Recommendation #5: Use out-of-the-box thinking
An adage in quality improvement is that “every system is designed to achieve the result it gets.” Why is deprescribing so challenging? Because the health care system is constructed in a manner that foils attempts to deprescribe in manifold ways. Tinkering around the edges of this system is likely to do little good.
Rather, we are likely to have the greatest impact on deprescribing by finding ways to bypass or step outside the system or to co-opt it for our own benevolent ends. For example, changing clinician behavior is notoriously difficult in many health systems. So, some of the most interesting deprescribing interventions have come from bypassing the system and most clinicians, bringing deprescribing messages and behavior change strategies straight to patients.5 Or, given the difficulty getting busy and overwhelmed clinicians to deprescribe, some pioneers have created their own dedicated deprescribing clinics. There is no single right answer, but in general we are likely to get more traction by embracing innovative, non-traditional approaches that bypass systems-level barriers than by butting up against them.