Abstract
The first step in improving physician performance when there are gaps between what physicians are doing and what they should be doing is to diagnosis the causes of suboptimal care. This "diagnosis" then guides the selection of the most efficient and effective strategies to improve performance. Some behaviours may be easy to change, but the factors that cause suboptimal care often present formidable barriers. Physicians are most likely to improve their performance in these situations if they use a combination of strategies that predispose them to provide improved care, enable them to do so and reinforce these changes in behaviour. Feedback on progress is always important, to ensure that physicians adapt and to provide personal satisfaction and positive reinforcement when performance does improve. Individualized strategies are also important: there are differences in physicians' learning experiences, practice environments and needs. Therefore, each physician must tailor his or her methods for learning and improving performance to his or her individual clinical practice.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Armstrong D., Fry J., Armstrong P. Doctors' perceptions of pressure from patients for referral. BMJ. 1991 May 18;302(6786):1186–1188. doi: 10.1136/bmj.302.6786.1186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992 Sep 2;268(9):1111–1117. [PubMed] [Google Scholar]
- Eddy D. M. Clinical policies and the quality of clinical practice. N Engl J Med. 1982 Aug 5;307(6):343–347. doi: 10.1056/NEJM198208053070604. [DOI] [PubMed] [Google Scholar]
- Green L. W. How physicians can improve patients' participation and maintenance in self-care. West J Med. 1987 Sep;147(3):346–349. [PMC free article] [PubMed] [Google Scholar]
- Lawrence R. S. Diffusion of the U.S. Preventive Services Task Force recommendations into practice. J Gen Intern Med. 1990 Sep-Oct;5(5 Suppl):S99–103. doi: 10.1007/BF02600852. [DOI] [PubMed] [Google Scholar]
- Manning P. R., DeBakey L. Lifelong learning tailored to individual clinical practice. JAMA. 1992 Sep 2;268(9):1135–1136. [PubMed] [Google Scholar]
- Woodward C. A., Rosser W. Effect of medicolegal liability on patterns of general and family practice in Canada. CMAJ. 1989 Aug 15;141(4):291–299. [PMC free article] [PubMed] [Google Scholar]