The research, led by pharmacist-researcher Aili Langford of the University of Sydney and Monash University’s Centre for Medicine Use and Safety, together with colleagues including deprescribing specialists Barbara Farrell of the Bruyère Research Institute in Ottawa, Wade Thompson of the University of British Columbia, and Emily Reeve of Monash University, involved in-depth interviews with 24 Australian healthcare professionals. The sample comprised ten medical practitioners—specialists spanning cardiology, clinical pharmacology, emergency medicine, general practice, geriatrics, nephrology, and psychiatry—alongside nine pharmacists and five nursing professionals, recruited across five Australian states and territories through professional organizations, social media, and the Australian Deprescribing Network. Between March and October 2024, participants completed semi-structured interviews lasting 33 to 56 minutes, in which they dissected real deprescribing recommendations drawn from published guidelines, ranked deliberately varied versions of the same recommendation, and explained what would make them follow such advice at the bedside. The team then analyzed the transcripts with thematic framework analysis, deductively mapping the data onto the Guideline Language and Format Instrument, or GLAFI—a validated tool that specifies how the wording, structure, and layout of guideline recommendations determine whether clinicians adopt them or abandon them—while remaining alert to themes the instrument could not capture.

The stakes are anything but academic. Deprescribing—the clinician-supervised process of tapering or stopping medications that are inappropriate or no longer necessary—remains uncommon, while the global prevalence of potentially inappropriate medication use continues to climb. Single-disease guidelines, which dominate clinical practice, routinely fail to account for older adults living with multiple conditions, generating stacks of disease-specific recommendations that can cumulatively promote polypharmacy, drug interactions, and medication-related harm. Class-specific deprescribing guidelines do exist for benzodiazepines, proton pump inhibitors, antipsychotics, and antihyperglycemic agents, among others, but their advice has never been routinely woven into mainstream treatment guidelines. A recent scoping review by the same research group found that only two percent of evidence-based deprescribing recommendations were supported by high-certainty evidence—a stark measure of the evidentiary hole that guideline developers are being asked to write their way out of.

The first and most striking finding was a double standard. Participants consistently described deprescribing as a distinct, more complex, and higher-risk clinical activity than initiating a drug, and consequently demanded far more from any recommendation telling them to do it. They wanted the full decision logic spelled out—who is suitable for deprescribing, who is responsible, which medications, when, and why—but above all, how: explicit tapering regimens, monitoring parameters, co-interventions, and strategies for engaging patients in the conversation. “With deprescribing, it’s much more common than in prescribing to have to work out complex regimens…a little bit of handholding would definitely make someone more comfortable,” one physician told the researchers. GLAFI’s content checklist asks developers to state the action to be performed, by whom, for whom, and under what conditions, yet stays silent on these operational mechanics—the precise gap participants kept flagging. The authors argue the instrument itself will need extending for de-implementation, the deliberate withdrawal of established practices, which poses challenges that implementation frameworks built for rolling out new interventions were never designed to handle.

Stopping a medication also collides with deeply ingrained clinical psychology. Participants summarized the prevailing mentality bluntly: “adding things is doing good, taking things away is doing bad.” Because deprescribing is rarely incentivized in practice settings while prescribing is reinforced by clear guidance, workflow defaults, and entrenched habit, clinicians default to continuation—a pattern the researchers frame as clinical inertia. To counter it, participants favored direct, active-voice language of the form “we recommend A for B” over hedged phrasing like “consider this,” paired with explicit statements of the relative advantage of stopping, whether the benefit of deprescribing or the harm of continued use. Perceived legal exposure sharpened the reluctance: “It takes balls to deprescribe something that someone’s been on for a long time,” one physician admitted. And because deprescribing typically aims to avert future harm rather than deliver immediate benefit, the persuasive framing that props up prescribing recommendations is intrinsically harder to construct for the reverse maneuver.

Evidence, or the perceived absence of it, compounded the hesitancy. Many participants assumed deprescribing recommendations rest on expert consensus rather than robust trials—”it would be some well-intentioned group of clinicians coming up with what seems reasonable,” in one physician’s words—and several said weak, low-certainty recommendations were so off-putting that they would rather the evidence ratings be omitted entirely, even though that would violate current best practices in guideline development. The researchers argue this reflects a misunderstanding of what evidence ratings mean rather than a genuine design flaw, and calls instead for plain-language interpretation of GRADE-style ratings and targeted clinician education. Participants also exposed a striking double standard: prescribing recommendations built on trials conducted in younger, healthier populations are applied to older, more complex patients without question, while deprescribing advice lacking direct evidence is met with suspicion. Some argued that the absence of evidence for a drug’s ongoing benefit should itself justify stopping it, and that guidelines should distinguish “evidence of no benefit” from “no current evidence of benefit” so clinicians can judge for themselves—while still anchoring decisions in patient goals and preferences rather than rigid evidence thresholds.

