Procedural Drift: An Underappreciated Element of Clinical Treatment Fidelity

Procedural fidelity involves delivering the correct guideline-supported treatment choice, in its designed manner, over the full care episode of the patient. Procedural drift is a subcomponent of procedural fidelity that involves performing the right treatment the right way initially, then drifting toward suboptimal treatment over time. Procedural drift occurs most often when providing intricate, patient-centered interventions that require attention to subtle nuances that potentially maximize their effectiveness. Drift comes from the belief that subtle nuances do not matter, or from a lack of motivation or incentive to maintain high fidelity. Strategies to reduce drift in practice include investment in early, high-quality training, using checklists and manuals when providing an intervention; using risk-adjusted patient data as a checks-and-balances system: and incorporating measures of drift in the practitioners annual review.