1) Getting research into practice is challenging due to barriers like information overload, specialty silos, and increasing patient safety issues.
2) Tools that can help include surveys, knowledge management strategies, and establishing an information team.
3) Key success factors include dedicating resources, ensuring relevance, and fostering collaboration between stakeholders.
4) Implementing research takes time and a multifaceted approach, as changing clinical behavior is complex.
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
This final webinar will emphasise the importance of understanding the problem before brainstorming solutions to better ensure a match between barriers and the solutions.
MORE INFO: http://bit.ly/2KctiLH
Please join CPSI as we conclude our Human Factors webinar series with our final presentation Collaborative "Spaces" and Health Information Technology Design
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
How Community Engagement Fits Into The Mission Of The National Center for Adv...SC CTSI at USC and CHLA
Christopher Austin, MD, Director of the National Center for Advancing Translational Sciences (NCATS) shared his thoughts on how community engagement fits into the mission of NCATS at the recent CTSA Community Engagement Key Function Committee (KFC) conference. He proposed a revision of NCATS' mission: "To catalyze the generation of innovative methods and technologies that will enhance the development, testing and implementation of interventions that tangibly improve human health across a wide range of human diseases and conditions." Learn more about NCATS http://www.ncats.nih.gov/
Member experiences in an Australian Translational Cancer Research Centre and ...Cancer Institute NSW
The experience of membership of multidisciplinary collaborative cancer research networks is largely unreported. Sydney Catalyst Translational Cancer Research Centre (TCRC) is a multi-disciplinary and multi-institutional virtual consortium of researchers and clinicians from institutions in metropolitan Sydney and regional New South Wales. Following the Westfall model of translational research, we support multi-disciplinary collaborative cancer research focused on T1112 bench to bedside research and T2/3 translation of evidence into practice.
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
This final webinar will emphasise the importance of understanding the problem before brainstorming solutions to better ensure a match between barriers and the solutions.
MORE INFO: http://bit.ly/2KctiLH
Please join CPSI as we conclude our Human Factors webinar series with our final presentation Collaborative "Spaces" and Health Information Technology Design
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
How Community Engagement Fits Into The Mission Of The National Center for Adv...SC CTSI at USC and CHLA
Christopher Austin, MD, Director of the National Center for Advancing Translational Sciences (NCATS) shared his thoughts on how community engagement fits into the mission of NCATS at the recent CTSA Community Engagement Key Function Committee (KFC) conference. He proposed a revision of NCATS' mission: "To catalyze the generation of innovative methods and technologies that will enhance the development, testing and implementation of interventions that tangibly improve human health across a wide range of human diseases and conditions." Learn more about NCATS http://www.ncats.nih.gov/
Member experiences in an Australian Translational Cancer Research Centre and ...Cancer Institute NSW
The experience of membership of multidisciplinary collaborative cancer research networks is largely unreported. Sydney Catalyst Translational Cancer Research Centre (TCRC) is a multi-disciplinary and multi-institutional virtual consortium of researchers and clinicians from institutions in metropolitan Sydney and regional New South Wales. Following the Westfall model of translational research, we support multi-disciplinary collaborative cancer research focused on T1112 bench to bedside research and T2/3 translation of evidence into practice.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
Health Evidence hosted a 60 minute webinar examining the effectiveness of school-based interventions for preventing HIV, sexually transmitted infections and pregnancy in adolescents. Click here for access to the audio recording for this webinar: https://youtu.be/yCeIEQ4OTCc
Amanda Mason-Jones, Senior Lecturer in Global Public Health, Faculty of Science, University of York led the session and presented findings from her recent Cochrane review:
Mason-Jones A, Sinclair D, Mathews C, Kagee A, Hillman A, & Lombard C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents.Cochrane Database of Systematic Reviews, 2016(11), CD006417
http://healthevidence.org/view-article.aspx?a=school-based-interventions-preventing-hiv-sexually-transmitted-infections-29881
Sexually active adolescents are at risk of contracting HIV and STIs. Unintended pregnancy can have detrimental impact on young people’s lives. This review examines the impact of school sexual education programs on number of young people that contract STIs and number of adolescent pregnancies. Eight cluster randomized control trials, including 55,157 participants are included in this review. Findings suggest there is little evidence that school programs alone are effective in improving sexual and reproductive health outcomes for adolescents. This webinar examined the effectiveness and components of interventions that prevent HIV, STIs and adolescent pregnancy.
School and community social influence programming for preventing tobacco and ...Health Evidence™
Health Evidence hosted a 90 minute webinar on substance use prevention and treatment interventions in children and adolescents, funded by the Canadian Centre on Substance Abuse. This webinar presented key messages and implications for practice.
