Improving clinical effectiveness: a practical approach

J Eval Clin Pract. 1997 Nov;3(4):255-64. doi: 10.1046/j.1365-2753.1997.t01-1-00002.x.


The publication of the government white paper 'Working for Patients' (1989, HMSO) and implementation of subsequent NHS reforms has led to the development of a great number of initiatives designed to improve the quality of patient care and to make the provision of care more clinically and cost effective. Many of these initiatives, whilst laudable, have been developed in isolation and often without proper consideration of how they relate to one another or might practically be implemented throughout the NHS. It has commonly been the case that attempts to transfer the initiative from an environment of high enthusiasm and, often, high resource to the NHS in general has either failed or led to poor application. Strategies to improve clinical effectiveness have not become a feature of the everyday practice of many, let alone most or all, clinicians in the NHS. The result has been their failure significantly to raise standards of care across the NHS as a whole. It is suggested that many of the initiatives are closely related, and more effective implementation in the NHS as a whole may follow attempts to integrate them in a more practical approach to care management within an organization-wide clinical effectiveness strategy. It is further suggested that this is best achieved by a continuous quality improvement approach focusing on the care process as the centrepiece of the initiative, and that this method will lead to significant improvements not only in clinical effectiveness but also in cost effectiveness. This paper describes a proposed method of achieving these goals.

MeSH terms

  • Cost-Benefit Analysis
  • Critical Pathways / economics
  • Critical Pathways / organization & administration
  • Critical Pathways / standards
  • Delivery of Health Care / economics
  • Delivery of Health Care / organization & administration
  • Delivery of Health Care / standards
  • Health Care Reform
  • Health Resources / economics
  • Health Resources / organization & administration
  • Health Resources / standards
  • Humans
  • Management Audit
  • Medical Audit
  • Organizational Culture
  • Organizational Objectives
  • Outcome Assessment, Health Care
  • Patient Care / economics
  • Patient Care / standards
  • Patient-Centered Care / economics
  • Patient-Centered Care / organization & administration
  • Patient-Centered Care / standards
  • Process Assessment, Health Care
  • Quality Assurance, Health Care* / economics
  • Quality Assurance, Health Care* / methods
  • Quality Assurance, Health Care* / organization & administration
  • Quality Assurance, Health Care* / standards
  • Risk Management
  • State Medicine / economics
  • State Medicine / organization & administration
  • State Medicine / standards
  • Total Quality Management
  • United Kingdom