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Dear all For the Sicily EBHC meeting in November we are discussing several "themes". One is "Change Management" We will compile a list of ideas and circulate to everyone now and again after the Sicily meeting. http://www.ebhc.org/program.htm So I'd like to get your suggestions on a framework To get this going I have a little discussion starter. Evidence based change mangement - this could range from readiness to change theories to audit. What is the evdience that the Kitson model is more appropraiet than the Lomas model? Can you compare them, does this matter? 1. Do certain change strategies for change work better in different settings and is there a grid/table that can help people in those settings select the most appropriate strategy? 2. I get a new POEM every day giving me evidence as well as weekly BMJ updates. You can’t audit everything in practice – how do you know what to start with? Is there a process or model for selecting the primary issue within a given setting? One of the major issues in assessing and E-B approach is that theoretically we should be changing all the time and this plays havoc with the continuity of management pillar of general/family practice. An example of this is the dilemma of having the patent content taking a NSAID for their arthritis while their blood pressure rises. As far as I know this has not really been explored and no academic framework exists for the process of change at the patient level. It is not just at the patient level where conflict occurs but at strategy levels as well. For example we have guidelines that contradict each other although both may have been through an AGREE process. 3. How does EB practice help the individual patient facing one of these dilemma’s? 4. Has there been any work in the change management setting that has come up with potential solutions for this continuous change 5. Should we be including in this theme work about risk sharing published by authors like Elwyn and Montgomery? Please could you help the discussion by adding any other areas of importance in change management as it relates to evidence based health care or/and provide suggestions for answers to the questions posed above. Best wishes Martin Dr Martin Dawes Chair Family Medicine McGill University 515 Pine Avenue West, Montreal Quebec, Canada Tel 514 398 7375 x0469 Fax 514 398 4202