Evidence-based care: 4. Improving performance: how can we improve the way we manage this problem? Evidence-Based Care Resource Group.

The first step in improving physician performance when there are gaps between what physicians are doing and what they should be doing is to diagnosis the causes of suboptimal care. This "diagnosis" then guides the selection of the most efficient and effective strategies to improve performance. Some behaviours may be easy to change, but the factors that cause suboptimal care often present formidable barriers. Physicians are most likely to improve their performance in these situations if they use a combination of strategies that predispose them to provide improved care, enable them to do so and reinforce these changes in behaviour. Feedback on progress is always important, to ensure that physicians adapt and to provide personal satisfaction and positive reinforcement when performance does improve. Individualized strategies are also important: there are differences in physicians' learning experiences, practice environments and needs. Therefore, each physician must tailor his or her methods for learning and improving performance to his or her individual clinical practice.