorous improvement and evaluative methodological designs and emerging areas of focus such as health equity and patient partnerships, which are currently not explicitly addressed. 

CQuIPS is committed to ensuring the SQuIRE guidelines are user-friendly and reflective of the healthcare improvement field they aim to support. We are engaging in an evidence-informed initiative to update the current SQuIRE guidelines to SQuIRE 3.0. The initiative will follow a three-phase plan outlined below:

  • Qualitative interviews with QI leaders and educators, SQuIRE users, and journal editors. The interviews will explore experiences of using SQuIRE and perceived strengths and weaknesses.
  • A scoping review of QI publications to assess the presence and quality of the elements of SQuIRE 2.0 in current QI literature to identify areas that would benefit from enhanced guidance.
  • Feedback from a Delphi consensus meeting. We will present findings from the qualitative interviews and scoping review to identify the most relevant and impactful recommendations for updating SQuIRE.

 

SQuIRE 3.0 Update Co-Leads
     

  Leahora Rotteau, PhD, is the manager of the Centre for Quality Improvement and Patient Safety (C-QuIPS) and oversees the general operations and the strategic priorities and activities of the centre . She also contributes to the Centre-based research programs and brings expertise in strategic management and qualitative healthcare care research to the team. Dr. Rotteau received her PhD from the University of Toronto, Institute for Health Policy, Management and Evaluation (IHPME). Her primary research interests include the use of social theory to better understand how and why certain interventions are taken up and spread in practice and the exploration of the social and structural factors that enable the integration of care across acute, primary and community sectors.
     
 

Kaveh Shojania, MD, is a Full Professor in the Department of Medicine at the University of Toronto, where his research focuses on identifying effective strategies for improving patient safety and healthcare quality more generally. He has more than 200 publications indexed in Medline, including in leading journals such as the New England Journal of Medicine, the Journal of the American Medical Association, and Lancet. Google Scholar lists over 25,000 citations to his work with an h-index of 74. From 2011-2020, Dr. Shojania was Editor-in-Chief (and then Co-Editor-in-Chief) of BMJ Quality and Safety. More recently, he has taken on a role as Associate Editor at JAMA Network Open

     
SQuIRE 3.0 Update Team
     
  Jerome Leis, MD, M.Sc., is an Infectious Diseases physician and Medical Director of Infection Prevention and Control at Sunnybrook Health Sciences Centre in Toronto.  He is an Associate Professor in the Temerty Faculty of Medicine at the University of Toronto and leads a Quality Improvement research program focused on development of models of care that support improved resource utilization and reduced risk of healthcare-associated infection.
     
  Lisha Lo, MPH, joined the Centre for Quality Improvement and Patient Safety in 2010. She coordinates the EQUIP Certificate and VAQS Fellowship as well as leads and supports literature review work for Centre-based research projects. Ms. Lo received her MPH from the University of Hong Kong and worked as a research assistant before returning to Toronto, where she undertook a literature review on trigger tools. She brings experience in conducting systematic and scoping reviews, program coordination, and project management and has a keen interest in statistical process control. She recently completed a review on the association between social/structural barriers and outcomes of transition to adult care. She is currently working on reviews exploring: i) equity considerations in safety monitoring systems, ii) equity frameworks in QI, iii) best practices in diagnostic communications, and iv) the use of education/training as an intervention component in QI projects.
     
 

Upasana Panda, MSc, BSc,  joined CQuIPS in 2023 as a Research Assistant. She has vast experience managing and coordinating research studies and applying scientific research methodologies. She is trained in conducting various qualitative methods and designing qualitative studies. She has an educational background in Psychology and Mental health. She has completed her Master’s in Rehabilitation Sciences from McMaster University. She brings a unique perspective to the team from her diverse experiences in the fields of education, healthcare improvement, and psychology.

