Quality of care: replacing or removing ineffective services

Clinicians have the important quality assurance task of implementing changes to treatments offered, on the basis of clinical effectiveness. Problems seem to arise when evidence emerges, casting doubt on the effectiveness of existing treatments, that require services to be substituted or reduced. In such cases, change is often slow and inconsistent across wide geographic areas. This study identifies factors that influence the success or failure of attempts to replace or reduce ineffective treatments. Success factors include the need for external support for a change, the development of training and education for staff, transitional resourcing and multi‐agency planning. Conflicting evidence, poor implementation planning, a lack of experience and internal organization issues were generally associated with failure.