Strategy for evidence-based health services a collaboration between Innlandet Hospital Trust and the Norwegian Knowledge Center for the Health Services Øystein Eiring, psychiatrist, Editor Norwegian Electronic Health Library/Mental Health, Medical Advisor.

Menu for 30 minutes About the Norwegian Knowledge Center About Innlandet Health Trust Challenges Strategy and action plan Summary

About the Norwegian Knowledge Center

About Innlandet Health Trust

Challenges

Strategy and action plan

Summary

Norwegian Knowledge Centre for the Health Services Founded 2004 Organised under The Directorate for Health Affairs Scientifically and professionally independent No authority to develop health policy or responsibility to implement policies 120 employees in Oslo

Founded 2004

Organised under The Directorate for Health Affairs

Scientifically and professionally independent

No authority to develop health policy or responsibility to implement policies

120 employees in Oslo

The Centre: Mission Gathers and disseminates evidence about the effect and quality of methods and interventions Uptake of evidence by the health services

Gathers and disseminates evidence

about the effect and quality of methods and interventions

Uptake of evidence by the health services

The Centre: Central tasks 1 HTA reports Systematic reviews Overviews of overviews and early warnings Projects that aim to improve the quality of patient information Surveys of patients and employees experiences with health services Support to the health services of poor countries through the provision of evidence

HTA reports

Systematic reviews

Overviews of overviews and early warnings

Projects that aim to improve the quality of patient information

Surveys of patients and employees experiences with health services

Support to the health services of poor countries through the provision of evidence

The Centre: Central tasks 2 Support to the government the regional health authorities the health services in general Host of The National Electronic Health Library Quality Measurement and Patient Safety Host of the National Council for Quality and Prioritization

Support to

the government

the regional health authorities

the health services in general

Host of The National Electronic Health Library

Quality Measurement and Patient Safety

Host of the National Council for Quality and Prioritization

June 4, 2009 Access to knowledge has varied widely National Hospital Rural hospital

Why does the Health Library exist? Equality: Equal access to health services implies equal access to knowledge Quality: Quality assessment of knowledge is quality assessment of health services Economy: National subscriptions and licenses saves time and money

Equality: Equal access to health services implies equal access to knowledge

Quality: Quality assessment of knowledge is quality assessment of health services

Economy: National subscriptions and licenses saves time and money

June 4, 2009 Helsebiblioteket Journals

June 4, 2009 Helsebiblioteket Databases

June 4, 2009 Helsebiblioteket Systematic reviews

June 4, 2009 Helsebiblioteket Clinical guidelines

June 4, 2009 Helsebiblioteket Reference books

June 4, 2009 Helsebiblioteket Specialist libraries

Challenges for the knowledge center Bein well known among even more health workers Being known for even more relevant services ” Develop a project that targets the health trusts” June 4, 2009

Bein well known among even more health workers

Being known for even more relevant services

” Develop a project that targets the health trusts”

Innlandet Health Trust …

Innlandet Health Trust … 06/04/09 Helsebiblioteket

Innlandet Health Trust Population 390 000 8 hospitals + 33 other units 8427 employees Ann. b udget CAD 1 bn 1301 beds

Population 390 000

8 hospitals + 33 other units

8427 employees

Ann. b udget CAD 1 bn

1301 beds

Challenge: The evidence-practice gap Interventions used without sound evidence Interventions with sound evidence not used The individual health worker decides

Interventions used without sound evidence

Interventions with sound evidence not used

The individual health worker decides

Challenge: The evidence-practice gap ” 30-45 % of treatments not evidence-based” Need more specific gap analyses Lack of benchmarking Lack of indicator systems Lack of comparing data

” 30-45 % of treatments not evidence-based”

Need more specific gap analyses

Lack of benchmarking

Lack of indicator systems

Lack of comparing data

Challenge: Infrastructure Lack of computers Lack of internet access Lack of access to paid internet resources outside of university hospitals 1000s of clinical protocols Quality of? In use?

Lack of computers

Lack of internet access

Lack of access to paid internet resources

outside of university hospitals

1000s of clinical protocols

Quality of? In use?

