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每个问题都嵌入在更大的整体中。

Every problem is embedded in a greater whole.

机构信息

College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia.

International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont, USA.

出版信息

J Eval Clin Pract. 2025 Feb;31(1):e14139. doi: 10.1111/jep.14139. Epub 2024 Sep 23.

Abstract

Peter Drucker pointed out an important distinction between 'doing things right' and 'doing the right thing', which recognised that all problems are embedded in a context and thus can only be understood within their unique contextual setting. Contemporary research practices in clinical medicine often regards contextual factors as potential confounders that will bias effect estimates and thus must be avoided. However rigorous, research devoid of context ultimately deprives users of understanding of the support factors that make research transferable to policy decisions or managing care of individual patients-it stands in the way of 'doing the right thing' in 'real life' settings. Appreciating that all problems are embedded in a greater context means that one should not ignore their interconnected and interdependent systemic nature, that is, every variable is simultaneously dependent and independent. This is the reason for the cascading effects and feedback loops witnessed in disease progression and policy efforts. We discuss the need for researchers to a-priori consider the context of their research question as well as the structural relationships of the variables under investigation, which in turn provides the basis for choosing the most appropriate research design. We have a moral imperative to first 'do the right thing'-ask questions that address the contextual needs of our patients, and then to 'do it right'-choose the best research method to answer this contextually framed need. Only then will our research efforts have meaningful and lasting impacts on patient care.

摘要

彼得·德鲁克(Peter Drucker)指出了“做正确的事”和“正确地做事”之间的一个重要区别,即所有问题都嵌入在一个背景中,因此只能在其独特的背景环境中理解。临床医学中的当代研究实践通常将背景因素视为潜在的混杂因素,这些因素会使效应估计产生偏差,因此必须加以避免。然而,没有背景的研究无论多么严谨,最终都会使使用者无法理解使研究能够转化为政策决策或管理个体患者护理的支持因素——这阻碍了在“真实生活”环境中“做正确的事”。认识到所有问题都嵌入在更大的背景中意味着,人们不应该忽视它们相互关联和相互依存的系统性质,也就是说,每个变量都是同时依赖和独立的。这就是疾病进展和政策努力中观察到的级联效应和反馈循环的原因。我们讨论了研究人员需要预先考虑其研究问题的背景以及所研究变量的结构关系,这反过来为选择最合适的研究设计提供了基础。我们有道德义务首先“做正确的事”——提出解决患者背景需求的问题,然后“正确地做”——选择最佳的研究方法来回答这种背景框架下的需求。只有这样,我们的研究工作才能对患者护理产生有意义且持久的影响。

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