I agree with Richard, with the added detail that we also need to
focus on getting the people who agree on what they ought to be doing
to also agree on how they should be measuring it. If someone else
decides the measures, there is a risk that people will but out of the
With reference to your concern that PDSA may not be methodologically
rigourous, I would say that it is important to start somewhere, in
terms of building an evaluative culture. And small evaluation steps
that bring quick results is a good way to stimulate interest and get
people to integrate the approach into their practice.
Wed, 16 Dec 1998 15:22:40 +0000
> Subject: Re: Does CQI effectively change prescribing practice?
> From: Richard Hancock <[log in to unmask]>
> To: Janet Martin <[log in to unmask]>
> Cc: [log in to unmask]
> Reply-to: Richard Hancock <[log in to unmask]>
> This is essentially the approach used as part of "Clinical Audit" in the
> UK. Sometimes useful changes are produced!
> To me, the main points is to get the "stakeholders" on board before you
> start. Get people to articulate and agree what they ought to be doing
> (EBP) and then measure whether they are doing it or not.
> Having already agreed what they ought to be doing, they can hardly
> refuse to change if they find practice differs from what they have
> What often happens, alas, is for a lot of "baseline data" to be
> collected with insufficient preparation with the stakeholders, followed
> by rather inconclusive analyses and discussions/arguements about whether
> change is necessary, desirable, possible etc.
> All the best.
> Richard Hancock
> Clinical Audit Analyst
> Burton Hospitals NHS Trust
> In message <[log in to unmask]>, Janet Martin
> <[log in to unmask]> writes
> >Question 1:
> >When considering what effectively changes prescribing practice, a
> >variety of interventions have been systematically reviewed (i.e. practice
> >guidelines, CME, audit & feedback, patient-mediated strategies, academic
> >detailing, etc, etc). But no where have I seen CQI methods
> >systematically reviewed. Has anyone looked at this? Is anyone in the
> >process of looking at this? Does good evidence exist to suggest CQI
> >works to bring about meaningful and lasting change in practice?
> >Question 2:
> >Don Berwick, head of the Institute for Healthcare Improvement in Boston,
> >advocates using PDSA quick-cycle testing (i.e. Plan the change; Do the
> >change, Study the results, Act on the results) for measuring whether
> >changes in practice have lead to improvment. (See Ann Intern Med
> >1998;128:460-466) This quick-cycle testing produces rapid results at the
> >front-lines of medicine by advocating measuring small, representative
> >samples, avoiding long baseline collection periods, and striving for
> >practicality rather than perfection in data collection. Obviously, this
> >approach is far from the methodologic rigour we prefer, but Berwick's
> >point is that this approach is practical and gets physicians (and other
> >practitioners) measuring things and making changes in their practice that
> >otherwise would never get done. He purports that this method is
> >preferable to not doing anything at all. This quick-cycle approach has
> >been used by a variety of tertiary care institutions in the US, and has
> >resulted in "reducing costs of care while improving outcomes" under the
> >tutelage of Berwick and IHI.
> >I welcome your input on the merits and risks of this CQI approach to
> >improving prescribing practice.
> >Thanks in advance,
> >Janet Martin, PharmD
> >Evidence-Based Prescribing Guidelines Pharmacist
> >London Health Sciences Centre
> >London, Ontario
> >N6A 4G5
> >[log in to unmask]
> Richard Hancock
Director of Health Care & Health Sciences
Centre for Professional Development
Department for Continuing Education
University of Oxford
67 St Giles
Oxford OX1 3LU
Tel (44) 1865 288174