Challenge: The individual health worker Knowledge about knowledge Awareness of EBM needs Core EBM skills Digital competence

Knowledge about knowledge

Awareness of EBM needs

Core EBM skills

Digital competence

Challenge: Users perspective Increasing demand for Transparency Influence Shared decision making Tailored information

Increasing demand for

Transparency

Influence

Shared decision making

Tailored information

Collaboration: trust – knowledge center

The four S´s model Systems Synopsis Systematic reviews and guidelines Studies

Aknowledge and identify information need Formulate questions Search for literature Critically appraise Evaluate knowledge in context of experience, patient values and preferences Put in practice Individual health worker model

Pipeline model EPR Quality-assessed guidelines Quality- asessed research Knowledge support Patient information Internet as transparent, common arena -Patient information mirror clinical protocols -minimize double work -support patients as change agents What Innlandet produces and carries through Patient Clinician Educational institutions, Knowledge Center, governmental agencies, Electronic Health Library

Strategy in the trust: Core components Find and create perceived needs Build on existing structures and processes Evidence-based knowledge support systems Evidence-based implementation Create good examples

Find and create perceived needs

Build on existing structures and processes

Evidence-based knowledge support systems

Evidence-based implementation

Create good examples

Task areas Basic infrastructure and prerequisites Knowledge systems The individual health worker Task force: supportive administration

Basic infrastructure and prerequisites

Knowledge systems

The individual health worker

Task force: supportive administration

Task 1: Policy of the trust soaked in EBM EBM one of three prioritized areas Prominent place in quality policy Cornerstone of inter- and intranet policy National and regional conferences

EBM one of three prioritized areas

Prominent place in quality policy

Cornerstone of inter- and intranet policy

National and regional conferences

Task 2: Educated and enthusiastic leaders Professional advisory boards created for all clinical fields Given basic training in EBM Mandate: responsible for fostering evidence-based medicine

Professional advisory boards created for all clinical fields

Given basic training in EBM

Mandate: responsible for fostering evidence-based medicine

Task 3: EBM policy for the library services Formal training of librarians EBM training by librarians R esponsible for the overall training plan Administer toolkit for those who make protocols M anual, courses, search ++

Formal training of librarians

EBM training by librarians

R esponsible for the overall training plan

Administer toolkit for those who make protocols

M anual, courses, search ++

Task 4: more computers and better internett access Higher pc density Wireless Mobile units ie. HHC Open zone Flexible login

Higher pc density

Wireless

Mobile units ie. HHC

Open zone

Flexible login

Task 5: Better knowledge support In addition to the Health Library Tender in process Will be used for B enchmarking EBM clinical care pathways T emplate for better protocols Point-of-care support tool

In addition to the Health Library

Tender in process

Will be used for

B enchmarking

EBM clinical care pathways

T emplate for better protocols

Point-of-care support tool

6: New inter- and intranet services CEO and board endorsed new policy : Knowledge platform Empower users through information Tool for cooperation and communication Building trust culture

CEO and board endorsed new policy :

Knowledge platform

Empower users through information

Tool for cooperation and communication

Building trust culture

7: Evidence based ”home made” knowledge support Systematic and explicit knowledge search behind C linical protocols Care pathways Care plans Process in accordance with simplified Agree To be published on the internet Can look to GAC

Systematic and explicit knowledge search behind

C linical protocols

Care pathways

Care plans

Process in accordance with simplified Agree

To be published on the internet

Can look to GAC

8. Evidence-based implementation Selection of staff Training Coaching Evaluation of staff Evaluation of program Facilitating administration Systems level support

Selection of staff

Training

Coaching

Evaluation of staff

Evaluation of program

Facilitating administration

Systems level support

9. Training of individual health workers Inhouse training by librarians/clinicians e-learning from sept 1. ” Rolls Royce” training on a secluded spot T raining trainers Training leaders Training makers of knowledge support

Inhouse training by librarians/clinicians

e-learning from sept 1.

” Rolls Royce” training on a secluded spot

T raining trainers

Training leaders

Training makers of knowledge support

10. Mass media EBM news and EBM education Intranet ” PsychNews” Paper magazine

EBM news and EBM education

Intranet

” PsychNews”

Paper magazine

What is not yet fully included Research unit Patient information project Monitoring unit Nurses´ education

Research unit

Patient information project

Monitoring unit

Nurses´ education

Some shortcomings EBM thinking does not permeate the wards Depends heavily on a few enthusiasts Lack of perceived need for EBM Resistance from some leaders

EBM thinking does not permeate the wards

Depends heavily on a few enthusiasts

Lack of perceived need for EBM

Resistance from some leaders

Perspective ahead The regional health trust now adopts strategy and action plan Full-hearted support from CEOs paves the way ahead

The regional health trust now adopts strategy and action plan

Full-hearted support from CEOs paves the way ahead

Discussion! Norwegian Electronic Health Library June 4, 2009 Helsebiblioteket Norwegian Electronic Health Library

Norwegian Electronic Health Library