Manville et al have presented an insightful account of their transitional care unit intervention to improve outcomes for elderly care patients.1
The authors were right to point out the limitations of their study. The main limitation was that it was conducted as a retrospective chart audit. However, this limitation was outweighed by the fact that this was real-world research with tangible, useful, and usable results. Questions about this field should not be so much about research methods but rather about how the research findings can be disseminated and taken up by other units. Before this happens a number of barriers need to be overcome. Perhaps the most important obstacle is to move the leadership agenda from the office environment, where chart audits might be conducted, to the ward environment, where leadership will have the greatest effect. This will require distributed leadership. All staff, including nursing and interdisciplinary staff, will need to be motivated to take part. They will need to be trained in quality improvement methods to drive forward change. They will need to be empowered not simply to reproduce the intervention described by Manville et al but rather to contextualize it for their own setting. Ultimately they will need to learn the skills of continuous measurement and plan-do-study-act cycles. Moreover, the culture of medicine and health care will need to change.
For too long, academic medicine has been almost exclusively about biomedical research. This has often been at the expense of paying adequate attention to those who run practical, outcomes-based research. All forms of research have their places, but the culture now likely needs to be rebalanced toward those engaged in more practical research.
Footnotes
Competing interests
None declared
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Reference
- 1.↵