Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

I am struck by how far research in this area has come since the initial randomized controlled trials. At that early stage, our efforts to examine the processes of facilitation were to be able to report on the fidelity of the intervention delivered as compared to the study protocol. Donahue and colleagues in this paper are studying the processes of quality improvement in a way they describe as the natural history of practice transformation. Rather than a facilitation intervention research project they are studying a quality improvement program that is state wide.

Donahue et al's work is precisely the kind of research that is needed now in this field. We do not need more randomly controlled trials to prove that it works. We need insight to how and in what circumstances it works as a program. Given the high cost of effective QI, one wonders if the practices that are "engaged" but not improving from the effort should wait and try again when they are better able to benefit. The resources could then be applied to activated and transforming practices.

I was amused by the QI effort to discourage the geese from hanging around the parking lot of one of the practices. As a Canadian researcher I feel the need to speak up. If these were Canadian geese, the practice must invoke a very slow PDSA cycle and wait a full year before they conclude whether or not they have been successful. The geese will leave and fly north in the spring regardless of what the practices does!

Competing interests:   None declared