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Right Care, More Patient Safety, & Professional Fulfillment
Lavin and Anderson [1] first published a paper on appropriateness in health care in 1996. 
Yet, twenty plus years on, it is only just now that we are starting to realize the importance of this concept to the sustainability of health care systems. 
Their paper described appropriateness as of two distinct types: 
1. Appropriateness of a service - related to patient safety and outcomes.
2. Appropriateness of the setting in which care is provided - related to cost effectiveness.
Canadian Medical Association (CMA) issued a policy paper in 2014 on 'appropriateness in health care' [2]
CMA in their paper suggested that in order to be truly useful in promoting quality and value, appropriateness must be understood to mean:
> the right care, 
> provided by the right provider, 
> to the right patient, 
> in the right venue, 
> at the right time.
Both these landmark papers further identified a need for objective tools & methods by which to assess appropriateness. 
Need for a framework to measure appropriateness.
CMA's paper suggested the following two policy recommendations for operationalizing the concept of appropriateness in its entirety.
1. Provinces and Territories should work with providers to develop a comprehensive framework by which to assess the appropriateness of health care.
2. Provinces and Territories should work with providers to develop robust educational products on appropriateness in health care and to disseminate evidence-informed strategies for necessary changes in care processes. 
Little progress to date.
To date, there has been no framework designed to describe, assess & measure the adoption of appropriateness in health. 
Furthermore, there also exists a clear lack of common understanding as to what the concept of appropriateness really means in practical terms. This again could also be attributed to the lack of a model to describe and measure appropriateness.  
The reasons? - one may obviously ask.
Well we've all seen innovation distribution curve - as described in the cartoon below.
But those of us involved in organisational change efforts might well recognize that the word “chasm” doesn’t quite describe the challenge we face...
The true picture is more like as described in the cartoon below.
@ppropriately is a framework designed by Health District to describe, as well as provide for a tool to assess & measure "meaningful" appropriateness in health. 
We have designed this framework in light of the recommendations from CMA's policy paper, as well as keeping true to the original vision conceptualized by Lavin and Anderson in their landmark paper.
Appropriateness in health - Inappropriate without measuring health professions wellness and wellbeing. 
Furthermore, we have added an extra dimension of health professions wellness and wellbeing as a core concept of the model - in addition to right care and patient safety. 
In times when efforts to employ concept of ‘appropriateness’ in health systems for sustainability is a priority for health care leaders and governments alike — workable solutions and quality improvement initiatives must include health care professions wellness and wellbeing - tied to outcome measures for assessment of health care quality and patient safety.
@appropriately™ - coming soon.
We will soon be submitting our innovative new model designed for appropriateness in health - called @ppropriately™ - for publication. 
We intend to make @ppropriately™ public once the paper has been accepted for publication.

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