The second theme captured a tension every guideline writer will recognize: clinicians want recommendations that are simultaneously succinct and complete. Ambiguous verbs were a particular worry. Terms such as “de-escalate,” “taper,” and “withdraw” leave it unclear whether dose reduction, abrupt cessation, or both are intended—a gap that can translate directly into harm when a drug requiring gradual weaning is stopped cold. “Taper slowly means nothing to anybody. Slowly for one person is a day and another person is a month…I think it’s quite easy for something like this to be misinterpreted or misapplied,” one pharmacist explained. Participants called for standardized, precise terminology—for example, “discontinue”—supported by glossary definitions, and they generally praised bullet points, color coding to signal evidence strength, and clinical algorithms that strip cognitive load from dense text and speed up decisions in time-poor environments.

Yet the same participants, when shown fully detailed step-by-step recommendations, judged them long, cumbersome, and overwhelming—text that nobody would actually read in a busy clinic. Recommendations offering multiple tapering regimens and co-intervention options triggered decision fatigue, delaying or deferring choices altogether. Intriguingly, some participants defended a degree of deliberate ambiguity, arguing that overly directive instructions risk a one-size-fits-all approach that tramples individual patient goals, while others complained that open-ended guidance left them feeling unsafe making the call. “The guidelines are meant to be guidelines, right? They’re meant to be giving you a direction. When it’s kind of open, I don’t feel good about making that call,” one physician said, while another bristled at the prospect of a “cookbook of medicine.” The authors suggest the resolution lies in flexibility of format rather than ambiguity of language: layered resources combining comprehensive technical documents, concise clinical tools, and plain-language summaries, plus multiple tailored options where the optimal strategy is genuinely uncertain.

Placement proved equally consequential. Some clinicians wanted deprescribing advice co-located with prescribing recommendations, so that the question of eventual withdrawal surfaces at the very moment of initiation, shifting deprescribing from a reactive response to adverse events—a fall, a hospitalization—toward proactive planning. “You might be prescribing it with no thought or intention of deprescribing it. But if you see that at the bottom of the article…you’re like, oh, hang on…I need to plan to wean this,” one physician reflected. Others preferred a standalone deprescribing section, reasoning that clinicians rarely open a hypercholesterolemia guideline to ponder statin withdrawal and that a dedicated section can hold broader principles and patient-conversation strategies beyond medication-specific advice. There was consensus, however, that paper alone is not enough: deprescribing advice must be embedded in national medicine handbooks, formularies, and prescribing and dispensing software, delivered as context-sensitive, patient-data-driven prompts engineered to avoid the alert fatigue that buries clinicians under notifications. Participants even envisioned artificial intelligence systems cross-referencing prescribing behavior against guidelines in real time, reducing reliance on external documents altogether.

Synthesizing the themes, the team distilled seven implementability design principles for deprescribing recommendations: specify the full decision logic—who, what, when, why, and how; use active, directive language with harmonized verbs; counteract clinical inertia with positive framing that states the relative advantage of stopping; standardize terminology and define it in a glossary; communicate the strength and certainty of evidence clearly, with plain-language interpretation; visualize information through bullet points, flowcharts, and algorithms; and place recommendations where clinicians will actually act on them, whether alongside prescribing guidance, in a dedicated section, or within digital workflows. The findings have already informed an international clinician survey designed to test preferred content, format, and terminology across a broader sample. The authors acknowledge the study’s limits—a qualitative design, an Australian volunteer sample, and analysis led by researchers with pharmacy backgrounds—while arguing the principles target universal features of clinical cognition, from cognitive load to the appetite for clear, directive guidance. If they hold up, guideline developers finally have a concrete recipe for writing the half of prescribing that has gone unwritten—a step that could shrink the burden of medications patients no longer need, before another 92-year-old like the nurse participant’s “Dot,” who fell while taking “a truckload of anti-hypertensives,” pays the price for medicine’s silence.

The healthcare system embodies a delicate equilibrium, where the interplay between governance frameworks and staffing determinations can significantly influence patient care quality. In Jamaica, as in many other nations, understanding how clinical governance structures influence the perceptions of healthcare providers is crucial. It acts as a catalyst for improving quality oversight and optimizing the staff-to-patient ratios, which are integral to enhancing overall care quality.

Clinical governance refers to the comprehensive framework through which healthcare organizations maintain and improve the quality of care provided to patients. It encompasses various elements, including risk management, clinical audit, and the cultivation of a culture that promotes continuous learning and improvement. This study shines a light on how such governance practices are perceived across different professional groups, each holding distinct yet interconnected views and experiences.

