Enhancing knowledge
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• Rigorous evidence in limited specific areas | • Research driven more by questions of improved outcomes for patients |
• Systematic assessment of learning what works in practice | • Techniques to appraise, organise and make accessible available evidence |
• Integrated patient perspective | • Capacity to pool and monitor local data including patient views in areas that require intervention |
| • Point of care computers that support rapid access to patient data, tests and evidence |
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Standardising processes (consistent application of practices known to be effective)
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• Differences in service configurations at local level | • Development of standards and protocols based on evidence where possible |
• Uneven resourcing at local level | • Decision support systems widely distributed at clinical encounter level |
• Predominance of apprenticeship learning | • Training and education that recognises practical barriers to implementation |
• Tensions between professional autonomy and public accountability | • Performance review at a local level by the multidisciplinary teams and by professional peers |
| • Personal incentives, both professional and financial (including the removal of disincentives) |
| • Public reporting with adequate interpretation of issues |
| • Automated communication processes |
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Increasing effectiveness and predictability of performance at system level
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• Infinite demand | • Clear operating values that appropriately balance capacity with the objectives of effectiveness, efficiency and equity |
• Hierarchical and feudal relationships | • Capacity for shared performance review |
• Low level of investment in work process design and review | • Incentives that foster adoption of best practices and remove barriers of blame, cost and lack of resources |
| • Long term funding stability that allows local level sustainable investment in service redesign |