 

 

 

 

  Brian Wong, MD, FRCPC, is the Director of CQuIPS, a staff general internist at Sunnybrook Health Sciences Centre and Professor of Medicine at the University of Toronto. Dr. Wong received his MD and subsequent specialty training in General Internal Medicine at the University of Toronto. After completing his residency training in 2007, he undertook a research fellowship in patient safety funded by the Canadian Health Services Research Foundation. He has co-led several major QI training programs at the University of Toronto, including the Faculty-Resident Co-Learning Curriculum, the Certificate Course in QIPS and EQUIP, and worked with academic departments at the University of Toronto to establish criteria to recognize QI and PS activities for the purposes of academic promotion. Outside of Toronto, Dr. Wong has worked with several national and international organizations, including the Royal College of Physicians and Surgeons of Canada, Choosing Wisely Canada, the Canadian Patient Safety Institute, the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education, to establish training programs and standards to build QI and patient safety capacity across the learning continuum.
     
SQuIRE Advisory Committee
     
 

Gail E. Armstrong, PHD, DHP, RN, ACNS-BC, FAAN,  is a Professor and Faculty Development Coordinator at the University of Colorado College of Nursing.  Gail was part of the University of Colorado Quality Safety and Education in Nursing (QSEN) pilot school team to update nursing curricula to reflect quality and safety trends.  Gail’s two-decade career in higher education has included teaching and curricular development in pre-licensure and graduate nursing programs. Gail’s clinical practice began at the bedside as Med/Surg nurse, then as an Adult Clinical Nurse Specialist, and more recently was focused in the area of quality and safety.  Gail’s academic and practice career has focused on updating quality and safety content in nursing curricula and developing high functioning teams in healthcare. Gail is the primary editor of Leadership and Systems Improvement for the DNP, a 2020 text that offers leadership and systems improvement content for DNP nursing clinical leaders.

     
 

Pierre M. Barker, MD, MBChB, Chief Scientific Officer, Institute for Healthcare Improvement (IHI), leads IHI’s commitment to use effective improvement science methods to achieve its mission of improving health and health care worldwide. Dr. Barker oversees IHI’s cutting-edge innovation, design, and learning activities, ensuring that we maximize the opportunities for impact and that practical improvement methods and tools are accessible to all. He has extensive experience in designing effective health improvement interventions across a variety of health systems and economies, and has worked closely with the World Health Organization to help develop a global implementation strategy to improve quality of care for mothers and newborns. He attended medical school in South Africa and has practiced pediatrics for more than 30 years in South Africa, UK, and US. Before joining IHI, Dr. Barker was Professor of Pediatrics and Medical 

 

Paul Batalden, MD, is Professor Emeritus of Pediatrics, Community and Family Medicine and the Dartmouth Institute for Health Policy and Clinical Practice at The Geisel School of Medicine, and Emeritus Professor of Quality Improvement and Leadership at Jönköping University in Sweden. For more than five decades, he practiced and taught about the leadership of improvement of health care quality, safety, and value. He founded, created or helped develop the Institute for Healthcare Improvement (IHI), the U.S. Veteran’s Administration National Quality Scholars program, the IHI Health Professions Educational Collaborative, the General Competencies of the Accreditation Council for Graduate Medical Education, the Center for Leadership and Improvement at Dartmouth, the Dartmouth Hitchcock Leadership Preventive Medicine Residency, the annual Health Professional Educator’s Summer Symposium, the initial SQUIRE publication guidelines, the Improvement Science Fellowship Program of The Health Foundation in the UK, the Vinnvård Improvement Science Fellowships in Sweden and the Kellogg Foundation Clinical Pharmaceutical Scholar program. He was a Commissioner of the JCAHO and is currently a member of the Minnesota Academy of Medicine, the International Academy of Quality and Safety in Health Care and the US National Academy of Medicine of the U.S. National Academy of Sciences.

     
 

Tara Burra, MD, is the Medical Director for Quality Improvement and Patient Safety at the Centre for Addiction and Mental Health in Toronto, Canada. At the University of Toronto, she is the Education Lead at the Centre for Quality Improvement and Patient Safety (CQuIPS), she co-leads the Quality, Innovation and Safety hub in the Department of Psychiatry, and she is an Assistant Professor of Psychiatry. She chairs the section on Quality, Innovation and Safety with the Canadian Psychiatric Association.

