Improving Patient Care

The Implementation of Change in Clinical Practice


  • Richard Grol, PhD, Professor and Director, Centre for Quality of Care Research [WOK], Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  • Michel Wensing, PhD, Senior Lecturer, Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  • Martin Eccles, MD, FMedSci, FRCP, FRCGP., William Leech Professor of Primary Care Research, Professor of Clinical Effectiveness (Personal Chair), School of Population and Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK

In the field of health care, a very large number of valuable insights, procedures and technologies become available each year. These come from well planned scientific research or careful experiments and evaluation in everyday practice. As many of these innovations are not adopted into daily practice, at the expense of improved patient care, it is crucial to understand how sucessful implementation can be achieved.

This book examinines the process of introducing change and innovation into practice. With chapters on identifying problems in the implementation, selecting strategies, effective implementation of policies, and evaluation of the success of the changes, this book provides a comprehensive overview of all of the elements involved in the successful implementation of change.
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Book information

  • Published: November 2004
  • ISBN: 978-0-7506-8819-2

Table of Contents

Introduction (Richard Grol)
1. Implementation of changes in practice(Richard Grol)
2. Theories on implementation of change in healthcare (Richard Grol, Marlies Hulscher, Michel Wensing, Martin Eccles)
3. Effective implementation: a model (Richard Grol, Michel Wensing)
4. Characteristics of successful innovations (Richard Grol, Michel Wensing)
5. Clinical guidelines as a tool for implementing change in patient care (Jako Burgers, Richard Grol, Martin Eccles)
6. Determinants of effective change (Michel Wensing, Richard Grol)
7. Methods to identify implementation problems (Michel Wensing, Richard Grol)
8. Selection of strategies (Richard Grol, Michel Wensing)
9. Dissemination of innovations (Richard Grol, Michel Wensing)
10. Educational interventions (Michel Wensing, Richard Grol)
11. Feedback and reminders (Trudy van der Weijden, Richard Grol)
12. Organisational and financial interventions (Michel Wensing, Niek Klazinga, Niek Klazinga, Richard Grol)
13. Patient-mediated stategies (Michel Wensing, Glyn Elwyn, Richard Grol)
14. Multifaceted interventions (Michel Wensing, Richard Grol)
15. Effective organisation of the implementation(Richard Grol)
16. Measuring changes in patient care: development and use of indicators (Joze Braspenning, Stephen Campbell, Richard Grol)
17. Experimental evaluations of change and improvement strategies (Martin Eccles, Jeremy Grimshaw, Marion Campbell, Craig Ramsay)
18. Observational evaluations of implementation strategies(Michel Wensing, Martin Eccles, Richard Grol)
19. Process evaluation of change interventions (Marlies Hulscher, Miranda Laurant, Richard Grol)
20. Economic evaluation of implementation strategies (Johan L Severens, Jody Martens and Michel Wensing)
Epilogue (Richard Grol)