Showing posts with label fidelity. Show all posts
Showing posts with label fidelity. Show all posts

Friday, 25 January 2013

The words innovation and improvement can be misleading

If you want an idea or activity to be judged as good, then label it as an innovation or an improvement. Correct?  Well, I'm not sure it should be, but it seems that's what happens. I've been wondering why it is that the words "innovation" and "improvement" are assumed to represent "the good".

At a high level, there is an ethics issue; to whom does the "good" belong? New ideas often stem from crises, and crises are often either sourced from or produced by competition. When one side creates an innovation, the other side loses.

At a more detailed level, what worries me is that by labelling an idea or activity using words that come with the assumption of good, is that we:

  • fail to evaluate whether the idea does what it intends (fidelity; more about fidelity here)
  • fail to check whether there are unintended consequences in applying it
  • fail to understand the drive of the person or organisation behind it
  • urge the spread of a "good" practice, without assessing its value
  • just accept; and the more we just accept, the more we open the floodgates to ideas and activities which may no longer be what we need
There's a lot of talk in the NHS about the need for "innovation". It will be good when this is grounded into discussion about the problems that need to be solved and then the ideas and activities being introduced to solve them. Solutions need to stand on their own right, not be labelled to give them credibility.

Tuesday, 30 October 2012

Paper: Surgical Safety Checklist - more than checking a box

Fabulous - the authors have published a study where the results show there's a problem. I've been harping on about the lack of negative studies for years. So well done to the authors.

Basically, they've done some follow up work to see how well used the surgical safety checklist is. No surprises to discover that is most cases only 4 of the 13 items were checked. They suggest there is a problem with the fidelity of implementation, and a poor dissemination strategy and implementation.

Fidelity really is key. There's no point in shouting from the rooftops that 100 hospitals are using a checklist, for example, if it is not being used as intended. The results will not be as good as the pilot study. The return on investment for the project will not be as good. And, who knows, in some programs, the results may actually be worse than if the program hadn't been disseminated.

Fidelity. Important.

Surgery. 2012 Jul 6. [Epub ahead of print]
Implementing a surgical checklist: More than checking a box.
Levy SMSenter CEHawkins RBZhao JYDoody KKao LSLally KPTsao K.