Quality improvement efforts in health care are often poorly reported, or not at all. This article traces the evolution of report-writing guidelines that address issues inherent in health care improvement work. The guidelines are intended to help authors produce more usable and consistent manuscripts and encourage more improvement studies to be published.

In 2005, draft guidelines, referred to as SQUIRE (Standards for QUality Improvement Reporting Excellence), were proposed. Since then, the SQUIRE guidelines have been refined through a consensus process which included gathering formal and informal feedback; "road testing" by journal editors and authors; a literature review; a two-day meeting of editors and scholars who critically analyzed the guidelines and their future use; and finally, a three-cycle Delphi process of final revisions, culminating in 50 participants being asked whether they would endorse the resulting consensus version.

Key elements that distinguish the final SQUIRE 19-item checklist from the draft guidelines include:

• Distinguishing clearly between the improvements themselves and the evaluation of whether and why or why not the improvements work;
• Highlighting the unique dimensions of the improvement process, such as its social nature, focus on changing performance, complexity, etc.;
• Detailing the elements of study design that assess whether efforts to improve care worked and why they did or did not work; and
• Explicitly addressing ethical issues inherent in studying how to improve health care.

The SQUIRE Web site, www.squire-statement.org,  provides numerous tools to help authors write complete, accurate and transparent articles, including "Explanation and Elaboration" pages on each of the 19 items. The site also provides a focus for continued refinement of the SQUIRE guidelines. The authors support efforts to measure the impact of SQUIRE and its specific elements on the quality of published information on health care improvement efforts.