Annals Journal Club: The Capability Framework

Article for Discussion

Ferrer RL, Carrasco AV. Capability and clinical success. Ann Fam Med. 2010;8(5):454–460.

Discussion Tips

This article is different from most Annals Journal Club selections. A theory piece, it provides a framework for us to see differently problems that often seem intractable from a narrower clinical perspective.

Discussion Questions

• What problem(s) are addressed by this article?

• How well does the opening case represent challenging patients in your setting? How responsive is your practice to the needs and opportunities presented by such patients?

• Do the article’s sections on epidemiological context, the disconnect between process and outcome improvements, and environmental barriers to healthy behaviors bring to mind shortcomings of your practice or health care system situation?

• How well does the capability framework reflect your life and clinical experience? Does this framework help you to see avenues to work on problems that previously seemed outside the bounds of your vision or clinical competence?

• How well grounded in literature or experience does this theory appear, as articulated in the article?

• What holes do you see in this framework?

• What are the implications of the framework for patient-centered care?

• Can you use Tables 1 and 2 to apply the framework to improve your care of a challenging patient you have seen this week?

• How might you develop practice systems and community partnerships to support application of the capability framework? What support already exists where you are?

• What policy implications are suggested by this theory?

• What research opportunities does this theory suggest? How might a participatory research approach² be used to pursue these opportunities?