This webinar focussed on interpreting the evidence in the following review, which synthesizes evidence related to social influence programming:
Skara, S. & Sussman, S. (2003). A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations. Preventive Medicine (37) 451-474.
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
The slide presentation that preceded of the annual Health Datapalooza in Washington DC, PCORI was pleased to participate in the latest installment in the Health Data Consortium and PricewaterhouseCoopers (PwC) Innovators in Health Data Series, a webinar featuring PCORI Executive Director Joe Selby, MD, MPH; NIH Director and PCORI Board of Governors member Francis Collins, MD, PhD; and Philip Bourne, PhD, NIH’s Associate Director for Data Science.
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
Dr. Dawn Stacey, University Research Chair in Knowledge Translation to Patients, and Director, Patient Decision Aids Research Group, Ottawa Hospital Research Institute, University of Ottawa, provides an overview of findings from her recent Cochrane review examining use of decision aids for identifying and making decisions about health treatment or screening options:
Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014(1), CD001431.
Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a ...Health Evidence™
An afternoon workshop - held in partnership with the National Collaborating Centre for Methods and Tools - at the Ontario Public Health Convention April 7, 2011
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
Bea Brown gave a presentation on her research for the Sax Institute at the University of Sydney for the School of Public Health's 2013 research presentation day.
En esta presentación encontrara los antecedentes del neoliberalismo en México, en que consiste y cuales son as consecuencias de el mismo, que hasta la actualidad son fáciles de determinar.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
Health Evidence hosted a 60 minute webinar examining the effectiveness of school-based interventions for preventing HIV, sexually transmitted infections and pregnancy in adolescents. Click here for access to the audio recording for this webinar: https://youtu.be/yCeIEQ4OTCc
Amanda Mason-Jones, Senior Lecturer in Global Public Health, Faculty of Science, University of York led the session and presented findings from her recent Cochrane review:
Mason-Jones A, Sinclair D, Mathews C, Kagee A, Hillman A, & Lombard C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents.Cochrane Database of Systematic Reviews, 2016(11), CD006417
http://healthevidence.org/view-article.aspx?a=school-based-interventions-preventing-hiv-sexually-transmitted-infections-29881
Sexually active adolescents are at risk of contracting HIV and STIs. Unintended pregnancy can have detrimental impact on young people’s lives. This review examines the impact of school sexual education programs on number of young people that contract STIs and number of adolescent pregnancies. Eight cluster randomized control trials, including 55,157 participants are included in this review. Findings suggest there is little evidence that school programs alone are effective in improving sexual and reproductive health outcomes for adolescents. This webinar examined the effectiveness and components of interventions that prevent HIV, STIs and adolescent pregnancy.
School and community social influence programming for preventing tobacco and ...Health Evidence™
Health Evidence hosted a 90 minute webinar on substance use prevention and treatment interventions in children and adolescents, funded by the Canadian Centre on Substance Abuse. This webinar presented key messages and implications for practice.
This webinar focussed on interpreting the evidence in the following review, which synthesizes evidence related to social influence programming:
Skara, S. & Sussman, S. (2003). A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations. Preventive Medicine (37) 451-474.
Implementing online mental health supports into community-based survivorship ...Cancer Institute NSW
The intersection of developmental vulnerabilities and cancer-related stressors means that adolescents and young adults (AYAs) with cancer show more complex distress relative to other age groups.
The slide presentation that preceded of the annual Health Datapalooza in Washington DC, PCORI was pleased to participate in the latest installment in the Health Data Consortium and PricewaterhouseCoopers (PwC) Innovators in Health Data Series, a webinar featuring PCORI Executive Director Joe Selby, MD, MPH; NIH Director and PCORI Board of Governors member Francis Collins, MD, PhD; and Philip Bourne, PhD, NIH’s Associate Director for Data Science.
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
Dr. Dawn Stacey, University Research Chair in Knowledge Translation to Patients, and Director, Patient Decision Aids Research Group, Ottawa Hospital Research Institute, University of Ottawa, provides an overview of findings from her recent Cochrane review examining use of decision aids for identifying and making decisions about health treatment or screening options:
Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014(1), CD001431.
Evidence-Informed Public Health Decisions Made Easier: Take it one Step at a ...Health Evidence™
An afternoon workshop - held in partnership with the National Collaborating Centre for Methods and Tools - at the Ontario Public Health Convention April 7, 2011
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
Bea Brown gave a presentation on her research for the Sax Institute at the University of Sydney for the School of Public Health's 2013 research presentation day.
