, ניהוליות עובדות קליניות עובדותTwo components are necessary to improve the quality ofmedical care: advances in evidence-based medicine (EBM),which identify the clinical practices leading to better care,ie, the content of providing care,4 and knowledge of howto put this content into routine practice. These advances inevidence-based management (EBMgt) identify the organizationalstrategies, structures, and change management practicesthat enable physicians and other health care professionalsto provide evidence-based care, ie, the context ofproviding care.5 Until both components are in place—identifying the best content (ie, EBM) and applying it withineffective organizational contexts (ie, EBMgt)—consistent,sustainable improvement in the quality of care received byUS residents is unlikely to occur.• Improving Patient Care by Linking• Evidence-Based Medicine• and Evidence-Based Management• Stephen M. Shortell, PhD, MBA, MPH• Thomas G. Rundall, PhD• John Hsu,

What went wrong with the quality and safety agenda?An essay by Michael Buist and Sarah Middleton

Despite huge investment in quality and safety over the past two decades, healthcare is still failing to learn the lessons from its mistakes. Michael Buist and Sarah Middleton examine the reasons and call for a shift in medical culture

BMJ 2013;347:f5800 doi: 10.1136/bmj.f5800 (Published 30 September 2013)

Tools of an Evidence Based Culture

• Issue: How to increase adherence to guidelines for prescribing anti-biotics in order to reduce costs and resistance.

• Methods: Administrative data mining, qualitative research, surveys

• Findings:

– Physicians want to be exposed to scientific information about anti biotic resistance– Physicians prefer to receive instruction and feedback from experts, not managers– Physicians have information to provide– Developing and implementing a clinical guideline is a process of communication in the

organization

• Message: Evidence and its Use for Accountability are not dependent on culture, they are part of the culture.

The Tools of an Evidence-Based Culture: Implementing Clinical-Practice Guidelines in an Israeli HMONatan R. Kahan, RPh, MHA, PhD, Ernesto Kahan, MD, MPH,Dan-Andrei Waitman, MD, MPH, Eliezer Kitai, MD, and David P. Chintz, PhDAcademic Medicine, Vol. 84, No. 9 / September 2009

Rachelle Kaye, Ehud Kokia,Varda Shalev, Dalia Idar, David Chinitz, (2010) Barriers and success factors inhealth information technology: A practitioner’s perspective

. Journal of Management & Marketing in Healthcare. VOL. 3 NO. 2. PP 163–175

• Barriers • lack of clear benefits, • sufficient incentives and adequate• support for clinicians as well as • payer–provider relationships,• marketplace competition and privacy legislation.

• Critical success factors• innovative leadership, integrated management and• collaboration with the doctors based on

• concrete needs, • benefits,• incentives • support.

– Dilemmas for managers• proof of return on investment for health IT versus leadership and tough management decisions• The optimal balance in the tradeoff between market dynamics, competition and choice, and• the value of an integrated system that can generate significant benefit to

– clinicians, patients and payers;

• and the appropriate balance– between privacy and improved quality of care, including the– reduction of clinical error.