failure of institutions to adopt and implement the policies, which may then stimulate corrective action.

This chapter discusses ways in which these diverse supporting organizations can cooperate with and influence the academic and other institutions that have the primary responsibility for dealing with conflicts of interest in medical research, education, and practice. The chapter begins by considering some of the productive forms that support and cooperation can take. The discussion emphasizes the roles of collaboration, consensus building, and incentives in making conflict of interest policies more effective and compliance with them less burdensome. It also recognizes that policies need to be backed by enforcement and sanctions. The chapter concludes with two recommendations that supplement the mostly mission-specific recommendations of earlier chapters. The first calls on supporting organizations to develop incentives for medical institutions to become more accountable for preventing, identifying, and managing conflicts of interest. The second calls for more research to provide a stronger evidence base for evaluating and improving conflict of interest policies.

HOW SUPPORTING ORGANIZATIONS CAN INFLUENCE MEDICAL INSTITUTIONS

Consensus Building and Collaboration

Consensus building and collaboration can operate within the institutions that are the focus of this report. Such efforts seek to engage those affected by policies in the process of developing them to improve the policies (e.g., by identifying and understanding obstacles to the success of the policies) and to win acceptance or buy in by those affected. Supporting organizations may likewise be more successful if they engage research, educational, and other institutions in the process of designing incentives and setting standards and if they give those institutions some discretion on how to reach specific performance goals. The leaders of those institutions are often in the best position to identify barriers to accountability (including burdensome or confusing administrative procedures) and to suggest ways to overcome those barriers. They are also well situated to identify and reduce the unintended negative consequences of proposed policies or procedures.

Some lessons for collaborative efforts that can be made to improve conflict of interest policies and practices are suggested by quality improvement initiatives within health care organizations. The typical quality improvement program in health care actively engages frontline caregivers and managers in an interdisciplinary process of identifying and analyzing problems in the quality of care, devising preventive or corrective interventions, monitoring outcomes, and modifying interventions on the basis of



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