Nurses, often the frontline of patient care, possess unique insights regarding staffing adequacy and the operational dynamics of clinical governance. Their perceptions are particularly noteworthy since they interact with patients daily and witness firsthand the impact of staffing levels on care delivery. Through interviews and surveys, the study reveals that nurses often feel overburdened due to high staff-to-patient ratios, which can lead to decreased job satisfaction and increased burnout.

In contrast, physicians, while also closely tied to patient outcomes, often have a different vantage point. Their focus may lean more towards the intricacies of treatment protocols and diagnostic accuracy. However, the researchers discovered that physicians echoed some of the concerns raised by nurses regarding staffing levels. Many physicians highlighted that adequate nursing support is crucial for implementing effective treatment plans, thereby directly linking staffing levels to patient safety and care efficacy.

Senior managers, on the other hand, bring a strategic perspective to the discussion. Their role involves not only overseeing operations but also ensuring compliance with clinical governance frameworks. The study found that while senior managers recognized the challenges posed by inadequate staffing, they often felt constrained by budgetary restrictions and organizational policies. This tension between maintaining clinical governance standards and managing financial limitations underscores a critical area for improvement in healthcare administration.

Interestingly, the study also reveals a disparity in how each group perceives the effectiveness of existing governance structures. Nurses and doctors generally have more negative experiences with the governance frameworks in place, often identifying bureaucratic hurdles that impede their ability to provide care efficiently. In contrast, senior managers tended to view governance systems as sufficient but acknowledged the need for ongoing refinement and adaptation to current challenges.

The implications of these findings are profound, as they highlight the necessity for healthcare institutions to foster a culture of collaboration and open communication among all stakeholders. Engaging frontline staff in decision-making processes can bridge the gap between governance policies and real-world practices, ultimately leading to more effective healthcare delivery.

Moreover, the researchers advocate for comprehensive training programs that not only emphasize clinical competencies but also enhance understanding of clinical governance principles among all healthcare workers. By elevating awareness and comprehension of governance frameworks, healthcare professionals can be better equipped to contribute to quality improvement initiatives.

The study’s results also call attention to the importance of continuous monitoring and evaluation of both staffing levels and governance practices. Regular assessments can provide valuable insights into the effectiveness of implemented policies and identify areas requiring urgent attention. This ongoing evaluation allows for data-driven adjustments to be made, enhancing both the quality of care provided and the working conditions for healthcare professionals.

As the researchers disseminate their findings, it is evident that fostering an environment of shared responsibility between nurses, doctors, and management leads to a cohesive approach to patient care. Shared governance models, particularly those that empower all stakeholders, could serve as a transformative framework for healthcare institutions aiming to elevate care quality and employee satisfaction.

The study’s findings are particularly timely as healthcare systems worldwide continue to grapple with challenges posed by an aging population, increasing chronic conditions, and the stressors brought on by global health crises. By focusing on the voices of those who are most affected, the research not only elevates awareness but also provides actionable insights into how clinical governance and staffing can evolve to meet contemporary demands.

The collaborative nature of this research stands as a beacon for future studies in healthcare governance and staffing dynamics. It emphasizes the importance of a multimodal approach that incorporates qualitative and quantitative data to fully appreciate the complexities of healthcare delivery systems.

As the healthcare landscape continues to transform, this study highlights the urgency of addressing the alignment between clinical governance structures and real staffing challenges. With its implications resonating far beyond Jamaica’s borders, the research serves as a critical reminder that the path to improved healthcare quality lies in an understanding of and responsiveness to the needs of those at the forefront of care.

In summary, the perception of clinical governance and staffing from the perspectives of nurses, doctors, and senior managers uncovers a multi-faceted understanding of healthcare quality. By acknowledging these distinct perspectives, healthcare institutions can pave the way for innovations that enhance care delivery, ultimately leading to improved outcomes for patients and a more fulfilling working environment for healthcare providers.

Subject of Research: Clinical governance and staffing for healthcare quality perceptions.

Article Title: Clinical governance and staffing for healthcare quality: perceptions of nurses, doctors, and senior managers at two tertiary hospitals in Jamaica.

Article References:

Thompson, C., Nevins, D.H., Walters, D. et al. Clinical governance and staffing for healthcare quality: perceptions of nurses, doctors, and senior managers at two tertiary hospitals in Jamaica. BMC Health Serv Res (2025). https://doi.org/10.1186/s12913-025-13826-y

Image Credits: AI Generated

DOI:

Keywords: clinical governance, healthcare quality, staffing perceptions, nurses, doctors, senior managers, Jamaica.

