• 1. Too often, interventions/programs/clinical pathways designed to enhance adherence to clinical "best practices" have not been preceded by a thorough enough assessment of the barriers/obstacles to success.
• 2. Changing medical practices is a process that requires time: time for changing an institution's culture, time for reorganizing resources or finding the financial support to add resources where necessary. Many other possible interventions will likely be necessary to finally lead to changes in practice. People need time to adapt their practice. Once they see the benefit and the improvements in the quality of their work, they will be more willing to implement the accepted changes.
• 3. It is crucial to develop and implement a system for the continuous improvement of COPD medical practices, which will remain in place at your institution, independent of any other specific projects. Your plan should ensure continuity in terms of:
  • Interventions: By engaging different actors in the system to intervene, you will not depend exclusively on one specific person.
  • Evaluation: By having a continuous evaluation process, you can justify your activities and related resources, thereby diminishing the risk of losing the administration's indispensable support.

By identifying obstacles to adherence, and including healthcare professional perspectives on potential barriers and their solutions to bridge the gaps in care, a more successful intervention can be achieved.