Improvement Interventions Are Social Treatments, Not Pills

Abstract

Editorials7 October 2014Improvement Interventions Are Social Treatments, Not PillsFrank Davidoff, MDFrank Davidoff, MDFrom Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1789 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Even the most effective medical treatment (test, drug, or procedure) provides its full benefit only if it is applied to the right patient, in the right way and at the right time, every time. Recognition of the unfortunate reality that effective treatments are often applied inconsistently and inappropriately (1) has spurred development of a "science" of health care improvement. Derived in part from initiatives in industry, this nascent discipline is essentially a systematized version of experiential learning (2), informed by a philosophy that encompasses an understanding of human organizations, the nature of variation, and aspects of human psychology (3). Improvement ...References1. Committee on Quality of Health Care in America. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Pr; 2001. Google Scholar2. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: PTR Prentice Hall; 1984. Google Scholar3. Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: exploring foundations. Qual Manag Health Care. 2013;22:170-86. [PMID: 23807130] doi:10.1097/QMH.0b013e31829a6a15 CrossrefMedlineGoogle Scholar4. Goldman LE, Sarkar U, Kessell E, Guzman D, Schneidermann M, Pierluissi E, et al. Support from hospital to home for elders. A randomized trial. Ann Intern Med. 2014;161:472-81. doi:10.7326/M14-0094 LinkGoogle Scholar5. Goodman SN. Toward evidence-based medical statistics. 1: The P value fallacy. Ann Intern Med. 1999;130:995-1004. [PMID: 10383371] LinkGoogle Scholar6. Lipsey MW. Theory as method: small theories of treatments. New Directions for Program Evaluation. 1993;57:5-38. CrossrefGoogle Scholar7. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61:173-90. [PMID: 16122896] CrossrefMedlineGoogle Scholar8. Bucher JA, Houts PS, Ades T, eds. American Cancer Society Complete Guide to Family Caregiving. 2nd ed. Atlanta, GA: American Cancer Society; 2011. Google Scholar9. Provost LP, Murray SK. The Health Care Data Guide: Learning from Data for Improvement. San Francisco: Jossey-Bass; 2011. Google Scholar10. St Clair T, Cook TD, Hallberg K. Examining the internal validity and statistical precision of comparative interrupted time series design by comparison with a randomized experiment. Am J Evaluation. 2014;35:311-27. doi:10.1177/1098214014527337 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.Acknowledgment: The author thanks Peter Houts and Laura Leviton for contributing important input to this editorial.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=M14-1789.Corresponding Author: Frank Davidoff, MD, 143 Garden Street, Wethersfield, CT 06109. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSupport From Hospital to Home for Elders L. Elizabeth Goldman , Urmimala Sarkar , Eric Kessell , David Guzman , Michelle Schneidermann , Edgar Pierluissi , Barbara Walter , Eric Vittinghoff , Jeff Critchfield , and Margot Kushel Support From Hospital to Home for Elders L. Elizabeth Goldman , Urmimala Sarkar , Eric Kessell , David Guzman , Michelle Schneidermann , Edgar Pierluissi , Barbara Walter , Eric Vittinghoff , Jeff Critchfield , and Margot Kushel Improvement Interventions Joanne Lynn Improvement Interventions Sarah L. Szanton , Bruce Leff , and Laura N. Gitlin Improvement Interventions Frank Davidoff Improvement Interventions Frank Davidoff Improvement Interventions Sarah L. Szanton , Bruce Leff , and Laura N. Gitlin Improvement Interventions Joanne Lynn Metrics Cited ByChanging Health-Related Behaviors 2: On Improving the Value of Health SpendingWhy is reporting quality improvement so hard? A qualitative study in perioperative careResearch versus practice in quality improvement? Understanding how we can bridge the gapSalzburg Global Seminar Session 565—'Better Health Care: how do we learn about improvement?'Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental studyImplementing, improving and learning: cross-country lessons learned from the African Health InitiativeData-driven quality improvement in low-and middle-income country health systems: