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.