Thursday, April 08, 2004
A 21st Century Issue in a 19th Century Organization
In the March 22, 2004 issue of the AHA News (the biweekly newsletter of the American Hospital Association), Dr. Nancy Greengold of Wolters Kluwer Health, a Chicago-based consulting firm, discussed the process by which new research findings get incorporated into medical practice. She pointed out that “There seems to be a waiting period, which can last years, before people [i.e., doctors] are willing to modify their approaches, and sometimes not even then.” She mentioned a specific research project that found that “….there is a considerable lag (sometimes 10 or more years) between the publication of randomized controlled trials reporting new advances in medicine and the incorporation of these results into the practice recommendations of expert reviewers.”
She pointed out that this problem results, in part, from the flood of medical information (amounting to some 150,000 articles per month) that makes it difficult for any individual practitioner to keep up. She mentioned the role that the Internet and other electronic information technologies might play in sorting through this plethora of material to identifying the information pertinent to the practice of an individual physician.
She did not, however, identify another major source of the difficulty, which is the anachronistic way in which the practice of medicine is organized and managed. Faced with the problem she reviewed, any other branch of human activity would organize itself to deal with it. For example, someone might be assigned responsibility for keeping up with the pertinent literature, spotting new findings that seemed pertinent, and bringing them to the attention of the proper authorities. Those authorities would then cause a decision to be reached on whether standard practice should be modified and that decision, once reached, would be binding on all members of the organization.
Conceptually, there is nothing very complicated about that, however difficult it might be to implement in particular situations. If it were primarily a matter of system design, one would expect to find the large group practices doing it. But they don’t - at least not very effectively.
Which leads to the conclusion that it is first and foremost an issue of culture, and one that we ought to be facing.
In the March 22, 2004 issue of the AHA News (the biweekly newsletter of the American Hospital Association), Dr. Nancy Greengold of Wolters Kluwer Health, a Chicago-based consulting firm, discussed the process by which new research findings get incorporated into medical practice. She pointed out that “There seems to be a waiting period, which can last years, before people [i.e., doctors] are willing to modify their approaches, and sometimes not even then.” She mentioned a specific research project that found that “….there is a considerable lag (sometimes 10 or more years) between the publication of randomized controlled trials reporting new advances in medicine and the incorporation of these results into the practice recommendations of expert reviewers.”
She pointed out that this problem results, in part, from the flood of medical information (amounting to some 150,000 articles per month) that makes it difficult for any individual practitioner to keep up. She mentioned the role that the Internet and other electronic information technologies might play in sorting through this plethora of material to identifying the information pertinent to the practice of an individual physician.
She did not, however, identify another major source of the difficulty, which is the anachronistic way in which the practice of medicine is organized and managed. Faced with the problem she reviewed, any other branch of human activity would organize itself to deal with it. For example, someone might be assigned responsibility for keeping up with the pertinent literature, spotting new findings that seemed pertinent, and bringing them to the attention of the proper authorities. Those authorities would then cause a decision to be reached on whether standard practice should be modified and that decision, once reached, would be binding on all members of the organization.
Conceptually, there is nothing very complicated about that, however difficult it might be to implement in particular situations. If it were primarily a matter of system design, one would expect to find the large group practices doing it. But they don’t - at least not very effectively.
Which leads to the conclusion that it is first and foremost an issue of culture, and one that we ought to be facing.