En esta presentación encontrara los antecedentes del neoliberalismo en México, en que consiste y cuales son as consecuencias de el mismo, que hasta la actualidad son fáciles de determinar.
El término neoliberalismo, proviene de la abreviación de neoclassical liberalism (liberalismo neoclásico), hace referencia a una política económica con énfasis tecnocrático y macroeconómico que considera contraproducente el excesivo intervencionismo estatal en materia social o en la economía y defiende el libre mercado capitalista como mejor garante del equilibrio institucional y el crecimiento económico de un país.
A joint presentation on Real People, Real Data at the 2016 International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden. Presented by Leanne Wells of the Consumers Health Forum of Australia; Sam Vaillancourt of St. Michael’s Hospital, Toronto, Canada, and; Dr Paresh Dawda of the Australian National University.
Evidence Based Practice is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care.
Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values.
The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology.
At the end of this presentation you will be able to:
Define evidence-based practice
Describe process & outline steps of EBP
Understand PICO elements & search strategy
Identify resources to support EBP
The focus of this presentation is nursing practice, although it is still of value to physicians and other health care professionals.
Demonstrating the value of km in your trust CKO workshop 011209suelb
Thinking about priorities for enabling colleagues to use and apply knowledge and how to improve performance through building know-how. How can we share and spread good practice and embed lessons learned. The Quality MK approach.
Bringing knowledge to bear. NHS Milton Keynes 020210
Getting a GRIP October 2007
1. Get a GRIP
Getting Research Into Practice
Sue Lacey Bryant
Whittlebury Hall
October 2007
2. Getting research into practice
“Health professionals and policy makers have
access to a large volume of research evidence
and guidance relevant to clinical effectiveness”
3. Getting a GRIP on the evidence
1. The challenge
2. Barriers
3. Tools we can use
4. Success factors
5. Implications for
Quality: MK
5. Courtesy of Bill Runciman, APSF;
Data extracted from AHRQ 2006
report
6. UK and Australia
Wrong plan nearly 50% of the time
Harm a patient with 10% of admissions
The harm is permanent or severe with 2% of
admissions
Death is associated with the harm in 1/300 patients
This amounts to 100,000 preventable deaths since 1995
(Australia alone)
Costs as much as $1 million /hour (Australia alone)
Data courtesy of Professor Jeff Richardson, CHE, Monash University and Professor
Runciman, Professorial Research Fellow, Patient Safety, University of Adelaide
7. Put another way
50% more deaths than annual combined total
from:
AIDS +
Suicide +
Motor vehicle accidents +
Homicide +
Drowning +
Falls +
Poisonings
8. OR – put another way
The equivalent of a jumbo jet crashing every
week with over 300 UK citizens on board
9. 2.BARRIERS
• Information and technology overload
Growing information base
• Specialty silos
Communication issues
• Clinical governance
Plethora of guidelines
Trainees, locum and agency staff
• Increasing patient safety issues
Less patient time, more referrals
Medical errors
Rising cost of claims
10. Reasons for resisting change
• Information problems
• Individual decision-making
• Effects of stress
• Getting the right people together
• The status quo
Getting evidence into practice
11. Main difficulties No.
Adopting Evidence based practice 13
research Time 12
evidence Access to information 8
Resources 7
Guidelines - overload 5
Baseline Changing practice 4
survey Costs 4
Patient expectations 2
Other 4
12. Information’s just landing on us!
“Robin weighed the NSF for the elderly, measured
its height and found it had a BMI of 86”
13. View from the frontline
1. Access 2. Skills
• Low levels of baseline
• Inadequate access to
information skills in using IT
• Low levels of baseline
• Lack of relevant
evidence skills in critical
appraisal
• Insufficient time for
clinicians to acquire
new skills
14. View from the frontline
3. Funding 4. Hierarchy
Insufficient money to Problems relating to
help clinicians to medical and nursing
acquire new skills hierarchies
5. Autonomy
Perceived threats to
medical autonomy
15. 3. TOOLS WE CAN USE
1. All groups involved
2. Characteristics of the change
that might influence its adoption
3. Readiness of health professionals
in the target group to change
4. Potential external barriers to change
5. Likely enabling factors
(including resources and skills)
16. Tools we can use: Barriers scale
• Benefits of change
• Quality of research
• Access to research
• Resources
• Adopter • Organisational
• Organization culture
• Innovation • Staffing issues
• Communication process • Personal feelings
17. Tools we can use: Survey monkey
• Online survey
• Different types of question -
single answer, multiple answers,
or a matrix
• Mandatory questions
• Conditional logic to direct users
• View results online
• Download as a *.csv file
• Make results available online
18. Tools we can use: the power of
Evidence
• 80% of physicians changed their care as a result
of evidence* - as follows:
• Avoided hospitalisation in 12%
• Reduced overall length of stay in hospital in 19%
• Changed diagnostic tests in 51% and drug choices in
45%
• Avoided additional tests or procedures in 49%
• Adhering to evidence-based guidelines for treating
hypertension alone could save at least $1.2 billion
annually in US**
•Marshall J G. …. The Rochester study.
