Replying to LO28976
Jim
I have a similar situation with a group of dentists and I believe the
issue resides in the way we are trained: independent thinking, final
decision rests with the clinician, etc.
There is evidence in the quality improvement literature that there exists
a resistance among clinicans to CQI activities and that the resistance
arises for 4 reasons:
1. Physicians may not agree with the criteria by which quality is being
measured
2. Physicians, not the (patient assessment/management) guidelines, are
held accountable for patient outcomes
3. Physicians already have heavy workloads to which QA/QI activities add
4. Lack of role models which demonstrate convincingly that QI activities
produce a measurable quantum leap in quality
(Shekelle P. Why don't physicians enthusiastically support quality
improvement programmes? Qual Saf Health Care 2002;11:6).
I suspect that similar reasoning may be applied to just about any activity
- clinical, management, CQI, etc - involving clinicians.
There is some evidence that this resistance can be modified to some extent
in the presence of strong leadership but, then, it seems that this already
applies in your present circumstances.
A number of organisations - including the Australian Council for Safety
and Quality in Healthcare and the Institute for Healtcare Improvement -
are looking at this matter and are attempting to apply lessons learned
from the aviation industry. If you've not looked at them it may be worth
your while. http://www.safetyandquality.org http://www.ihi.org
Regards
Mark Smith
Sydney, Australia
--"Mark Smith" <parradc@bigpond.com>
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