     
 

Marshall H. Chin, MD, MPH, is a Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics at the University of Chicago, is a practicing general internist and health services researcher who has dedicated his career to advancing health equity through interventions at individual, organizational, community, and policy levels. Through the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation program, Dr. Chin collaborates with teams of state Medicaid agencies, Medicaid managed care organizations, frontline healthcare delivery organizations, and community-based organizations to implement payment reforms to support and incentivize care transformations that advance health equity within an anti-racist framework.  He also co-chairs the Centers for Medicare & Medicaid Services Health Care Payment Learning and Action Network Health Equity Advisory Team. 

Dr. Chin evaluates the value of the federally qualified health center program, improves diabetes outcomes in Chicago’s South Side through healthcare and community interventions, and improves shared decision making among clinicians and LGBTQ persons of color.  He also applies ethical principles to reforms to advance health equity, discussions about a culture of equity, and what it means for health professionals to care and advocate for their patients.  Dr. Chin uses improv and standup comedy, storytelling, and theater to improve training of students in caring for diverse patients and engaging in constructive discussions around systemic racism and social privilege.  Dr. Chin is a graduate of Harvard College and the University of California at San Francisco School of Medicine, and he completed residency and fellowship training in general internal medicine at Brigham and Women’s Hospital, Harvard Medical School.   He is a former President of the Society of General Internal Medicine (SGIM).  Dr. Chin received SGIM’s 2024 Robert J. Glaser Award for outstanding contributions to research, education, leadership, and mentoring in generalism in medicine, and has received mentoring awards from SGIM and the University of Chicago. Dr. Chin was elected to the National Academy of Medicine in 2017, and is on the Steering Committee for the NAM paper series on structural racism and health, and is a co-author of the Asian American paper and cross-cutting solutions paper.

     
 

Louise Davies, MD, is a surgeon and researcher.  She is at the Geisel School of Medicine at Dartmouth where she holds a primary appointment as a Professor of Surgery – Otolaryngology – Head and Neck Surgery and a secondary appointment at The Dartmouth Institute for Health Policy & Clinical Practice (TDI).  She has practical experience in large scale quality improvement from her work at the VA to improve instrument sterilization and organization procedures for the operating room.  She was the Co-PI on the SQUIRE 2.0 Publication Guidelines, for which she led the evaluation process that drove the revision work.  As a researcher, she particularly enjoys clinical epidemiology and applied mixed methods work as applied to health services research, healthcare improvement and clinical trial implementation.

     
 

Mary Dixon-Woods, DPhil, is the Director of THIS Institute and The Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge.

A Professorial Fellow at Homerton College, Cambridge, she is also a fellow of the Academy of Social Sciences and the Academy of Medical Sciences, an honorary fellow of the Royal College of Physicians, the Royal College of General Practitioners, and the Royal College of Obstetricians and Gynaecologists. She was an NIHR Senior Investigator 2017-2022.

Mary served on England’s National Advisory Group on the Safety of Patients in England, which produced the Berwick report in 2013. She also served on the review of information technology in the NHS led by Professor Bob Wachter, which reported in 2016. She was a Wellcome Trust Senior Investigator 2012-2019. Mary was the Harveian Orator for the Royal College of Physicians in 2018, the 500th anniversary of the College’s founding. She is a member of the BMJ’s international advisory board.

     
 

Mary Dolansky, PhD, RN, FAAN, is the Sarah C. Hirsh Endowed Professor at the Frances Payne Bolton School of Nursing and Associate Professor at the School of Medicine at Case Western Reserve University. She was the past Director of the QSEN Institute (Quality and Safety Education for Nurses) and now leads the Sarah Cole Hirsh Institute (Implementation science. At the VA North East Ohio Health System, she co-directs the VA Quality Scholars Fellowship program.

