Challenges with the implementation of new methods in clinical neurophysiology: What are the rate limiting steps?

Abstract

New methods often spread by means of passionate individuals who see the greater perspective and purpose of the technique. The great challenge then, is to inspire local colleagues, superiors, administrators and technical staff. Accordingly, methods should provide a major advantage to previous methods or fill in a hitherto weak spot in the diagnostic armamentarium. A conservative attitude/skepticism over new methods can be due to: lack of first line evidence evidence exists, but implementation requires a major paradigm shift inertia and lack of resources in the system new methods require time and brains for implementation, some basic concepts may be hard to follow clinical interpretation may be difficult, it may pertain very few patients, and make it difficult to get experience methods may be extremely expensive and time consuming, limiting implementation to resourceful sites. The implementation process must be performed in an appreciative atmosphere, to motivate all parts. Often it is advisable to start with small scale implementation, then gradually including more of the staff. A do-plan-study-act approach is advised to optimize the method before large scale implementation.