Riding the Waves of Change Together: Are We All Paying Attention?

By Giuse, Nunzia Bettinsoli | Journal of the Medical Library Association, April 2008 | Go to article overview

Riding the Waves of Change Together: Are We All Paying Attention?


Giuse, Nunzia Bettinsoli, Journal of the Medical Library Association


DOI: 10.3163/1536-5050.96.2.85

Galileo's (1564-1642) introduction of the experimental method and Newton's (1643-1727) further advancement in analytical thinking and scientific methodology created in the seventeenth and eighteenth centuries a fertile scientific environment for change [1-3]. As the community of science registered and embedded these new experimental methodologies, the world began to see them applied to the field of medicine. With Pierre Louis (17871872), recognized by many as the father of epidemiology, the field of medicine first adopted the methodology of tabulating data for purposes of observation and improvement in the health sciences [4, 5], processes further refined and applied by both Florence Nightingale (1820-1910) and Earnest A. Codman (1869-1940) [5-8].

Through his 1916 publication on hospital efficiency, Codman showed the need to collect and publish convincing data that can be used by others to improve patient outcomes [7-9]. As data collection and analysis proliferates, so does our understanding and knowledge of medicine. Medical principles known as "the truth" for centuries are now being challenged and constantly rethought. A famous quote by Sydney Burwell (1863-1967), medical educator of the twentieth century, perhaps best illustrates this constant pattern of change:

My students are dismayed when I say to them, "Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, none of your teachers know which half." [10]

As new scientific discoveries will further challenge current knowledge of medicine, no one is likely to feel at ease anytime soon while hearing the above-mentioned statement, as it still stands true today. Researchers and clinicians alike will continue to benefit in the pursuit of excellence in care from the continual strengthening of scientific methods and data collection. The unquestionable contributions of Archibald Cochrane and David Sackett [5, 11-13], with their development of evidence-based methodologies, have allowed for a new discourse for change and improvement.

The current complexity of health care, as evidenced by the explosion of medical knowledge, has called for a transition from an individual expert model to a model centered around principles of evidencebased medicine [14]. These concepts are endorsed by the Institute of Medicine in the 2001 publication, Crossing the Quality Chasm: A New Health System for the 21st Century.

Evidence-based decision making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place. [15]

As the only true constant in history is change, successful businesses have learned to accept it, and good visionary leaders are trained to identify revolutionary spikes along the waves of change that can act as potential "killer apps," creating excitement and giving a competitive edge to their businesses. These changes are necessary for leaders to introduce innovative business practices with new models that can truly signal progress and provide the organization with a better return on investment. For a new innovation to be totally realized, however, key business elements must be aligned to justify and recognize its potential for revolutionary impact. For example, email had been around since the early 1970s [16], but it took two more decades for all the necessary elements of success to merge as the entrepreneurial community understood its unrealized business potential. This type of vigilance toward change anticipation is critical, as any missed opportunity could result in costly errors and delays and a lack of true progress for the enterprise.

Now the question for all in the health sciences is whether health care leaders are listening to the message communicated in the Quality Chasm report. Are they understanding and internalizing the lessons conveyed, or are they focusing too specifically on the current business challenges of health care without realizing the opportunities to bridge the "chasm? …

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