Evidence to Care: Mobilizing Childhood Disability Research into Practice Dr. Shauna Kingsnorth Evidence to Care Lead Clinical Study Investigator Assistant Professor (status), Department of Occupational Science and Occupational Therapy, University of Toronto Holland Bloorview Kids Rehabilitation Hospital skingsnorth@hollandbloorview.ca Presented at: Canadian Knowledge Mobilization Forum Saskatoon, Saskatchewan June 9, 2014

1. Evidence to Care:
Mobilizing Childhood Disability Research into Practice
Canadian Knowledge Mobilization Forum
Saskatoon, Saskatchewan
June 9, 2014
Dr. Shauna Kingsnorth
Evidence to Care Lead
Clinical Study Investigator
Assistant Professor (status), Department of Occupational Science
and Occupational Therapy, University of Toronto
Holland Bloorview Kids Rehabilitation Hospital
skingsnorth@hollandbloorview.ca

2. Healthcare in Ontario:
Ministry of Health and Long-Term Care
• Provincial governing body for healthcare services
• Patient-focused, results-driven, integrated and
sustainable, publicly funded
• Provide strategic direction on provincial
priorities; establish sustainable funding models,
legislation, monitoring, reporting, and policies
MOHLTC. (2013). http://www.health.gov.on.ca/en/common/ministry

3. Legislation: What is ECFAA?
The Excellent Care for All Act (ECFAA), which
came into law in June of 2010, puts Ontario
patients first and helps define quality for the
health care sector, by reinforcing shared
responsibility for quality of care, building and
supporting boards’ capability to oversee the
delivery of high quality of care, and ensuring
health care organizations make information on
their commitment to quality publicly available
MOHLTC. (2012). http://www.health.gov.on.ca/en/public/programs/ecfa

4. What is the aim of ECFAA?
•To ensure that:
–Best practices information is supported by
available scientific evidence
–This information is translated into materials
for employees and persons providing
services within the health care organization
–The use of these materials is monitored
through user-based surveys and standards
of care
Ontario Government. (2010). http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_10e14_e.htm

5. ECFAA as a Social Innovation
•Places the patient at the centre of care
•Creates an enduring organizational focus on
quality and continuous improvement
•As a regulatory systems driver, ECFAA
creates conditions to support, enable and
compel quality improvement
Quality
improvement
for better
outcomes

6. 6
Holland Bloorview
Kids Rehabilitation Hospital

7. Discovering Evidence Use at Holland
Bloorview
Indicator
Audit
Validated
Tool
Best
practices?
Focus
Groups
7
To what extent
is current
research
evidence being
used in clinical
practice?

8. Results: How evidence-friendly are we?
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7
Anchored Scale (-/+)
Percentfrequency
8
Waste of time
Fundamental!
Mode
• Solid understanding of evidence-informed best practice
• Strong appreciation of value and need
• Very positive attitudes

9. Results: Is it easy is it to access?
•Described as limited and self-directed
–Research Librarian fundamental for direct
access
–Conference attendance key learning vehicle
–Collaborative research partnerships not
optimized
–No systematic organizational push/pull
processes
9

10. Conclusions: Enablers and Barriers to
Use
•Resource drivers
– Individual skill
– Organizational capacity
•Evidence enablers
– Quality and fit
– Availability
•Professional drivers
– Colleges and associations (i.e., regulated roles)
– Colleagues
10

11. ECFAA at Holland Bloorview
Evidence to Care
Evidence
Informed
Best
Practice
Excellent
Care for
All Act
(ECFAA)
Health
Quality
Ontario

12. Evidence to Care (EtC):
A Catalyst for Knowledge Translation
"The collaborative and systematic review,
assessment, identification, aggregation, and
practical application of high-quality disability
and rehabilitation research by key stakeholders for
the purpose of improving the lives of individuals
with disabilities.”
12
NCDDR. (2005). http://www.ncddr.org/knowledge_trans_over.html

13. What is Evidence to Care?
•Our vision is to
promote the best
available research
evidence to inform
care in childhood
disability
•A bridge between
research and clinical
care and policy
13

14. What is Evidence to Care?
Position Holland Bloorview
as a ‘go to’ hub for:
• Systematic reviews
• Clinical practice
guidelines
• Evidence-informed
best practices
CIHR. (2014). http://www.cihr-irsc.gc.ca/e/39033.html

