Glasziou discusses on determining the "next action" for improving clinical practice. The next action can be a variety of things. Sometimes it involves garnering additional information through another search, writing to the authors, or writing to a local expert. It doesn't need to be a whole implementation plan, just the next physical action and who is responsible for it. However, there are no routine next actions in setting up a satisfactory system to implement change: Each clinical change involves its own problem-solving process. It would also help if research articles with implications for clinical practice suggested what steps were needed to implement a change; however, there will always be some tailoring needed for individual clinics and clinicians because of local resources and skills and personal tastes. And even if what is needed is clear, someone in the practice must still decide the "what" and "when" of change and take responsibility to monitor that change has occurred.
|Annals of Internal Medicine
|Published - 20 Jan 2009