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- sean adams on The Influence of Ownership on Human Behavior: “Feeding the Beast”
- Sam Campbell on Unnecessary EKGs – The Heart of the Matter
- Lorna Lynn on The Influence of Ownership on Human Behavior: “Feeding the Beast”
Choosing Wisely: What’s Next?
The standard operating procedure for improving systems focuses on answering questions related to the technical issues of the science of quality improvement; a typical PDSA cycle (Plan-Do-Study-Act):
- What do you want to improve (in this case, reduction of wasteful practices)?
- How will you improve it?
- How will you measure the change?
Technical solutions can focus on building databases and feedback (identifying outliers), decision support tools (built into EMRs) and incentives for motivating new behaviors (financial and non-financial). Certainly, reducing unnecessary care will require these technical solutions and others, and we expect delivery systems and clinical practices to employ them to reduce use of unnecessary tests and procedures.
But, in my estimation, a first priority is adaptive change. The fundamental concepts of complex adaptive theory are:
- The notion of awareness and discernment of conversations.
- Emergence through a group process.
- Relationships and mutual understanding of underlying values and motives.
- Meaning emerges through a continuous ongoing iterative interaction of individuals.
The Choosing Wisely campaign attempts to employ both adaptive and technical changes. What makes the campaign different is its focus on the conversation between physicians and patients, and between physicians and other providers about resource use. Per the concepts of complex adaptive theory, the first priority of the campaign needs to be on those conversations. Systematic changes simply won’t occur without them. There needs to be an agreement between teams of clinicians and administrators that appropriate management of health care resources is an important component of their organization’s mission as well as a critical tenet of medical professionalism in the 21st century.
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