Editorial: The Fundamentals
Although a great deal has been written about what we do not have, what
about what we do have? What we do have are advances in
We have the tools to deal with the challenges at hand. So why, per the IOM, is our healthcare system "plagued by a serious quality gap"? Put simplistically, we may be overlooking our fundamentals and not working with what we do have. These fundamentals are process redesign, EBP, and change management. The limitations do not lie in the technological possibilities but in the oversight of these fundamentals, which are required for successful technological adoption.
Many organizations are struggling because they are trying to use technological tools without adequate knowledge. A lack of knowledge not just with the actual technology but, more importantly, with the foundational fundamentals needed to ensure the success of the technology's use in practice.
New systems are put into place over existing ineffective processes
within an institution. Anecdotal nursing and medicine are still being practiced
instead of evidence-based healthcare. Insufficient attention has been given to
establishing the social, cultural, and practice changes that have to precede
technological initiatives. The magnitude of change required in implementing
Without the fundamentals in place first, unrealistic expectations are formed relating to the technology's ability to provide a solution. A lack of attention to the fundamentals results in costly systems that go under-utilized. When the system falls short, the credibility of future
initiatives may also be diminished.
What we do have is the ability to re-design ineffective processes,
implement evidence-based research into practice, and proactively manage the
changes. These fundamentals serve to facilitate, promote, and bring to the
hands-on clinician the tools necessary to improve