Table 1

Defining and Identifying Generalist Best Practice–All Elements Must be Present

Defining Best Practice: Describing Quality Generalist PracticeRecognizing Best Practice: What You’d Expect to See in a Service Delivering Quality Expert Generalist Care
The goal(s) of care
Best care optimizes an individual’s health-related ability to continue their daily life.Individually tailored care is ENDORSED by health systems, professionals, and patients.
Individuals, practice teams, and organizational systems consistently and actively emphasize the value/importance of individual goal-related care.
Individual health-related capacity for daily living is ENHANCED by health services.
Contact with health services leaves patients better able to understand and to respond and adapt to their illness experience, resulting in enhanced capacity to manage daily living and health literacy; minimized illness burden.
The data used in practiceGeneralist practice is ENABLED by:
Best care is informed by scientific evidence, together with patient accounts of experience, contexts, and preferences; and professional experience of illness and disease in this patient’s particular context.9
Scientific evidence is viewed not as “top of an evidence hierarchy” but rather 1 source of a wide range of data, information, and knowledge to be used in interpreting what is wrong and what might need to be done.
Contact time with patients is designed to support access to, and use of, an appropriate range of data sources.
Informational continuity: accessible, appropriately completed, updated, and summarized records to provide patient context data
Scientific data: readily accessible in formats that are suitable for patients and professionals, eg, guideline summaries, decision aids
Patient-centered consultation spaces that enable both parties to exchange patient accounts of experience, context, and preference
Professional-centered work spaces that provide opportunities outside of the consultation for the creation, use, and maintenance of locally constructed “mindlines,” a term to describe “collectively reinforced, internalized tacit guidelines” constructed from brief reading, tacit knowledge, and interactions with professionals and patients; so creating “knowledge-in-practice-in-context.”10
The tasks of clinical practice
Best care recognizes the intellectual task of the clinician to integrate data, information, and knowledge; to construct a unique individual interpretation of illness experience; to safety-net/check that interpretation (including appropriate follow-up); and to empower the patient to own the decision process.Clinicians are trained in, and confident to use, the skills needed for the intellectual task of using data to construct new context-sensitive knowledge about this individual.
Clinicians and patients perceive that they work in an enabling context with adequate resources to support this form of practice (including prioritization of workload).
Process of care is described with reference to the context in which clinical decisions are made and not just on the basis of the decision itself.
Assessment of quality of care/practice
Quality of care is described with reference to the context in which clinical decisions are made and not just on the basis of the decision itself; and assesses whether context and care have ideally enhanced— certainly not undermined—health-related capacity for daily living.Feedback and monitoring processes assess both the context of, and outcomes from, care from a person-centered perspective.
Services support longitudinality11 of care—to observe the impact of personalized clinical decision making—is evident.
Clinicians and patients are supported to judge the quality of care (decision making) based on the goal/impact of the decision over time rather than any decision itself.