Changing Practice: Implementation strategies

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Evidence based summary of strategies for changing clinical practice

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Changing Practice: Implementation strategies

  1. 1. CHANGING PRACTICE Evidence Based Implementation José Francisco García Gutiérrez Escuela Andaluza de Salud Pública PAHO HQ HSS/HRH
  2. 2. The Path Continuous Improvement Design & Evaluation Need Redesign Design Management Audit Implementation
  3. 4. NO MAGIC BULLETS ! All strategies are effective sometimes, but none is effective in all circumstances
  4. 5. Summary points <ul><li>Systematic reviews of rigorous studies provide the best evidence on the effectiveness of different strategies to promote the implementation of research findings </li></ul><ul><li>Passive dissemination of information is generally ineffective </li></ul><ul><li>It seems necessary to use specific strategies to encourage implementation of research based recommendations and to ensure changes in practice </li></ul><ul><li>Further research on the relative effectiveness and efficiency of different strategies is required </li></ul>
  5. 6. <ul><li>Interventions to promote behavioural change among health professionals </li></ul><ul><li>Bero, Grilli Grimshaw et al (1998). British Medical Journal. </li></ul><ul><li>Bero, Grilli, Grimshaw and Oxman (1998). Cochrane Library . </li></ul>
  6. 7. Consistently effective interventions <ul><li>Reminders (manual or computerised) </li></ul><ul><li>Multifaceted interventions (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing) </li></ul><ul><li>Interactive educational meetings (participation of healthcare providers in workshops that include discussion or practice) </li></ul>
  7. 8. Interventions of variable effectiveness <ul><li>Audit and feedback (or any summary of clinical performance) </li></ul><ul><li>The use of local opinion leaders (practitioners identified by their colleagues as influential) </li></ul><ul><li>Local consensus processes (inclusion of participating practitioners in discussions to ensure that they agree that the chosen clinical problem is important and the approach to managing the problem is appropriate) </li></ul><ul><li>Patient mediated interventions (any intervention aimed at changing the performance of healthcare providers for which specific information was sought from or given to patients) </li></ul>
  8. 9. Interventions that have little or no effect <ul><li>Educational materials (distribution of recommendations for clinical care, including clinical practice guidelines, audiovisual materials, and electronic publications) </li></ul><ul><li>Didactic educational meetings (such as lectures) </li></ul>
  9. 11. TRADITIONAL MODEL OF DISEMINATION Publication of information Target audience Changes in clinical practice
  10. 12. DESIGN OF INTERVENTIONS <ul><li>Problem identification (Presentation) </li></ul><ul><li>Evaluation of barriers (Diagnosis) </li></ul><ul><li>Intervention design (Prescription) </li></ul><ul><li>Behavioural change/ </li></ul><ul><li>Quality improvement (Cure) </li></ul><ul><li> </li></ul>
  11. 13. IMPLEMENTATION PLAN <ul><ul><li>Objectives </li></ul></ul><ul><ul><li>Key messages </li></ul></ul><ul><ul><li>Target audience </li></ul></ul><ul><ul><li>Responsible person </li></ul></ul><ul><ul><li>Situation analysis </li></ul></ul><ul><ul><li>Core improvement indicators </li></ul></ul><ul><ul><li>DAFO: Identification of barriers & “ad hoc” interventions </li></ul></ul><ul><ul><li>Proposal for improvement interventions </li></ul></ul><ul><ul><li>Priorization </li></ul></ul><ul><ul><li>Context adaptation </li></ul></ul>
  12. 14. FROM THEORY TO ACTION Three key questions <ul><li>Setting up GOALS </li></ul><ul><li>What are we trying to achieve </li></ul><ul><li>Establishing INDICATORS </li></ul><ul><li>How we do know that a change is an improvement </li></ul><ul><li>Developing CHANGES </li></ul><ul><li>What interventions might help to achieve improvements </li></ul>

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