Chronic health conditions often require continuous management and regular follow-up visits, which can significantly influence patient outcomes. However, maintaining a consistent engagement with healthcare services can prove challenging for patients. This study dissected the differences between high-temporally regular (TR) and low-TR clinics, ultimately aiming to uncover the primary factors that lead to successful follow-up patterns in patients with chronic illnesses. By employing qualitative methodologies, the researchers conducted semi-structured interviews with 46 healthcare professionals from 12 primary care clinics across Israel. The varied perspectives collected highlighted an emerging theme: the critical importance of interpersonal relationships and cohesive teamwork among healthcare staff.

As the researchers sifted through the data, numerous critical factors came to light. High-TR clinics demonstrated a fundamental commitment to systematic outreach and communication strategies aimed at engaging patients. Administrative staff in these clinics proactively reached out to patients, reminding them of upcoming appointments and encouraging their continued participation in follow-up care. This administrative initiative illustrates that patient engagement often begins long before a patient enters the clinic, showcasing the impact of an organized outreach approach on compliance with healthcare appointments.

Furthermore, the research underscored the significance of flat relational dynamics among healthcare staff. Traditional healthcare hierarchies can often create barriers to effective communication and collaboration. In contrast, high-TR clinics functioned with a more egalitarian structure that fostered open dialogue and teamwork. Staff members were encouraged to share their insights and suggestions, leading to innovative care strategies tailored to meet the needs of chronic patients. The ability to communicate transparently not only bolstered staff morale but also created an environment in which patient care was a collective responsibility.

In tandem with relational dynamics, the study found that regular meetings among staff played a crucial role in maintaining continuity of care. High-TR clinics scheduled frequent team huddles aimed at addressing patient care challenges, discussing ongoing cases, and sharing insights gleaned from their interactions with patients. This adaptive and reflective approach allowed teams to fine-tune their practices continuously, to ensure that they remained responsive to the evolving needs of their patients. The research indicates that consistent collaboration among staff is vital for creating a strong network of support for patients, enhancing their engagement and adherence to follow-up schedules.

Moreover, the involvement of multidisciplinary team members, including social workers, emerged as a vital component in the success of high-TR clinics. This multifaceted strategy enables clinics to address the broader determinants of health that patients face. Social workers provided essential resources and support to help patients navigate challenges such as transportation barriers, financial constraints, or mental health issues. By removing these obstacles, clinics not only improved patient retention rates but also fostered a more trusting and collaborative patient-provider relationship. The integration of social work into primary care teams serves as a compelling reminder of the interconnected nature of physical and social health.

Dr. Maram Khazen stressed the profound impact of relational dynamics within healthcare teams, noting that while clinical expertise is essential, collaboration among team members fundamentally shapes patient outcomes. In her words, “When staff work together as a cohesive team, they create an environment that supports patients more effectively and fosters trust.” This statement encapsulates the essence of the study—an appeal for healthcare providers to prioritize teamwork as much as clinical performance.

Likewise, Prof. Adam Rose accentuated the importance of cultivating a culture of adaptability within primary care settings. According to Rose, “By fostering a culture of teamwork and adaptability, we can significantly improve the long-term health outcomes for patients with chronic conditions.” This call to action resonates deeply within the context of a healthcare system continuously striving for better patient care. The findings urge clinic administrators and healthcare providers to reevaluate current frameworks and invest in creating teams that are not only skilled but are also integrated and responsive.

The study concluded with an actionable directive: healthcare teams must adopt a high-functioning, multidisciplinary approach to better manage chronic illnesses proactively. The unique insights gleaned from this research are poised to impact the future of healthcare delivery, particularly as the nation grapples with rising rates of chronic conditions. The study serves as a clarion call for transforming primary care into a holistic, team-oriented ecosystem where patient engagement is prioritized and nurtured through collaborative efforts.

In summary, Dr. Khazen and Prof. Rose’s research elucidates the profound effects of teamwork, relational dynamics, and proactive care strategies on improving follow-up care for chronic condition patients. This study serves not only as a significant contribution to the literature on healthcare delivery but also as an inspiration for healthcare professionals across the globe. By integrating these findings into everyday practice, the potential to revolutionize patient care and ultimately enhance health outcomes is not just a possibility – it is a necessity.

Subject of Research: Team collaboration in primary care to enhance patient follow-up for chronic conditions
Article Title: Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients
News Publication Date: 24-Mar-2025
Web References: DOI link
References: Annals of Family Medicine
Image Credits: N/A

Keywords: health care delivery, chronic conditions, patient engagement, multidisciplinary teams, teamwork, primary care, health outcomes, proactive care, relational dynamics, healthcare staff collaboration.