What are the barriers to and enablers of good medical practice?

Today’s doctors are working in an increasingly challenging environment. The findings of our report, The state of medical education and practice in the UK: 2012, outlined some of the barriers and enablers to doctors meeting our standards for patient care.  

We wanted to understand more about these issues so that we can support you in delivering better care when you start work as a doctor. We commissioned a rapid review of published evidence and a small number of interviews with experts in the field.  

The findings highlighted that undergraduate education is the key time to embed the codes of good practice in the future practice and behaviours of doctors. The review also showed that, although medical schools teach students about professionalism, continuing professional development throughout a doctor’s career is particularly important to help them deal with the reality of clinical practice.  

What were the most significant barriers?

• Habit and self-belief can be a barrier to doctors changing their behaviour and practice.
• Overloading doctors with information, and giving them limited reading time, can mean they aren’t aware and able to assimilate published guidelines.
• Workload pressures can lead to doctors thinking they can take short cuts when delivering care, potentially lowering standards.
• Unrecognised differences between the care goals of doctors and patients can hamper effective communication and shared decision making.
• Organisational culture can discourage doctors from raising concerns about standards of patient care.

What were the most significant enablers?

• Reinforcing the importance of non-clinical skills at medical school, such as communication, leadership and management, is particularly important.
• Doctors’ performance improves when they can access systems for review and feedback, and can get experience of good practice from opinion leaders and visiting other units.
• Doctors are more likely to adopt new guidelines or practices if they can clearly see the potential benefit to their patients.
• Doctors are motivated to implement new guidelines or practices when it is made easier by, for example, implementation tools, clinical networks or peer support, education or training, and funding.    
• The behaviours and attitudes of colleagues influences uptake of good practice, so it’s important to have good role models.      
• Continuing education and training is important to help doctors challenge their personal assumptions, beliefs and values, and to encourage them to reflect on their practice and work as a team.
• Commitment to improving practice tends to flourish where reflective practice and quality improvement is actively supported.  

See the full report Barriers and enablers of good practice.  

What do you think?

We would be interested to know your views on this – do you think these are the issues that affect the quality of doctors’ practice? Are there other issues not picked up in this report that you think we should consider? We will be using the findings from this research to inform our engagement work with doctors.