15. Aligning Evidence with the Pillars
• Accelerate Knowledge
• Provide expertise in best practices in the field of
knowledge translation
• Hold events that promote and showcase using
evidence to enhance care
• Support BRI grant requests through suggesting
creative knowledge translation strategies
• Lead the System
• Identify gaps in evidence-informed best practice in
childhood disability
• Generate systematic reviews and clinical practice
guidelines to meet our needs
• Raise Holland Bloorview’s knowledge translation

16. Aligning Evidence with the Pillars
• Transform Care
• Identify, appraise and communicate research
evidence
• Develop and implement clinical practice
guidelines
• Evaluate changes in care related to evidence use
• Inspire our People
• Develop a strategy that enhances staff’s ability to
use evidence
• Create opportunities for researchers and
clinicians (and families where possible) to work
together to solve issues using evidence
• Promote evidence use in all programs throughout
the organization

17. Funding
• Foundation
• Partnership with MOHLTC
• Grant funding

18. EtC in Action: Energy in the System
● Success contingent on inter-professional
cooperation
● Partnerships and key enablers:
− Academic health science centre
− Commitment to research
− Collaborative structures
− Senior management engagement
− Change champions
− Expertise

19. Progression of the Model: In Practice
19
Organizational
partners
EtC Steering
Committee
Core Staff Associates
Teaching &
Learning Institute
Hospital CEO Lead Collaborative Practice
Leaders
Bloorview
Research
Institute
VPs Knowledge
Brokers(2)
Research Librarian
Senior Directors Knowledge
Translation
Specialist (2)
Scientists & Clinicians
Directors Administrative
Assistant
Communications &
Public Affairs
EtC Lead Research
Assistant
Family &
Youth Leaders

20. Organizational Impact
•Embedding KT Competencies in:
–Research Curriculum
–KT Consultations
–HR Interview Questions
–Investigator Performance Appraisal
–Key Performance Indicator Reporting
–Grant application process

21. EtC in Action:
Best Practice Projects
21
Phase 2:
Evidence
appraisal
Phase 3:
Product develop
and tailoring to
context
Phase 4:
Dissemination,
Implementation
& Evaluation
Integrated Knowledge Translation Strategy
Phase 1:
Identify Priority
Area

22. EtC in Action: Best Practice Projects
Chronic Pain and Cerebral Palsy Project
Develop and implement a best practice
recommendation for the assessment of chronic
pain among paediatric outpatients with cerebral
palsy

23. Cerebral Palsy Chronic Pain Toolbox
23
Multi-phase approach
identified:
• Registered Nurses
Association of Ontario
(RNAO) Best Practice
Guideline (BPG) for Pain
Assessment
Recommendations6
• Cerebral Palsy specific care
and practice points
• 7 pain interference tools

24. Knowledge
Translation
Activities
- Printed Educational
Materials
- Champions
- Educational Meetings
(e.g. workshops,
huddles)
- Audit and Feedback
- Reminders
Chronic Pain and Cerebral Palsy Implementation:
Knowledge Translation Strategies

25. EtC in Action: Best Practice Projects
Children with Medical Complexity Project
Engage in a best practice project to develop a
compendium of evidence informed resources for
children with medical complexity

26. Children with Medical Complexity
Project
Identifying
Best Practice:
How are best
practices
advanced
when the evidence
doesn't exist?
Scoping Review
of the Evidence
Stakeholder
Engagement
for Product
Development
Leading
Practices Scan
Engaging
Families
is Critical!

27. Early Learnings
• Emerging field of KT
– Advancing a model of 'on the ground' learning
• Building skills while building products
– Big investment short-term long-term pay offs
• 'Evidence-informed Practice' vs.
'Practice-informed Evidence '
– Medical advance, technology and societal attitudes are changing
– Disability research is not simple or easy
• Early wins to foster culture of change

28. Social Innovation
Social innovation is a process of change emerging
from the creative re-combination of existing assets,
the aim of which is to achieve socially recognized
goals in a new way - Ezio Manzini (2014)
Evidence to Care
bridges the gap
between research and
clinical practice to
create a world of
possibility for kids with
disability

29. Evidence to Care acts as a bridge between
research and clinical care and policy.
Our vision
is to promote the
best available research
evidence
to inform care in childhood
disability.
Find us on the web at:
www.hollandbloorview.ca/TeachingLearning/EvidencetoCare

30. Thank you!
Evidence to Care