Physician practice change I: a critical review and description of an Integrated Systems Model.
نویسندگان
چکیده
The long lag time between medical discovery and when Americans benefit from that discovery has a huge cost in terms of morbidity and mortality. Medicine needs more effective methods for moving discovery to practice. In this article, the authors first offer a critical review of the models of structure and change process gleaned from the physician change literature. Next, they describe the Integrated Systems Model (ISM) that they derive from this review. The ISM has four major components: superstructure, change motivators, change process, and functional interactions. The ISM considers the physician practice to operate as a complex adaptive system requiring diversion of resources from reserves to make a change. In the ISM, resource return is a function of improved quality of care and reimbursement for services. Changes decreasing the resources of the system (parasitic) will be harder to make than those that increase resources (symbiotic) because of resistance to resource loss. The authors extend the ISM to the individual level and describe the need to consider whether individuals within the practice have sufficient reserves to fulfill their part in making the change. Any given change is generally competing with other changes for adoption. Finally, the authors consider the strengths and weaknesses of their model, concluding that by keeping patient welfare, quality care, and finances in the forefront, the ISM provides a more complete picture of forces affecting medical practice change.
منابع مشابه
Evaluation Components of Health Promoting Hospitals: An Integrated Review Study
Introduction: Health promotion is a new mission of hospitals, and the mission of health promotion hospitals is to change the treatment-oriented approach to the health-oriented approach. Therefore, this study aims to evaluate the components of health promotion hospitals. Methods: The present study is an integrated review that searches using the keywords Health Promotion, Evaluation model, Hospi...
متن کاملModels of clinical reasoning with a focus on general practice: a critical review
Introduction: Diagnosis lies at the heart of general practice.Every day general practitioners (GPs) visit patients with awide variety of complaints and concerns, with often minor butsometimes serious symptoms. General practice has many featureswhich differentiate it from specialty care setting, but during thelast four decades little attention was paid to clinical reasoningin general practice. T...
متن کاملCritical Global Health: Responding to Poverty, Inequality and Climate Change; Comment on “Politics, Power, Poverty and Global Health: Systems and Frames”
A recent article by Sol Benatar calls on the global health community to reassess its approach to twin crises of global poverty and climate change. I build on his article by challenging mainstream narratives that claim satisfactory progress in efforts to reduce poverty and improve health for all, and arguing that any eradication of poverty that is consistent with environmental sustainability wil...
متن کاملAn Integrated Model for a Two-supplier Supply Chain with Uncertainty in the Supply
The objective of this paper is to study an integrated two-supplier supply chain whose suppliers are unreliable. An unreliable supplier is alternative between available (ON) and unavailable (OFF) states which are considered to be independent exponential variables. The suppliers apply a continuous review policy and the retailer uses an adapted continuous review base on an(R,Q) policy. Transportat...
متن کاملI-21: Medical Ethics Education: Advancements in Iran
Background: History of medical ethics shows a great attention toward morality and ethical behavior in practice of Iranian physicians. Traditional medical ethics with its conventional methods of teaching have been included in medical education by Iranian physicians over centuries. However, modern academic methods of medical education have also been introduced in medical schools. We aim to summar...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Academic medicine : journal of the Association of American Medical Colleges
دوره 84 8 شماره
صفحات -
تاریخ انتشار 2009