Education and debate

Personal paper: Beliefs and evidence in changing clinical practice

^a Centre for Quality of Care Research, Universities of Nijmegen and Maastricht, Postbox 9101, 6500 HB Nijmegen, Netherlands

	Introduction

That improvements are possible in many areas of clinical care has become increasingly clear. The different players within health care, however—clinicians, epidemiologists, health services researchers, educationalists, social scientists, economists, health authorities—often have different ideas on the best strategies to improve practice and the best way of making changes.

	An example

Let us assume that aggregated data, collected by health authorities, disclose that the rate of caesarean section in a specific district is exceptionally high. A committee is formed with experts and representatives of various interests to develop plans for improving obstetric care. Hearing the problem, all are worried.

The clinician either denies there is a problem or proposes setting up a well designed course to increase clinicians' knowledge and skills.

"OK," says the clinical epidemiologist, "but we first need to know what the evidence is on the indications for a caesarean section. We should perform a meta-analysis and come . . . [Full text of this article]

Summary points

	Approaches and theories

	What is the evidence?

	A model for implementing changes

	Conclusions

	References

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