Incorporating clinical guidelines through clinician decision-making

<p>Abstract</p> <p>Background</p> <p>It is generally acknowledged that a disparity between knowledge and its implementation is adversely affecting quality of care. An example commonly cited is the failure of clinicians to follow clinical guidelines. A guiding assumption of this view is that adherence should be gauged by a standard of conformance. At least some guideline developers dispute this assumption and claim that their efforts are intended to inform and assist clinical practice, not to function as standards of performance. However, their ability to assist and inform will remain limited until an alternative to the conformance criterion is proposed that gauges how evidence-based guidelines are incorporated into clinical decisions.</p> <p>Methods</p> <p>The proposed investigation has two specific aims to identify the processes that affect decisions about incorporating clinical guidelines, and then to develop ad test a strategy that promotes the utilization of evidence-based practices. This paper focuses on the first aim. It presents the rationale, introduces the clinical paradigm of treatment-resistant schizophrenia, and discusses an exemplar of clinician non-conformance to a clinical guideline. A modification of the original study is proposed that targets psychiatric trainees and draws on a cognitively rich theory of decision-making to formulate hypotheses about how the guideline is incorporated into treatment decisions. Twenty volunteer subjects recruited from an accredited psychiatry training program will respond to sixty-four vignettes that represent a fully crossed 2 × 2 × 2 × 4 within-subjects design. The variables consist of criteria contained in the clinical guideline and other relevant factors. Subjects will also respond to a subset of eight vignettes that assesses their overall impression of the guideline. Generalization estimating equation models will be used to test the study's principal hypothesis and perform secondary analyses.</p> <p>Implications</p> <p>The original design of phase two of the proposed investigation will be changed in recognition of newly published literature on the relative effectiveness of treatments for schizophrenia. It is suggested that this literature supports the notion that guidelines serve a valuable function as decision tools, and substantiates the importance of decision-making as the means by which general principles are incorporated into clinical practice.</p

Teamflow: theorie en proposities

Teamflow kan de effectiviteit, productiviteit, prestaties en capaciteiten van een team aanzienlijk verbeteren. Toch zijn studies naar het construct in de werkomgeving schaars. Het meeste onderzoek naar flow op groepsniveau is gericht op prestaties in de atletiek of de kunst en gaat over de collectieve ervaring. Maar de werkomgeving heeft andere parameters, die vereisen dat je zowel naar teamervaringen als individuele ervaringen kijkt. In dit artikel werken de auteurs de huidige theorieën uit en proberen we een testbaar, multilevel-model van teamflow op de werkplek te schetsen, met inbegrip van de voorwaarden, kenmerken en voordelen. Teamflow kan de effectiviteit, productiviteit, prestaties en capaciteiten van een team aanzienlijk verbeteren. Toch zijn studies naar het construct in de werkomgeving schaars. Het meeste onderzoek naar flow op groepsniveau is gericht op prestaties in de atletiek of de kunst en gaat over de collectieve ervaring. Maar de werkomgeving heeft andere parameters, die vereisen dat je zowel naar teamervaringen als individuele ervaringen kijkt. In dit artikel werken de auteurs de huidige theorieën uit en proberen we een testbaar, multilevel-model van teamflow op de werkplek te schetsen, met inbegrip van de voorwaarden, kenmerken en voordelen

Overcoming impediments to team flow

Building on Csikszentmihalyi’s research on flow, team flow is defined as a shared experience of flow during the execution of interdependent personal tasks that serve the interest of the team, originating from an optimized team dynamic and typifed by seven prerequisites and four characteristics at the team level Despite the noted potential for team flow to enhance team performance, subjective well-being, and a healthy team dynamic, there are potential pitfalls that can inhibit team flow that have not yet been researched. To remedy this, we collected interview and focus group data from both student teams and business teams, and we conclude that disorder, dissent, distrust, and delays, which are the inverses of the team flow prerequisites, are the primary impediments to team flow Based on this research, we offer guidelines for preventing and/or overcoming these obstacles