•** Fischer MA, Avorn J. Economic implications of E-B-based prescribing for hypertension:
19. Tools we can use:
Knowledge management
• Public Health professionals
are the ‘pumping stations’
that drive the ‘water’
(knowledge) through
the organisation
• The librarians are the ‘treatment works’ that
ensure that the knowledge is fit for purpose and
available in the right quantities to be consumed’
20. Tools we can use:
Information team
• Suppporting journal clubs
• Supporting service review and developmen
• Supporting patient engagement workstream
• Best evidence, best practice, models of service
• Information skills training
• “Alerts”
• Access to resources
• Promoting use of the Map of medicine
• Sharing information: intranet / internet
21. •Evidence based
care pathways
•Framework for available to
sharing clinical clinicians at the
knowledge across point of care
care settings
•Localizable
benchmark for
clinical
processes
23. Influencing behaviour
Identifying local priorities for change
Exploring barriers to change
Gaining commitment, building coalitions
Incentives for change
Effective communication
Supporting/managing change
Monitoring change
Experience, evidence and everyday practice. King’s Fund
24. Getting the message across
Information
Context:
Local priorities,
Involvement,
Overcoming barriers
Process:
Leadership,
Collaboration
Communication
25. Key questions for managers
Who wants the change?
Why?
What is its importance for the service and for
the organization?
What are the measures of success?
Which staff groups are to be involved with this
change?
26. How to put evidence into practice
• What is the purpose? • What are the barriers?
• Who can help? • Are things on track?
• What is the situation? • What are the options?
• Who should be involved? • Which strategies should
• What are the key be used?
messages? • Is support available?
• What is the aim? • What would it cost, and
• Is the available is it worth doing?
information suitable? • Has it worked?
27. Research-to-practice pipeline
By clinicians:
1. Awareness
2. Acceptance
3. Applicable
4. Available and able
5. Acted on
By patients:
1. Agreed to
2. Adhered to
Taking the paths from research to improved health outcomes
28. 5. LESSONS FOR QUALITY:MK
Analyse the local situation
There will always be unplanned consequences
Getting evidence into practice is a lengthy and
complicated business
Change must offer benefits to frontline staff
29. No magic bullets
• “A multi-faceted approach using a range of
techniques can be successful”.
• “A costly and messy process”
• “ A group of complex inter-related tasks.”
Experience, evidence and everyday practice
30. Changing clinical behaviour
Be flexible
Tailor the approach
Start small
Build incrementally
Use existing channels
Build on previous work
Target enthusiasts first
AND it takes several years
31. Reality check
Implementation is the real work
While some teams focus on developing guidelines
the “much harder task of implementation was
sometimes under-prioritised”
Use the evidence we have
Getting better with evidence
32. The challenge for Quality: MK
• “the field of quality improvement is broadly
accepted and institutionalised now and is highly
politically correct.”
• “What is left is the question whether it really
contributes to a better, a more effective, efficient
and patient centred care.
Editor's Notes
We need to know how to embed the findings of high quality research into the day-to-day practice of heath professionals…..
“ Health professionals and policy makers have access to a large volume of research evidence and guidance relevant to clinical effectiveness” with which to inform their decisions on how to effect the necessary changes. Getting evidence into practice, 1999 … Yet the gap between research evidence and implementation at policy and local level remains.
