Barriers and enablers of good practice

What were the key findings?

Doctors have a responsibility to ensure that patients receive a good standard of care and treatment, in a safe, supportive environment. Given the many influences on doctors’ day to day practice, we need to increase our understanding of what factors may act as incentives or barriers to doctors meeting these standards in different healthcare settings. We commissioned RAND Europe to undertake a rapid review of published evidence along with a small number of interviews with experts in this field.

The research, which included published papers from the mid-1980s to March 2012, does not provide comprehensive data on all healthcare settings or doctor profiles. However it has provided indicative evidence of a number of barriers and enablers at three ‘levels’ of the healthcare system – the individual, the local or organisational and the wider policy framework. Amongst the most significant barriers:

  • Habit and self belief can be a barrier to changing behaviour and practice.
  • Information overload with limited reading time can prevent awareness and assimilation of published guidelines.
  • Workload pressures can create an acceptance of ‘short cuts’ in the delivery of care that may lower standards.
  • Unrecognised differences between the care goals of doctors and patients can hamper effective communication and shared decision making.
  • Organisational culture can discourage individuals from raising concerns about standards of patient care.

In terms of enabling good practice:

  • Various interventions which link audit and feedback, reminders, visits to other units and translation of good practice from opinion leaders have demonstrated improvements in doctors’ performance.
  • Organisational incentives that focus on patient experience and patient outcomes as opposed to financial issues and throughput are more effective.
  • An increased focus on inter-professional education/training can help to encourage positive multi-disciplinary working (which itself is associated with improved outcomes).
  • Doctors are more likely to adopt new guidelines/practices if they see them as ‘authoritative’ and relevant — i.e. the potential benefit to their patients is clear.
  • Doctors are motivated to implement new guidelines/practices where it is straightforward to do so, for example where they have access to implementation tools, clinical network or peer support, education/training and funding.
  • Good role models - behaviours and attitudes of colleagues influence uptake of good practice.
  • Education and training can help challenge personal assumptions, beliefs and values, and encourage reflective practice and team working.
  • Commitment to improving practice tends to flourish where reflective practice and quality improvement is actively supported.

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Barriers and enablers of good practice