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The 2015 Garrod Lecture: Why is improvement difficult?

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Improving antibiotic use requires moving beyond education and restrictions. Interventions should focus on decision support and feedback, integrating social science and workplace learning for sustainable, large-scale change.

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Area of Science:

  • Healthcare Improvement Science
  • Medical Education Research
  • Human Factors and Ergonomics

Background:

  • Despite recognition over 40 years ago, sustained, large-scale improvement in antibiotic use remains elusive.
  • Medical failures often stem from ineptitude (failure to apply knowledge) rather than ignorance.
  • Current interventions primarily focus on educating or restricting practitioners, neglecting knowledge application support.

Purpose of the Study:

  • To address the failure in achieving sustained, large-scale improvement in antibiotic use.
  • To explore the role of context in facilitating change and human performance.
  • To advocate for interdisciplinary approaches and a shift in professional education.

Main Methods:

  • Analysis of existing interventions for improving antimicrobial prescribing.
  • Emphasis on the need for interdisciplinary collaboration with social scientists.
  • Proposal for integrating human factors, improvement science, and educational research.

Main Results:

  • Most interventions fail to enable practitioners to apply existing knowledge effectively.
  • A deeper understanding of contextual factors is crucial for sustained improvement.
  • Rethinking professional education to embrace complexity and foster workplace learning is essential.

Conclusions:

  • Sustained improvement in antibiotic use requires interventions supporting knowledge application, not just education or restrictions.
  • Interdisciplinary approaches and understanding context are key to enabling change.
  • Workplace-based learning of improvement science can empower professionals as change agents for sustainable transformation.