     
 

Kyler M. Godwin, PhD, MPH, is the Assistant Dean for Quality Improvement and Implementation and an Associate Professor of Medicine at Baylor College of Medicine (BCM). Her expertise encompasses healthcare improvement through implementation science and the development, delivery, and evaluation of multisite programs. She directs both the Learning Health System Accelerator and the Institute for Quality Improvement and Patient Safety at BCM and is the Vice Chair for Quality Improvement and Innovation in the Department of Medicine. She serves as the Chief of the Implementation and Innovation Program at the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center. She directs two national training programs, the VA Quality Scholars (VAQS) program, the premier interprofessional fellowship program for healthcare improvement training located at 10 sites throughout North America, VAQS trains physicians, nurses, physical therapists, pharmacists, and clinical psychologists in evidence-based quality improvement, implementation science, and leadership, and the Health Professions Education Evaluation and Research Advanced Fellowship program that trains clinicians and non-clinicians in health professions education and program evaluation.

     
 

Tara Kiran, MD, is a family doctor and renowned primary care researcher. Dr. Kiran investigates how changes in the health care system impact patients, particularly the most vulnerable. In her research and practice, she develops and tests solutions to make health care more inclusive and more effective.

Much of Tara’s research has evaluated how primary care reforms have impacted quality of care. She also leads research to directly improve quality of care including initiatives to measure and reduce care disparities, engage patients in health service improvement, and support physicians to learn from data. In 2022, Tara launched OurCare, a national initiative to engage the public in co-creating the blueprint for a stronger, more equitable primary care system in Canada.

Tara holds the Fidani Chair of Improvement and Innovation at the University of Toronto. She practices family medicine at St. Michael’s Hospital, Unity Health Toronto. She is the Vice Chair for Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto, a Scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, a Senior Adjunct Scientist at ICES and an Associate Professor in the Faculty of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto. You can learn more about her research at https://maphealth.ca/kiran/.

     
 

Tijn Kool, MD, PhD, is professor Appropriate Care at the Radboud University Medical Center in Nijmegen, the Netherlands. His research focuses on implementing appropriate care and de-implementing low-value care. He is an active member of the Choosing Wisely initiative.

     
 

Jennifer Myers, MD, FHM, FACP, is Professor of Clinical Medicine and the Director of the Center for Healthcare Improvement and Patient Safety (CHIPS) at the Perelman School of Medicine, University of Pennsylvania. This center serves as the nexus of education in quality and safety at Penn and has houses several educational programs and career pathways for residents, fellows, and faculty with career interests in this field, including a Masters Program in Healthcare Quality & Safety.

Dr. Myers is past chair of the Association of American Medical Colleges’ (AAMC) Integrating Quality Steering Committee, faculty for the AAMC’s Teach for Quality initiative, and past co-chair of the National Board of Medical Examiners Patient Safety Test Development Committee. She is the founding and ongoing director of the Quality & Safety Educators Academy, the first national faculty development program in this field which is now in its eleventh year and has trained more than 500 faculty across the United States.

Dr. Myers is an Associate Editor for BMJ Quality & Safety and has published more than 70 peer-reviewed articles in the area of healthcare quality and safety and medical education. She received her medical degree from Hahnemann University in Philadelphia, PA and completed her internal medicine training at the Johns Hopkins Hospital in Baltimore, MD.

     
 

Greg Ogrinc, MD, MS, is the Senior Vice President, Certification Standards and Programs, American Board of Medical Specialties (ABMS), collaborating with Member Boards on all aspects of their program of certification, including initial certification and continuing certification.  He provides strategic leadership for the ongoing evolution and implementation of ABMS’ board certification standards and programming.

Dr. Ogrinc previously served as the Senior Associate Dean for Medical Education at Geisel School of Medicine at Dartmouth College and as the Associate Chief of Staff for Education at the White River Junction VA. He currently is a hospitalist at the Jesse Brown VA Medical Center in Chicago and a Clinical Professor of Medicine at the University of Illinois College of Medicine at Chicago.

Dr. Ogrinc received his medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, and earned a master’s degree from Dartmouth Medical School, Center for Evaluative Clinical Sciences in Hanover, New Hampshire. Dr. Ogrinc is board certified by the American Board of Internal Medicine.

