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Beyond the Dusty Shelf: Shifting Paradigms and Effecting Change

机译：超越尘土飞扬的架子：转变范式，影响变革

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This paper addresses how to make happen the improvements in the quality of health care that have been identified from significant investments in patient safety research by the Agency for Healthcare Research and Quality (AHRQ). We make the case that the usual supply-side research model is inefficient to produce the health care changes expected from AHRQ. We propose a shift to a demand-side paradigm that engages users throughout the research process, and two models to guide the management of 'action production.' The first model is based on Rogers' model of diffusion of innovations, which indicates that users must absorb a great deal of information in a variety of staged and specific ways in order to make a successful passage from knowledge to action through tactics including awareness, persuasion, adoption, implementation, and confirmation. The second is a decision model, termed distillation, which provides a framework for determining the potential utility and priority of an innovation based on the strength of the science, potential impact, adoptability, and readiness. We address lessons learned from the application of these models to the early implementation experiences of five early outputs from the AHRQ patient safety portfolio. We find that the implementation of the early findings places a strong reliance on information dissemination mostly at the awareness and persuasion stages--efforts directed at the later stages of decision, implementation, and confirmation have been modest. Ongoing evaluation of the impact of these approaches on patient safety practices and quality of care will indicate if the models provide useful guidance in making changes happen.

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