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case 5 - choosing strategies for change
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Case 5 course 6 learning year 2 GW (BMEZ)Name: Esmée Cox
Student number: i6160834
Date: 24 June 2019
Learning goals:
1. What different strategies for change in health care are there?
Grol, R., Wensing, M., Eccles, M., & Davis, D. (2013). Improving patient care: The
implementation of change in health care. Oxford: Wiley Blackwell.
The literature provides a wide variety of methods, strategies and measures to introduce
improvements from which to choose when planning or introducing changes to work
processes, guidelines or best practices. Also, there are different ways to categorize these
methods. Strategies are based on barriers to change.
1) Taxonomy of strategies for change (EPOC):
a. Professional interventions:
o Distribution of educational materials → distribution of published or
printed recommendations for clinical care, including clinical practice
guidelines, audiovisual materials and electronic publications.
o Educational meetings → conferences, lectures, workshops or
traineeships.
o Local consensus processes → inclusion of participating providers in
discussion to ensure that they agree that the chosen clinical problem
was important and the approach to managing the problem was
appropriate.
o Educational outreach visits → use of a trained person to meet with
providers in their practice settings to give information with the
intent of changing the provider’s practice. The information given
may include feedback on the performance of the providers.
o Local opinion leaders → use of providers nominated and explicitly
identified by their colleagues as “educationally influential”.
o Patient-mediated interventions → new, previously unavailable
clinical information collected directly from patients and given to the
provider, e.g. patient depression scores from a survey instrument.
o Audit and feedback → any summary of clinical performance of
healthcare over a specified period of time from medical records,
computerized databases or observations from patients. The
following interventions are excluded from audit and feedback:
Provision of new clinical information not directly reflecting
provider performance collected from patients, e.g. scores on a
depression instrument, abnormal test results; these
interventions are better described as patient mediated.
Feedback of individual patients’ health record information in
an alternate format (e.g., computerized); these interventions
are described as organizational.
o Reminders → patient- or encounter-specific information designed to
prompt a health professional to perform or avoid a clinical action,
based on information provided verbally, on paper, by computer, in
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, the medical records, or through interactions with peers. Computer-
aided decision support and drug dosage are included.
o Marketing → use of personal interviewing, group discussion such as
focus groups, or a survey of targeted providers to identify barriers to
change and subsequent design of an intervention that addresses
identified barriers.
o Mass media → varied use of communication strategies that reach
great numbers of individuals including television, radio, newspapers,
posters, leaflets and booklets, alone or in conjunction with other
interventions; targeted at the population level.
b. Financial interventions
o Provider interventions
Fee-for-service → providers is paid for number and type of
service delivered.
Prepaid services or contractual relationships.
Capitation → provider is paid a set amount per patient for
providing specific care.
Provider salaried service → provider receives basic salary or
providing specific care.
Prospective payment → provider is paid a fixed amount for
healthcare in advance.
Provider incentives → provider receives direct or indirect
financial reward or benefit for undertaking a specific action.
Institution incentives → institution or group of providers
receives direct or indirect financial rewards or benefits for
doing specific action.
Provider grant/allowance → provider receives direct or indirect
financial reward or benefit not tied to specific action.
Institution grant/allowance → institution or group of providers
receives direct or indirect financial reward or benefit not tied
to specific action.
Provider penalty → provider receives direct or indirect financial
penalty for behavior not aligned with clinical or improvement
goals.
Institution penalty → institution or group of providers receives
direct or indirect financial penalty for inappropriate behavior.
Formulary → items such as a specific drug or investigations are
added or removed from a list of reimbursable items.
Other
o Patient interventions
Premium → patient payment for health insurance, this includes
different types of insurance plans, including those paid fully or
partly by employers.
Co-payment → patient payment at the time of healthcare
delivery in addition to health insurance coverage; for example,
while many insurance plans cover prescription medications,
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