{"title":"超越障碍与推动者:医师主导创新利益驱动的定性研究","authors":"Miriam Wiersma, Ian Kerridge, Wendy Lipworth","doi":"10.1111/jep.70274","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Rationale</h3>\n \n <p>Clinical innovation—where physicians develop and use novel interventions that differ significantly from standard practice and that have not been shown to be sufficiently safe or effective for regular use in healthcare systems—has the potential to transform patient care and drive medical advancement. However, it is not without risk.</p>\n \n <p>It is important, therefore, that policymakers and healthcare institutions develop strategies to encourage responsible clinical innovation. For these strategies to be effective, they need to be based on a comprehensive understanding of the factors driving physicians' development and use of innovative interventions. While research has provided important insights into contextual barriers and facilitators, individual factors, particularly physicians' interests, remain underexplored.</p>\n </section>\n \n <section>\n \n <h3> Aims and Objectives</h3>\n \n <p>The aims of this qualitative study were to investigate the factors that drive and deter clinical innovation in diverse medical specialties and to examine whether these factors differ significantly between specialties.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>Thirty-one semi-structured interviews were conducted with Australian physicians from surgery, reproductive medicine, and cancer care.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Physicians' interests (e.g., obligations to patients and personal financial concerns) were perceived to play an important role in driving their use of innovative interventions, along with individual traits and contextual factors. There were also significant differences between specialties—with fertility specialists and surgeons more strongly emphasizing financial and commercial interests as key drivers of clinical innovation than oncologists.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our findings suggest that while addressing structural barriers to clinical innovation at the health system level remains important, policymakers must also give attention to the diverse interests of physician-innovators. Understanding these interests, the ways in which they align and conflict, and which are most prominent across different specialties, will enable policymakers and healthcare institutions to develop targeted strategies to encourage physician-led innovation and ensure it is responsible.</p>\n </section>\n </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 6","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70274","citationCount":"0","resultStr":"{\"title\":\"Beyond Barriers and Facilitators: A Qualitative Study of the Interests Driving Physician-Led Innovation\",\"authors\":\"Miriam Wiersma, Ian Kerridge, Wendy Lipworth\",\"doi\":\"10.1111/jep.70274\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Rationale</h3>\\n \\n <p>Clinical innovation—where physicians develop and use novel interventions that differ significantly from standard practice and that have not been shown to be sufficiently safe or effective for regular use in healthcare systems—has the potential to transform patient care and drive medical advancement. However, it is not without risk.</p>\\n \\n <p>It is important, therefore, that policymakers and healthcare institutions develop strategies to encourage responsible clinical innovation. For these strategies to be effective, they need to be based on a comprehensive understanding of the factors driving physicians' development and use of innovative interventions. While research has provided important insights into contextual barriers and facilitators, individual factors, particularly physicians' interests, remain underexplored.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aims and Objectives</h3>\\n \\n <p>The aims of this qualitative study were to investigate the factors that drive and deter clinical innovation in diverse medical specialties and to examine whether these factors differ significantly between specialties.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Method</h3>\\n \\n <p>Thirty-one semi-structured interviews were conducted with Australian physicians from surgery, reproductive medicine, and cancer care.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Physicians' interests (e.g., obligations to patients and personal financial concerns) were perceived to play an important role in driving their use of innovative interventions, along with individual traits and contextual factors. There were also significant differences between specialties—with fertility specialists and surgeons more strongly emphasizing financial and commercial interests as key drivers of clinical innovation than oncologists.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Our findings suggest that while addressing structural barriers to clinical innovation at the health system level remains important, policymakers must also give attention to the diverse interests of physician-innovators. Understanding these interests, the ways in which they align and conflict, and which are most prominent across different specialties, will enable policymakers and healthcare institutions to develop targeted strategies to encourage physician-led innovation and ensure it is responsible.</p>\\n </section>\\n </div>\",\"PeriodicalId\":15997,\"journal\":{\"name\":\"Journal of evaluation in clinical practice\",\"volume\":\"31 6\",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70274\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of evaluation in clinical practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jep.70274\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of evaluation in clinical practice","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jep.70274","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Beyond Barriers and Facilitators: A Qualitative Study of the Interests Driving Physician-Led Innovation
Rationale
Clinical innovation—where physicians develop and use novel interventions that differ significantly from standard practice and that have not been shown to be sufficiently safe or effective for regular use in healthcare systems—has the potential to transform patient care and drive medical advancement. However, it is not without risk.
It is important, therefore, that policymakers and healthcare institutions develop strategies to encourage responsible clinical innovation. For these strategies to be effective, they need to be based on a comprehensive understanding of the factors driving physicians' development and use of innovative interventions. While research has provided important insights into contextual barriers and facilitators, individual factors, particularly physicians' interests, remain underexplored.
Aims and Objectives
The aims of this qualitative study were to investigate the factors that drive and deter clinical innovation in diverse medical specialties and to examine whether these factors differ significantly between specialties.
Method
Thirty-one semi-structured interviews were conducted with Australian physicians from surgery, reproductive medicine, and cancer care.
Results
Physicians' interests (e.g., obligations to patients and personal financial concerns) were perceived to play an important role in driving their use of innovative interventions, along with individual traits and contextual factors. There were also significant differences between specialties—with fertility specialists and surgeons more strongly emphasizing financial and commercial interests as key drivers of clinical innovation than oncologists.
Conclusions
Our findings suggest that while addressing structural barriers to clinical innovation at the health system level remains important, policymakers must also give attention to the diverse interests of physician-innovators. Understanding these interests, the ways in which they align and conflict, and which are most prominent across different specialties, will enable policymakers and healthcare institutions to develop targeted strategies to encourage physician-led innovation and ensure it is responsible.
期刊介绍:
The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.