The majority of clinicians and physicians are averse to changes in practice or in the institution that they work in that would improve the quality of care delivered by the practitioner and the institution. This is the conclusion of a study of 25 years of quality improvement attempts in the medical field conducted by Dr. Noah Ivers from Women's College Hospital. The study was published in the June 25, 2014, edition of the Journal of General Internal Medicine.
Ivers evaluated the effect of quality improvement regimens that were presented in 62 studies in the scientific literature and found that only 28 percent of the recommendations were adopted by the majority of practicing physicians and clinicians. Only 10 percent of the recommendations produced a documentable improvement in the quality of health care delivered by a physician or institution. One should note that the health care industry was one of the last industries in the United States to adopt stringent quality control practices.
Ivers found that physicians behave very much like teenagers when presented with a need to change behavior. Like teens, doctors would accept an improvement from a colleague or equal but not from a superior in the institution’s administration or from a patient. Like teens, doctors implemented quality improvement changes only after repeated requests. The change had to be laid out step-by-step for the doctors because the majority could not make a quality plan for themselves. There had to be an added value for the doctor beyond improvement in quality before the doctor would make a quality improvement.
Dr. Ivers contends that there is no discernible change in the behavior of physicians, clinicians, or health care institutions despite the necessity to improve quality as mandated by the Patient Protection and Affordable Care Act (PPACA) also known as “Obamcare”. The PPACA cannot sustain itself financially unless stringent quality changes in practice occur that reduce costs. In states that opted out of the PPACA like Alabama, clinical quality assessment is done by an understaffed state run program that has had its budget cut to reduce the loss of Medicaid funds to the state.
The PPACA cannot work without quality improvement changes. Physicians are in majority oblivious to changes that improve quality of care. While the PPACA does create a structure that imposes financial losses on physicians and institutions that do not improve the quality of care the study indicates that the health care industry as a whole does not care.