Ranasinghe Lasith, Dor Frank Jmf, Herbert Paul
Faculty of Medicine, Imperial College London, London, UK.
Imperial College Renal and Transplant Unit, Hammersmith Hospital, London, UK.
Adv Med Educ Pract. 2019 Jul 11;10:507-511. doi: 10.2147/AMEP.S197570. eCollection 2019.
Although health care is encouraged to follow an evidence-based approach, there are perceived instances where suboptimal practice persists in the presence of better options due to an inherent resistance to change within many health care systems. To continue striving for clinical excellence, it is important to identify deficient practices and make appropriate corrections by implementing new and improved techniques and treatments. Bringing about change, however, tends to be a long, arduous process consisting of several small and successive deviations from the norm, analogous to "turning the oil tanker". Analyzing the methods employed by successful health care innovators has allowed the development of a "three-pronged" approach to overcoming resistance to change: 1) a determined opinion leader with a network or like-minded opinion leaders; 2) the presentation of hard evidence with adequate praise for current practice and the generation of clearly worded, specific guidelines; and 3) the use of simple reminders and continuous analysis of outcomes. Employing this three-pronged approach could lead to faster and more successful implementation of change within the health care system.
尽管鼓励医疗保健遵循循证方法，但在许多医疗保健系统中，由于存在固有的变革阻力，在有更好选择的情况下，仍存在次优做法的情况。为了继续追求临床卓越，识别不足的做法并通过实施新的和改进的技术及治疗方法进行适当纠正很重要。然而，带来变革往往是一个漫长而艰巨的过程，由几个小的、连续的偏离常态的情况组成，类似于“转动油轮”。分析成功的医疗保健创新者所采用的方法，已形成一种克服变革阻力的“三管齐下”方法：1）一位有决心的意见领袖以及一群志同道合的意见领袖网络；2）展示确凿证据，对当前做法给予充分肯定，并制定措辞清晰、具体的指导方针；3）使用简单的提醒并持续分析结果。采用这种三管齐下的方法可能会使医疗保健系统内的变革更快、更成功地实施。
