Clinical inquiry can result in evidence-based recommendations for changes in clinical practice. However, sustaining the recommended changes over time is challenging, even in cases where the change clearly improves patient outcomes. Other steps in the inquiry process, such as identifying a clinical problem, designing a project to test a solution, or recommending a change in practice based on study results, all seem easier. Planning for the necessary work processes and monitoring the outcomes over the long term, which are both necessary to sustain the improvement, often go by the wayside. To sustain change, one needs to prioritize a few simple measures—by determining which of many changes are critical to safe and effective patient care—and then hardwire the monitoring of the outcome into the usual activities of everyday work. New approaches for achieving sustained improvements are emerging, in part as a result of the...

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