     
 

Brant J. Oliver, PhD, MS, MPH, FNP-BC, PMHNP-BC, is Associate Professor in the Departments of Community & Family Medicine, the Dartmouth Institute for Health Policy & Clinical Practice, and Psychiatry at the Geisel School of Medicine at Dartmouth, and System Vice President for Care Experience for the Dartmouth Health system in New Hampshire. Dr. Oliver has specific expertise in Learning Health Systems, healthcare coproduction and improvement methodology, and has served as principal investigator, co-investigator, improvement faculty, or methodologist for improvement, implementation and research collaboratives internationally in the U.S., Canada, the U.K., Sweden, and Australia. Brant also directs the Chronic Health Improvement Research Program at Dartmouth Health (CHIRP) which conducts improvement and implementation research using learning health system approaches for “3C” (complex, chronic, costly) conditions, including MS, IBD, Long COVID, and others. As a health professions educator, he teaches graduate and doctoral students, residents, and post-doctoral fellows in quality improvement and implementation methodology with a specialization in measurement and analytics. As a clinician, he is a board-certified family and psychiatric nurse practitioner with over 20 years of clinical experience, a majority of which has been in multiple sclerosis neurobehavioral care. Dr. Oliver is the 2022 recipient of the national improvement and implementation science research award from the QSEN Institute, the 2023 recipient of the Batalden Award for career achievement in healthcare improvement from the US Department of Veterans Affairs, and is lead editor of the new Joint Commission Resources textbook Practical Measurement for Healthcare Improvement, released in 2022.

     
 

Lori E. Rutman, MD, MPH, is Assistant Professor of Pediatric Emergency Medicine (PEM) at University of Washington School of Medicine and an attending physician in the Emergency Department at Seattle Children’s Hospital. She completed her medical degree and pediatric residency training at Stanford University and her Master’s in Public Health at UC Berkeley prior to moving to Seattle Children’s in 2011.  Dr. Rutman has an interest in Quality Improvement (QI) research, and is also a graduate of the Advanced Improvement Methods (AIM) course at Cincinnati Children’s Hospital in 2014.  Her current projects involve using statistical process control (SPC) and other QI methodologies to evaluate outcomes of standardized care for common pediatric conditions.  In addition to her work as a mentor in the QI Scholars Program, Dr. Rutman provides medical oversight for the Improving Pediatric Sepsis Outcomes (IPSO) Collaborative and is a member of the IPSO Research Workgroup. She also serves as the QI Section Editor for Pediatric Emergency Care and co-chairs the planning committee for the annual APA QI conference. 

     
 

Samir S. Shah, MD, MSCE, MHM, is Professor of Pediatrics at the University of Cincinnati College of Medicine. He is Vice Chair of Clinical Affairs and Education at Cincinnati Children’s Hospital, where he practices both pediatric hospital medicine and pediatric infectious diseases. He is also Editor-in-Chief of the Journal of Hospital Medicine. Dr. Shah’s research focuses on improving the effectiveness and efficiency of hospital-based care for children.

     
 

Erin Spicer, MD, FRPC, MSc, QIPS, is a Clinician-Researcher within the Division of General Internal Medicine at London Health Sciences Centre and Western University. Her research interests centre around quality of care and education on the clinical teaching unit, especially iatrogenic complications of inpatient admissions, including frailty and delirium. She is a member of the Centre for Quality Improvement, Innovation and Patient Safety (C-QuINS), co-leads the CTU Quality, Innovation and Education Research (C-QuIER) Hub, and is the local QI lead for the London branch of the General Medicine Quality Improvement Network (GeMQIN).  

     
 

Emma Vaux, OBE, DPhil, FRCP, is a Consultant Nephrologist and General Physician at the Royal Berkshire NHS Foundation Trust where she is Clinical Lead, Berkshire Kidney Unit; Clinical Director, integrated medicine; and Associate Medical Director, patient safety. She is the clinical lead for the CKD work-stream, NHSE South East Renal Network. She has been the Royal College of Physicians past Vice President (education & training 2017-20), Chief Examiner 2017-22 and remains on the RCP education faculty from 2009. She continues as a MRCP PACES examiner. Emma led on the development of the RCP500 Code of Conduct. She is a The Health Foundation Generation Q Fellow and founding member of the Q Community. Emma is Co-editor of ABC Quality Improvement in Healthcare. She is an assessor with NHS Resolution. Emma was awarded an OBE for services to medical education in 2021.