Quality Improvement Article | Published:

Aletheia—20 unconcealed observations from quality improvement and evidence-based medicine


Quality improvement (QI) and evidence-based medicine (EBM) activities ideally generate value (benefit/cost). Physicians and hospitals vary in ability to demonstrate efficiency despite common methodology available to all. Based upon our 60-some years of combined QI and EBM experience, we suggest reasoned consideration of meta-cognition—thinking about thinking. How do we observe, analyze, intuit, then share observations and learning with collaborative networks? The Greek word aletheia denotes disclosure of the essence of an object or event as its genuine nature, “unhidden, revealed, unconcealed”. Aletheia is authenticity, not a claim or opinion, not an argument or hypothesis, nor an intervention-based assertion. QI and EBM have crucial features obscured by the lure and distraction of technology, economic conflicts, and inherent self-interests. We offer 20 QI and EBM observations in the spirit of aletheia. Enhancing the well-being of children is the foundation of a civilized society, a journey needful of shared QI understanding.

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Author contributions

Dr. Kaempf conceptualized the essay and drafted the initial manuscript. Dr. Suresh added insights, more references, and participated in the subsequent formulation. Both authors reviewed and approved the final revision.


This collaborative quality improvement report was supported by the Providence St. Joseph Health System and Providence Foundation, Women and Children’s Services, Portland, OR.

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Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Joseph W. Kaempf.

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