Is clinical effectiveness a management issue?

Dunning, Michael; Lugon, Myriam; MacDonald, John M.

doi:10.1136/bmj.316.7127.243

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…In most of these success stories, multidisciplinary teamwork and managerial support were key factors. The added benefit of a strong team culture is that it can also provide a climate within which more cautious team members can be encouraged (Dunning et al . 1998b).…”

Section: Discussionmentioning

confidence: 99%

“…They also emphasize the importance of identifying potential barriers to change so that, wherever possible, these may be circumvented, thus increasing the chances of successful change implementation. Identified barriers include limitations of time, lack of motivation and incentives, inadequate information sources, obsolete knowledge, and inadequate financial resources (Oxman et al . 1995, Dunning et al .…”

Section: Introductionmentioning

confidence: 99%

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Achieving clinical excellence through evidence-based practice: report of an educational initiative

2002

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We live in a political and professional climate which requires us to define, maintain and seek to improve the quality of all aspects of health care practice, not least via underpinning decisions and actions with robust evidence. In order to meet this challenge, staff must be clinically competent, reflective about their practice, committed to delivering a 'First Class Service' and able to work in a truly multidisciplinary way (as opposed to the unidisciplinary model frequently seen in operation). In addition, they need to be research 'literate' and able to contribute positively to the management and sustainment of planned change. For managers, the role of staff development in order to meet these goals is not inconsiderable. This paper discusses the process and outcomes of a successful educational initiative which sought to meet the plethora of challenges that face managers and their staff in the course of trying to achieve these goals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Achieving clinical excellence through evidence-based practice: report of an educational initiative

2002

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“…The emergence of evidence of variations in practice, with accompanying doubts on the clinical effectiveness of some of those practices, 1 2 has shown the need for a fundamental questioning of the way in which clinical decisions are made, identifying the reasons for such variation, and finding ways of addressing inappropriate variations. 3 4…”

Section: Introductionmentioning

confidence: 99%

General practitioners' perceptions of effective health care

Tomlin

Humphrey

Rogers

1999

BMJ

110

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Objectives To explore general practitioners' perceptions of effective health care and its application in their own practice; to examine how these perceptions relate to assumptions about clinicians' values and behaviour implicit in the evidence based medicine approach. Design A qualitative study using semistructured interviews. Setting Eight general practices in North Thames region that were part of the Medical Research Council General Practice Research Framework. Participants 24 general practitioners, three from each practice. Main outcome measures Respondents' definitions of effective health care, reasons for not practising effectively according to their own criteria, sources of information used to answer clinical questions about patients, reasons for making changes in clinical practice. Results Three categories of definitions emerged: clinical, patient related, and resource related. Patient factors were the main reason given for not practising effectively; others were lack of time, doctors' lack of knowledge and skills, lack of resources, and "human failings." Main sources of information used in situations of clinical uncertainty were general practitioner partners and hospital doctors. Contact with hospital doctors and observation of hospital practice were just as likely as information from medical and scientific literature to bring about changes in clinical practice. Conclusions The findings suggest that the central assumptions of the evidence based medicine paradigm may not be shared by many general practitioners, making its application in general practice problematic. The promotion of effective care in general practice requires a broader vision and a more pragmatic approach which takes account of practitioners' concerns and is compatible with the complex nature of their work.

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“…They doubt managers’ skills of critical appraisal and research. They are suspicious not only on the grounds of interference with their clinical freedom but also because of the reduction in resources that is likely to result (Dunning et al . 1998).…”

Section: Clinical Governance: the New Solution?mentioning

confidence: 99%

Alteration without change?: a commentary on the proposed policy reforms of the British National Health Service

Pl¹

1998

J Nurs Manag

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Is clinical effectiveness a management issue?

Cited by 6 publications

References 3 publications

Achieving clinical excellence through evidence-based practice: report of an educational initiative

Achieving clinical excellence through evidence-based practice: report of an educational initiative

General practitioners' perceptions of effective health care

Alteration without change?: a commentary on the proposed policy reforms of the British National Health Service

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