A great deal of work has already been undertaken on what it takes to Get Research Into Practice. Late 90s saw publication/commissioning of several pieces of work reviewing the evidence into aspects of the dissemination, and implementation of research, yet this research itself seems to be poorly utilised! Together these reports inform our understanding: 1. Recognise barriers to making use of research findings which we need to overcome 2. Identify the factors that are critical to the success of implementation programmes 3. Think about the implications for Quality: Mk
To paint a broad brush - extrapolate on patient safety issues from national data – using slides shared by MoM
Courtesy of Bill Runciman, APSF – Extracted data from AHRQ 2006 report, USA Start with the Australian patient safety foundation
Mike Stein – Map of medicine. September 2007
“ Getting evidence into practice , a selective review of the literature by staff of CRD published as an Effective Health Care Bulletin - back in 1999 , Identified 5 major reasons for resistance to change
VERY Small scale survey, Of a total of 31 respondents 21 people (67.7%) listed the main difficulties they experience in their practice in adopting research findings into day-to-day care. Quotations: Issues around applying evidence-based medicine came to the fore eg. skills, confidence in validity of research, ease of interpreting findings, practicality, “Research is often restricted to narrow cases - not everyday reality”. “time to keep abreast of new findings” concerns around access to information eg. “easy ways of finding out what is best practice in a particular area”. There were other issues around access: “Accessibility of research material - cannot be copied / passwords & access arrangements keep changing”. A lack of resources was highlighted by seven people “eg CBT”. Five respondents picked up on the number of guidelines now available. One mentioned “conflict with national guidelines.”
Lest we risk losing our grip on day to day practice – Doctors set any discussion on using evidence, guidelines, etc in terms of their time, and the sheer QUANTITY of information they already get!
The Front-Line Evidence Based Medicine Project studied twenty teams in hospitals across North Thames for three years. This research identified a number of practical barriers to the use of databases and the application of research evidence by doctors in the context of their routine clinical practice: Donald, A. The frontline evidence based medicine project: the final report London: NHSE North Thames Regional office, 1998.
Problems deriving from medical and nursing hierarchies, perceived threats to medical autonomy and a lack of relevant evidence too
In Getting evidence into practice CRD recommended carrying out an “’information and diagnostic analysis’ to inform the development of an appropriate dissemination and implementation strategy” as the first stage of any proposed change. This analysis might include identification and assessment of:
There are tools we can use to measure the barriers that our colelagues face Closs and Bryar looked at the BARRIERS scale, developed in the States – and concluded that along with characteristics of the adopter, the organisation, the innovation itself and the communication process, other issues are also critical in the UK environment: reveals that issues relating to ”the benefits, quality and accessibility of research and resources for implementation” are also critical in a UK context. 22 They believe that there is also a need to look at the impact of organizational culture, staffing issues and personal feelings.
* Marshall J G. The impact of the hospital library on clinical decision making: the Rochester study. Bull Med Libr Assoc. 1992 April; 80(2): 169–178 ** Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA 2004;291:1850-6.
Suppporting journal clubs: finding information, facilitating, recording discussion, sharing CATS Supporting service review and development: evidence, best practice, models of service Supporting patient engagement workstream Information skills : finding information, reading for effectiveness, critical appraisal “ Alerts” Access to resources Promoting use of the Map of medicine
The Kings’ fund report on Getting better with evidence pooled the findings of seventeen projects across fifteen project teams, over eighteen months: They identified 4 critical success factors: Sufficient resources - In terms of time, money and skills Benefits - The proposed change needs to offer benefits of interest to frontline staff Collaboration - Enough of the right people need to ‘on board’ early enough Relevance - The approach needs to be interactive and relate research clearly to practice
The Kings’ Fund published a book on Experience, evidence and everyday practice . Creating systems for delivering effective health care Learning from the experiences of the NHS staff involved in three prestigious programmes (PACE, 18 the Front-Line project 20 and FACTS 23 ) And these are the common practical and organizational issues that need to be addressed to influence the behaviour of health professionals:
Palmer and Fenner’s getting the message across INFORMATION: Its nature & quality CONTEXT: Supporting Local priorities; Involving all the groups involved in the proposed change; Overcoming organizational barriers. PROCESS: Leadership: allocating responsibility to an authoritative figure Collaboration – with local services and initiatives COMMUNICATION A planned process, creating new mechanisms where necessary Come back to this separately; key issue. Checklist for comms.
Drawing on the evidence uncovered, the NHMRC handbook poses a series of questions to guide the steps involved in guideline dissemination and implementation. Those planning “deliberate actions” to implement research based knowledge are advised to consider:
7 stage model Identifying the blockages
Summarising the lessons derived from the Promoting Action on Clinical Effectiveness (PACE) project, Dunning et al confirmed the key message from previous studies, in their book on Experience, evidence and everyday practice. Creating systems for delivering effective health care – book Far from being a linear task, it is rather “ a group of complex inter-related tasks.” No magic bullets: Oxman, A.D. et al. No magic bullets: a systematic review of 102 trials of interventions to help health care professionals deliver services more effectively or efficiently . London: North East Thames Regional Health Authority, 1994
The authors of Getting better with evidence showed that the scope of the work of implementation amplifies over time, involving a widening circle of professionals and organizations They recommend: