Strategy for evidence-based health services  a collaboration between Innlandet Hospital Trust and the Norwegian Knowledg...
Menu for 30 minutes <ul><li>About the Norwegian Knowledge Center </li></ul><ul><li>About Innlandet Health Trust </li></ul>...
Norwegian Knowledge Centre for the Health Services <ul><li>Founded 2004 </li></ul><ul><li>Organised under The Directorate ...
The Centre: Mission <ul><li>Gathers and disseminates evidence  </li></ul><ul><ul><li>about the effect and quality of metho...
The Centre: Central tasks 1 <ul><li>HTA reports </li></ul><ul><li>Systematic reviews </li></ul><ul><li>Overviews of overvi...
The Centre: Central tasks 2 <ul><li>Support to  </li></ul><ul><ul><li>the government </li></ul></ul><ul><ul><li>the region...
June 4, 2009 Access to knowledge has varied widely National Hospital Rural hospital
Why does the Health Library exist? <ul><li>Equality:  Equal access to health services implies equal access to knowledge  <...
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 <ul><li>Bein well known among even more health workers </li></ul><ul><li>Being known f...
Innlandet Health Trust …
Innlandet Health Trust … 06/04/09 Helsebiblioteket
Innlandet Health Trust <ul><li>Population 390 000 </li></ul><ul><li>8 hospitals + 33 other units </li></ul><ul><li>8427 em...
Challenge: The evidence-practice gap <ul><li>Interventions used without sound evidence </li></ul><ul><li>Interventions wit...
Challenge: The evidence-practice gap <ul><li>” 30-45 % of treatments not evidence-based” </li></ul><ul><li>Need more speci...
Challenge: Infrastructure <ul><li>Lack of computers </li></ul><ul><li>Lack of internet access </li></ul><ul><li>Lack of ac...
Challenge: The individual health worker <ul><li>Knowledge about knowledge </li></ul><ul><li>Awareness of EBM needs </li></...
Challenge: Users perspective <ul><li>Increasing demand for </li></ul><ul><ul><li>Transparency </li></ul></ul><ul><ul><li>I...
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 ...
Pipeline model EPR Quality-assessed  guidelines Quality- asessed research Knowledge  support Patient information Internet ...
Strategy in the trust: Core components <ul><li>Find and create perceived needs </li></ul><ul><li>Build on existing structu...
Task areas <ul><li>Basic infrastructure and prerequisites </li></ul><ul><li>Knowledge systems </li></ul><ul><li>The indivi...
Task 1: Policy of the trust soaked in EBM <ul><li>EBM one of three prioritized areas  </li></ul><ul><li>Prominent place in...
Task 2: Educated and enthusiastic leaders <ul><li>Professional advisory boards created for all clinical fields </li></ul><...
Task 3: EBM policy for the library services <ul><li>Formal training of librarians </li></ul><ul><li>EBM training by librar...
Task 4: more computers and better internett access <ul><li>Higher pc density </li></ul><ul><li>Wireless  </li></ul><ul><li...
Task 5: Better knowledge support <ul><li>In addition to the Health Library </li></ul><ul><li>Tender in process </li></ul><...
6: New inter- and intranet services <ul><li>CEO and board endorsed new policy : </li></ul><ul><ul><li>Knowledge platform <...
7: Evidence based ”home made” knowledge support <ul><li>Systematic and explicit knowledge search behind </li></ul><ul><ul>...
8. Evidence-based implementation <ul><li>Selection of staff </li></ul><ul><li>Training </li></ul><ul><li>Coaching </li></u...
9. Training of individual health workers <ul><li>Inhouse training by librarians/clinicians </li></ul><ul><li>e-learning fr...
10. Mass media <ul><li>EBM news and EBM education </li></ul><ul><ul><li>Intranet </li></ul></ul><ul><ul><li>” PsychNews” <...
What is not yet fully included <ul><li>Research unit </li></ul><ul><li>Patient information project </li></ul><ul><li>Monit...
Some shortcomings <ul><li>EBM thinking does not permeate the wards </li></ul><ul><li>Depends heavily on a few enthusiasts ...
Perspective ahead <ul><li>The regional health trust now adopts strategy and action plan </li></ul><ul><li>Full-hearted sup...
Discussion! <ul><li>Norwegian Electronic Health Library </li></ul>June 4, 2009 Helsebiblioteket   Norwegian Electronic Hea...
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Strategy For Evidence Based Health Services

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Strategy For Evidence Based Health Services

  1. 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. 2. Menu for 30 minutes <ul><li>About the Norwegian Knowledge Center </li></ul><ul><li>About Innlandet Health Trust </li></ul><ul><li>Challenges </li></ul><ul><li>Strategy and action plan </li></ul><ul><li>Summary </li></ul>
  3. 3. Norwegian Knowledge Centre for the Health Services <ul><li>Founded 2004 </li></ul><ul><li>Organised under The Directorate for Health Affairs </li></ul><ul><li>Scientifically and professionally independent </li></ul><ul><li>No authority to develop health policy or responsibility to implement policies </li></ul><ul><li>120 employees in Oslo </li></ul>
  4. 4. The Centre: Mission <ul><li>Gathers and disseminates evidence </li></ul><ul><ul><li>about the effect and quality of methods and interventions </li></ul></ul><ul><li>Uptake of evidence by the health services </li></ul>
  5. 5. The Centre: Central tasks 1 <ul><li>HTA reports </li></ul><ul><li>Systematic reviews </li></ul><ul><li>Overviews of overviews and early warnings </li></ul><ul><li>Projects that aim to improve the quality of patient information </li></ul><ul><li>Surveys of patients and employees experiences with health services </li></ul><ul><li>Support to the health services of poor countries through the provision of evidence </li></ul>
  6. 6. The Centre: Central tasks 2 <ul><li>Support to </li></ul><ul><ul><li>the government </li></ul></ul><ul><ul><li>the regional health authorities </li></ul></ul><ul><ul><li>the health services in general </li></ul></ul><ul><li>Host of The National Electronic Health Library </li></ul><ul><li>Quality Measurement and Patient Safety </li></ul><ul><li>Host of the National Council for Quality and Prioritization </li></ul>
  7. 7. June 4, 2009 Access to knowledge has varied widely National Hospital Rural hospital
  8. 8. Why does the Health Library exist? <ul><li>Equality: Equal access to health services implies equal access to knowledge </li></ul><ul><li>Quality: Quality assessment of knowledge is quality assessment of health services </li></ul><ul><li>Economy: National subscriptions and licenses saves time and money </li></ul>
  9. 9. June 4, 2009 Helsebiblioteket Journals
  10. 10. June 4, 2009 Helsebiblioteket Databases
  11. 11. June 4, 2009 Helsebiblioteket Systematic reviews
  12. 12. June 4, 2009 Helsebiblioteket Clinical guidelines
  13. 13. June 4, 2009 Helsebiblioteket Reference books
  14. 14. June 4, 2009 Helsebiblioteket Specialist libraries
  15. 15. Challenges for the knowledge center <ul><li>Bein well known among even more health workers </li></ul><ul><li>Being known for even more relevant services </li></ul><ul><li>” Develop a project that targets the health trusts” </li></ul>June 4, 2009
  16. 16. Innlandet Health Trust …
  17. 17. Innlandet Health Trust … 06/04/09 Helsebiblioteket
  18. 18. Innlandet Health Trust <ul><li>Population 390 000 </li></ul><ul><li>8 hospitals + 33 other units </li></ul><ul><li>8427 employees </li></ul><ul><li>Ann. b udget CAD 1 bn </li></ul><ul><li>1301 beds </li></ul>
  19. 19. Challenge: The evidence-practice gap <ul><li>Interventions used without sound evidence </li></ul><ul><li>Interventions with sound evidence not used </li></ul><ul><li>The individual health worker decides </li></ul>
  20. 20. Challenge: The evidence-practice gap <ul><li>” 30-45 % of treatments not evidence-based” </li></ul><ul><li>Need more specific gap analyses </li></ul><ul><ul><li>Lack of benchmarking </li></ul></ul><ul><ul><li>Lack of indicator systems </li></ul></ul><ul><ul><li>Lack of comparing data </li></ul></ul>
  21. 21. Challenge: Infrastructure <ul><li>Lack of computers </li></ul><ul><li>Lack of internet access </li></ul><ul><li>Lack of access to paid internet resources </li></ul><ul><ul><li>outside of university hospitals </li></ul></ul><ul><li>1000s of clinical protocols </li></ul><ul><ul><li>Quality of? In use? </li></ul></ul>
  22. 22. Challenge: The individual health worker <ul><li>Knowledge about knowledge </li></ul><ul><li>Awareness of EBM needs </li></ul><ul><li>Core EBM skills </li></ul><ul><li>Digital competence </li></ul>
  23. 23. Challenge: Users perspective <ul><li>Increasing demand for </li></ul><ul><ul><li>Transparency </li></ul></ul><ul><ul><li>Influence </li></ul></ul><ul><ul><li>Shared decision making </li></ul></ul><ul><ul><li>Tailored information </li></ul></ul>
  24. 24. Collaboration: trust – knowledge center
  25. 25. The four S´s model Systems Synopsis Systematic reviews and guidelines Studies
  26. 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. 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. 28. Strategy in the trust: Core components <ul><li>Find and create perceived needs </li></ul><ul><li>Build on existing structures and processes </li></ul><ul><li>Evidence-based knowledge support systems </li></ul><ul><li>Evidence-based implementation </li></ul><ul><li>Create good examples </li></ul>
  29. 29. Task areas <ul><li>Basic infrastructure and prerequisites </li></ul><ul><li>Knowledge systems </li></ul><ul><li>The individual health worker </li></ul><ul><li>Task force: supportive administration </li></ul>
  30. 30. Task 1: Policy of the trust soaked in EBM <ul><li>EBM one of three prioritized areas </li></ul><ul><li>Prominent place in quality policy </li></ul><ul><li>Cornerstone of inter- and intranet policy </li></ul><ul><li>National and regional conferences </li></ul>
  31. 31. Task 2: Educated and enthusiastic leaders <ul><li>Professional advisory boards created for all clinical fields </li></ul><ul><li>Given basic training in EBM </li></ul><ul><li>Mandate: responsible for fostering evidence-based medicine </li></ul>
  32. 32. Task 3: EBM policy for the library services <ul><li>Formal training of librarians </li></ul><ul><li>EBM training by librarians </li></ul><ul><ul><ul><li>R esponsible for the overall training plan </li></ul></ul></ul><ul><li>Administer toolkit for those who make protocols </li></ul><ul><ul><li>M anual, courses, search ++ </li></ul></ul>
  33. 33. Task 4: more computers and better internett access <ul><li>Higher pc density </li></ul><ul><li>Wireless </li></ul><ul><li>Mobile units ie. HHC </li></ul><ul><li>Open zone </li></ul><ul><li>Flexible login </li></ul>
  34. 34. Task 5: Better knowledge support <ul><li>In addition to the Health Library </li></ul><ul><li>Tender in process </li></ul><ul><li>Will be used for </li></ul><ul><ul><li>B enchmarking </li></ul></ul><ul><ul><li>EBM clinical care pathways </li></ul></ul><ul><ul><li>T emplate for better protocols </li></ul></ul><ul><ul><li>Point-of-care support tool </li></ul></ul>
  35. 35. 6: New inter- and intranet services <ul><li>CEO and board endorsed new policy : </li></ul><ul><ul><li>Knowledge platform </li></ul></ul><ul><ul><li>Empower users through information </li></ul></ul><ul><ul><li>Tool for cooperation and communication </li></ul></ul><ul><ul><li>Building trust culture </li></ul></ul>
  36. 36. 7: Evidence based ”home made” knowledge support <ul><li>Systematic and explicit knowledge search behind </li></ul><ul><ul><li>C linical protocols </li></ul></ul><ul><ul><li>Care pathways </li></ul></ul><ul><ul><li>Care plans </li></ul></ul><ul><li>Process in accordance with simplified Agree </li></ul><ul><li>To be published on the internet </li></ul><ul><li>Can look to GAC </li></ul>
  37. 37. 8. Evidence-based implementation <ul><li>Selection of staff </li></ul><ul><li>Training </li></ul><ul><li>Coaching </li></ul><ul><li>Evaluation of staff </li></ul><ul><li>Evaluation of program </li></ul><ul><li>Facilitating administration </li></ul><ul><li>Systems level support </li></ul>
  38. 38. 9. Training of individual health workers <ul><li>Inhouse training by librarians/clinicians </li></ul><ul><li>e-learning from sept 1. </li></ul><ul><li>” Rolls Royce” training on a secluded spot </li></ul><ul><li>T raining trainers </li></ul><ul><li>Training leaders </li></ul><ul><li>Training makers of knowledge support </li></ul>
  39. 39. 10. Mass media <ul><li>EBM news and EBM education </li></ul><ul><ul><li>Intranet </li></ul></ul><ul><ul><li>” PsychNews” </li></ul></ul><ul><ul><li>Paper magazine </li></ul></ul>
  40. 40. What is not yet fully included <ul><li>Research unit </li></ul><ul><li>Patient information project </li></ul><ul><li>Monitoring unit </li></ul><ul><li>Nurses´ education </li></ul>
  41. 41. Some shortcomings <ul><li>EBM thinking does not permeate the wards </li></ul><ul><li>Depends heavily on a few enthusiasts </li></ul><ul><li>Lack of perceived need for EBM </li></ul><ul><li>Resistance from some leaders </li></ul>
  42. 42. Perspective ahead <ul><li>The regional health trust now adopts strategy and action plan </li></ul><ul><li>Full-hearted support from CEOs paves the way ahead </li></ul>
  43. 43. Discussion! <ul><li>Norwegian Electronic Health Library </li></ul>June 4, 2009 Helsebiblioteket Norwegian Electronic Health Library

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