Physicians have a great deal of autonomy when providing care, and this is an essential part of their work.  But can that autonomy in care delivery ever get in the way of adopting best practices?  When a provider determines an individualized course of action for their patients, does that more often lead to inconsistency, or does it more often ensure that patient-centered, personalized care is delivered?  These are interesting questions—ones that can be answered by examining the complexities within a healthcare system and how those systems have learned to adapt in different situations.  There is certainly a way to balance both physician autonomy and evidence-based medicine.  That way is through Agile Implementation (AI).

Consider this excerpt from an article in the Health Affairs journal…

“The success of the current EBM [evidence-based medicine] paradigm has been constrained by its orientation toward a traditional image of the autonomous medical professional decision-maker. The construction and implementation of clinical practice guidelines tend to remain the exclusive purview of leading experts and thereby regularly fail to take into account available resources and opinions of allied professionals, support staff, and patients who will be directly affected by the guidelines. Adherence to guidelines is also seen as a matter of individual choice. In keeping with traditional conceptions of professional autonomy, few mechanisms have been put in place to encourage the use of EBM or to discourage individual deviation from accepted guidelines. The individualistic, voluntary, and exclusive character of EBM as it is largely implemented undermines its overall effectiveness as a tool for improving care.

Addressing these difficulties does not necessarily require placing greater emphasis on enforcement but requires the introduction of explicit strategies to take advantage of the interdependent and collaborative character of medical work. A multifaceted approach tailored to local stakeholders and their differing interests is one such strategy that solves the problem of transparency without undermining professional autonomy. In the current health care climate, clinical practice guidelines used to capitalize upon interdependency and coordinate collaboration, as well as to install uniform best practices, increase the likelihood of a better standard of medical care.”¹

Here at the Center for Health Innovation and Implementation Science, we offer Agile Implementation as that “multifaceted approach.”  The strategy of using Agile Implementation to address the multi-dimensional equation of care delivery results in evidence-based care while preserving the autonomy of the provider.  Because AI was founded on the framework of Complex Adaptive Systems theory, it is an all-encompassing strategy for both healthcare quality improvement and change management.

“A CAS [Complex Adaptive System] has the ability to adapt and evolve in response to changes in its environment (internal and external) by learning from prior experiences.  As such, the capability of the organization to adapt to internal and external changes depends on individuals’ characteristics as well as local organizational structures and environment.  This is a key factor for why a CAS provides an accurate framework for healthcare delivery organizations”² (Boustani, Azar, Solid p. 62).

Agile Implementation takes into account the complexities of the system and its surrounding environment, and therefore leads to more sustainable and successful results than traditional linear change implementation.  For clinicians and health systems, this means that through AI you can determine the most human-centered solutions and implement them in the way that fits best within your organization.  This is an important differentiator of Agile Implementation, because the best care is the care that considers the personalized needs of the patient and staff while also following the most validated, evidence-based clinical practices.

Are you passionate about implementing evidence-based practices to improve the quality and value of the care that you provide?  Do you have clinical staff who would benefit from training in change management?  Learn more about the foundations of Agile Implementation so that you can apply them in your health system by visiting http://www.hii.iu.edu/.  Here you will be connected to resources and training from the IU School of Medicine’s Center for Health Innovation and Implementation Science, like our 3-day Agile Implementation Boot Camp and our professional certificate in Health Innovation & Implementation Science.

References

• Timmermans, S., & Mauck, A. (2005). The Promises and Pitfalls of Evidence-Based Medicine. Health Affairs, 24(1), 18–28. Retrieved from https://doi.org/10.1377/hlthaff.24.1.18
• Boustani, M., Azar, J., & Solid, C. A. (2020). Agile Implementation: A Model for Implementing Evidence-Based Healthcare Solutions into Real-World Practice to Achieve Sustainable Change. New York, NY: Morgan James Publishing.