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Improving Quality: A Steeplechase of Sorts?

This symposium explores the necessity of using science for both practice and the public in order to improve quality in various fields. It addresses challenges and opportunities in research and evaluation designs, as well as the need to reconnect funders, users, and providers of research. The symposium also discusses the importance of context, culture, and credibility in disseminating findings and supporting their application.

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Improving Quality: A Steeplechase of Sorts?

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  1. Improving Quality: A Steeplechase of Sorts? The Necessity of Science for Practice and Science for the Public Junius J. Gonzales, MD Symposium: Expanding Research and Evaluation Designs and Methods September 14, 2005

  2. Improving Quality Steeple chase, a race across country between a number of horsemen, to see which can firstreach some distant object, as a church steeple; hence, a race over a prescribed course obstructed by such obstacles as one meets in riding across country, as hedges, walls, etc.

  3. We Are Not Alone: Findings from a December 6, 2003 BMJ Report • All groups feel an urgent need to reconnect the funders, users, and providers of research • Users and researchers unanimously agree: • Responsibility for dissemination of findings and supporting its application does not rest with them • Context, culture and credibility issues

  4. The PLAYERS ACADEMIC RESEARCH BUSINESS POLICY Practice Communities Communities Patients Families SOCIETY

  5. Design/Methods Issues • Randomization vs. Ecological Realities • Goals (tensions in validity) • Reduce error variance • Increase signal to noise ratio • Decrease chances of type I and II errors

  6. Process: To Describe or to Quantify? • Can process data and theorizing help make the ‘business case’? • Variance and Process Theories (Langley 1999) • Balancing ‘accuracy, generality and simplicity’ • Can analytic strategies such as alternate templates or temporal bracketing help? • Tensions in ‘levels of evidence’

  7. Challenges & Opportunities • Learning from the terrific VA Experience – how to apply to other settings, populations? • What do we need? • Understanding modifiable mechanisms of change and not just identifying patterns? • Better utilizing and studying types of transfer? • Building research infrastructure in ‘real world’ settings

  8. Access and Engagement Organization Structure and Climate Intervention (“EBP”) External Environment (stigma, financing) Provider knowledge and behavior The Science to Services Challenge:Intervention (i.e. an “evidence-based-practice”) is only one piece of the implementation puzzle

  9. ‘The difficulty lies, not in the new ideas, but in escaping from the old ones.’ John Maynard Keynes

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