Philipp;
The Spinal Cord Injury Knowledge Mobilization Network of which I am Scientific Director is a learning and innovation collaborative that utilizes participatory action research methodology to ensure that knowledge producers are knowledge users are knowledge producers etc; all of this in the interests of continuous optimization of patient outcomes and provider performance.
As such SCI KMN embraces, and invests in participants in nested roles as depicted in the recently posted survey synthesis by Catherine Fisher.
Regards
Rick

Thank you Louise and thank you Rick.
Rick, that sounds very interesting. Do you find that this approach requires a lot of commitment and time from the participants? What are their motivations to participate (in this way)?
Thanks again for your comments.
Best wishes,
Philipp

Philipp;
Time and intellectual commitments from the participants, while a challenge, is key. While they are motivated with respect to doing their best for their patients, practicalities of their 'day jobs' are an issue. To circumvent this reality, our investment in their organizations represents a Full Time Equivalent salary per year which the organizations can use at their discretion in support of activities of the collaborative.
Regards;
Rick

Rick,
I see. Do organisations use that "position" in similar ways or do they take different approaches dependent on their context?
Are you familiar with this paper by Chandler et.al.? It might be an interesting read for you if I understand your context right? http://www.ncbi.nlm.nih.gov/pubmed/18384669
Best wishes,
Philipp

Philipp;
The mindline-guideline spectrum debate is alive and well! Physicians in particular tend to position themselves to the left of middle of this spectrum where the organizations within which they work (if they do so) are more inclined to be in the right of middle position where performance measurement is captured within the organization's quality scorecards.
Since most performance measures for evidence-based guidelines are rate-based (eg. '% of patients receiving the intervention'), alignment between physicians and other clinicians in their organizations is possible as long as the 'mindline-guided decision' for a particular group of patients is removed from the denominator, but, more importantly, is documented within the quality scorecard, and utilized in the interests of continuous quality
improvement.
All of this of course in the interests of accountability to patients and to the system that serves them. In this regard the pressures for accountability are increasing as, at least in the Canadian context, health is moving to a 'pay for performance' funding model.
Best regards;
Rick

Hello Rick,
It is interesting how you see the "mindline-guideline spectrum" as a individual vs. organisational (performance measure) issue. Do you think that the fact that mindlines exist and how they are constructed has important implications for the performance measuring in organisations? Do you think that the gap between the two is inherent to the way things seem to develop (individual practice on the one and pay for performance funding models on the other side) and do you think it is up to people in positions like your own to find bridges?

What you say about the funding models is true for the UK context as well. It is also something that can be observed in other sectors (especially academia). In my opinion it is connected to the still increasing influence of managerial thinking in some sectors that were traditionally rather far away from it. Its character of quantification, categorisation and dividing seems to bring these changes about.
Best wishes,
Philipp

Philipp;
Some of us, and I speak of senior colleagues in our professional federation, see P4P as one catalyst, among others, to align the physician practitioners with other clinician professionals in organizations. Others include posting of Quality Improvement Plans to which the organization is held accountable in the P4P scheme, and a higher order health jurisdiction focus on quality (eg. the recently crafted Health Quality Ontario department, and in Quebec the National Institute of Excellence in Health and Social Services).

I am of the opinion that the mindline-guideline hiatus is fundamentally related to the cognitive dissonance displayed by health jurisdictions failing to hold physician-clinician groups accountable for their services while doing so for other clinicians linked to organizations. But we are beginning to see some high level decision-making in some health jurisdictions to address this dissonance.

As for bridges, that's what the work is all about in the interests of the value proposition and its measures.
Regards;
Rick

Thanks Rick. Good to see people building bridges :)
P4P surely is a catalyst. However, sometimes it catalyses the wrong things. Every initiative has to be aware of that risk and I think that the guidelines-mindlines difference points to this risk.
Best wishes,
Philipp

Philipp;
All things considered I retain a good measure of optimism that the mindline-guideline is shifting to the 'right'. As an example, when I first became engaged in building innovation fluency in organizations (a regional acute stroke program), the physician group represented barriers. As time has gone on, and with the increasing alignment of organizations with accreditation bodies for certification for specific programs (eg. Accreditation Canada's Stroke Distinction Program), there is broad buy in to meeting the performance standards required.
Regards;
Rick