Simplistic Problem Analysis Reinforces Reform Resistance


Setting up yet another research study or pilot initiative is commonly used to avoid making and acting on hard decisions about changing comfortable, but unproductive behavior. This avoidance pattern occurs even when we have evidence that our clients are not being well served; even when there have been a series of previous delaying tactics.

The new research or pilot initiative is doubly damned if it is hastily conceived and built on overly simplistic problem analysis. For example, when we see professional behavior not meeting best practice standards we assume that more education is needed for the practitioner. Hence, the large and very remunerative market in professional continuing education. It is not necessarily a lack of practitioner knowledge, skills or appropriate attitude that prevents best practice.

Often practitioners are not aware of the gap between their practice and best practice or not aware of relevant guidelines for best practice. There are also human limits on information processing. There may be too many simultaneous and even conflicting phenomena to observe and uncoordinated guidelines to apply. Financial incentives often maintain the status quo.

Other barriers built into the local structures may similarly prevent improved behavior patterns. Organizational barriers to change would include lack of more appropriate skill mixes, for example, nurse practitioners, advance practice technologists or visiting case workers. The local peer group culture may militate against any behavioural change or even engagement in innovation experimentation.

An accurate and shared understanding of both the problem behaviors and the barriers to changing those behaviors are prerequisites to overcoming reform resistance.

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