Sticky Notes of Thoughts

…because some thoughts are worth remembering

On Compliance, Adherence and Concordance


Compliance, adherence and concordance are terms used to describe interactions between doctors and their patients. Compliance refers to a direct order where patients are not given any choices, e.g., go down to the 3rd floor and get an x-ray. Adherence is more of an order posed as a suggestion or an observation: e.g., exercise for 30 min. daily will help. There is no enforcement. The first two are considered asymmetric in that the patients are only on the receiving end. Concordance however is a more collaborative relationship model where they both agree to a solution to be implemented. It might be a brief discussion about what kind of exercise do you think you can do, and for how many minutes?

While compliance and adherence are valid modes and have their place, it is not surprising that concordance seems to have the most sustainable results, i.e., patients continuing to honor the agreement. Yet it is not used as much, most likely because it requires a non-cookie cutter approach where each patient is treated as an individual, and perhaps also because the current medical paradigm continues to fuel the power dynamic of an omniscient healer prescribing a remedy, rather than treating the doctor-patient pairing as a team.

There are many academic papers on this topic, such as “Concordance: A Critical Participatory Alternative” (by Grönvall et al.) because this dynamic affects how home medical devices are used, and has significant healthcare implications. The interaction is worth examining and extending to other field where power dynamics exist, such as in a mentoring relationship, management, and others. When giving your employee a goal, the concordance mode of interaction makes more sense if you want the staff to own that goal and maximize the possibility of success. The power of concordance further affirms why presenting a problem to be solved by the team rather than the management setting up quotas (compliance) or suggesting solutions (adherence) is more effective, as I saw first hand in encouraging tech support staff to improve the quality of customer service.

Photo: Southern Maine Coast at dusk

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This entry was posted on September 1, 2015 by in Management and tagged , , , , .
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