No respect: research in quality, safety, and process improvement.

The need for good quality and safety research has never been more imperative, but even as we encourage and promote such work, we seem to suppress it through institutional bias and inertia. Indeed the culture of health care seems to have a love-hate relationship with quality-improvement work as a whole. In this commentary we explore some of the implications of the application of pure science standards at the sharp end of clinical practice, where the down-and-dirty street-level improvement work happens.