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Strategy For Evidence Based Health Services

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    • 1. 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.
    • 2. Menu for 30 minutes
      • About the Norwegian Knowledge Center
      • About Innlandet Health Trust
      • Challenges
      • Strategy and action plan
      • Summary
    • 3. 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
    • 4. The Centre: Mission
      • Gathers and disseminates evidence
        • about the effect and quality of methods and interventions
      • Uptake of evidence by the health services
    • 5. 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
    • 6. 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
    • 7. June 4, 2009 Access to knowledge has varied widely National Hospital Rural hospital
    • 8. 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
    • 9. June 4, 2009 Helsebiblioteket Journals
    • 10. June 4, 2009 Helsebiblioteket Databases
    • 11. June 4, 2009 Helsebiblioteket Systematic reviews
    • 12. June 4, 2009 Helsebiblioteket Clinical guidelines
    • 13. June 4, 2009 Helsebiblioteket Reference books
    • 14. June 4, 2009 Helsebiblioteket Specialist libraries
    • 15. 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
    • 16. Innlandet Health Trust …
    • 17. Innlandet Health Trust … 06/04/09 Helsebiblioteket
    • 18. Innlandet Health Trust
      • Population 390 000
      • 8 hospitals + 33 other units
      • 8427 employees
      • Ann. b udget CAD 1 bn
      • 1301 beds
    • 19. Challenge: The evidence-practice gap
      • Interventions used without sound evidence
      • Interventions with sound evidence not used
      • The individual health worker decides
    • 20. 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
    • 21. 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?
    • 22. Challenge: The individual health worker
      • Knowledge about knowledge
      • Awareness of EBM needs
      • Core EBM skills
      • Digital competence
    • 23. Challenge: Users perspective
      • Increasing demand for
        • Transparency
        • Influence
        • Shared decision making
        • Tailored information
    • 24. Collaboration: trust – knowledge center
    • 25. The four S´s model Systems Synopsis Systematic reviews and guidelines Studies
    • 26. 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
    • 27. 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
    • 28. 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
    • 29. Task areas
      • Basic infrastructure and prerequisites
      • Knowledge systems
      • The individual health worker
      • Task force: supportive administration
    • 30. 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
    • 31. 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
    • 32. 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 ++
    • 33. Task 4: more computers and better internett access
      • Higher pc density
      • Wireless
      • Mobile units ie. HHC
      • Open zone
      • Flexible login
    • 34. 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
    • 35. 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
    • 36. 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
    • 37. 8. Evidence-based implementation
      • Selection of staff
      • Training
      • Coaching
      • Evaluation of staff
      • Evaluation of program
      • Facilitating administration
      • Systems level support
    • 38. 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
    • 39. 10. Mass media
      • EBM news and EBM education
        • Intranet
        • ” PsychNews”
        • Paper magazine
    • 40. What is not yet fully included
      • Research unit
      • Patient information project
      • Monitoring unit
      • Nurses´ education
    • 41. 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
    • 42. Perspective ahead
      • The regional health trust now adopts strategy and action plan
      • Full-hearted support from CEOs paves the way ahead
    • 43. Discussion!
      • Norwegian Electronic Health Library
      June 4, 2009 Helsebiblioteket Norwegian Electronic Health Library

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