Rugged landscapes: complexity and implementation science

Abstract Background Mis-implementation—defined as failure to successfully implement and continue evidence-based programs—is widespread in public health practice. Yet the causes of this phenomenon are poorly understood. Methods We develop an agent-based computational model to explore how complexity hinders effective implementation. The model is adapted from the evolutionary biology literature and incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches—Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM). Results The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM. Conclusions The model’s results emphasize the importance of adapting one’s approach to the characteristics of the problem at hand. Evidence-based decision-making (EBDM), which combines evidence from multiple independent sources with on-the-ground local knowledge, is a particularly potent strategy for implementation and quality improvement.

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Evidence-Based Practice and Public Health

10.1093/med/9780190238308.003.0012 ◽

2018 ◽

Author(s):

Patrick Bryant ◽

Peter D Hurd ◽

Ardis Hanson

Keyword(s):

Public Health ◽

Decision Making ◽

Public Health Practice ◽

Standards Of Care ◽

Evidence Based ◽

Clinical Knowledge ◽

Health Practice ◽

Challenges And Opportunities ◽

Based Medicine ◽

Evidence Based Decision Making

The most difficult step of evidence-based medicine (EBM) and evidence-based public health (EBPH) is to link the evidence with current clinical knowledge and experience, especially with the continued focus on using evidence in decision-making. Standards of care and clinical practice guidelines are now established and reported using nationally and globally recognized protocols to ensure standard nomenclature and clinical crosswalks. This chapter examines relevant background issues, including concepts underlying EBM, EBPH, and definitions of evidence; describes key analytic tools to enhance the adoption of evidence-based decision-making; and finishes with challenges and opportunities for implementation in public health practice.

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A qualitative exploration of evidence-based decision making in public health practice and policy: the perceived usefulness of a diabetes economic model for decision makers

Evidence & Policy A Journal of Research Debate and Practice ◽

10.1332/174426418x15245020185055 ◽

2019 ◽

Vol 15 (4) ◽

pp. 461-487

Author(s):

Amy Grove ◽

Tom Sanders ◽

Sarah Salway ◽

Elizabeth Goyder ◽

Susan Hampshaw

Keyword(s):

Public Health ◽

Decision Making ◽

Economic Model ◽

Public Health Practice ◽

Perceived Usefulness ◽

Decision Makers ◽

Evidence Based ◽

Economic Modelling ◽

Health Practice ◽

Evidence Based Decision Making

<sec id="st1"> Purpose The purpose of this paper is to explore the perceived usefulness of a diabetes economic model as a potential tool for aiding evidence-based decision making in public health.</sec> <sec id="st2"> Methods Fifteen interviews and two focus groups, with four participants in each, were conducted with health and management professionals working in one public health department in a local council. Data were analysed using inductive thematic analysis to generate four themes.</sec> <sec id="st3"> Findings The findings reflect attitudes and beliefs of a diverse staff group situated in public health services. Findings reveal that the economic model was perceived as useful and participants reported positive views regarding the principles of economic modelling for decision making. However, it was potentially problematic in practice due to organisational constraints linked to limited resources, restricted budgets and local priorities. Differences in institutional logics of staff working across public health and local government departments were identified as a potential barrier to the use of the model in practice.</sec> <sec id="st4"> Discussion The findings highlight anticipated challenges that public health practice and policy decision-makers could face if they selected to implement an economic modelling approach to fulfil their evidence needs. Previous studies have revealed that healthcare decision makers would find evidence around the economic impacts of public health interventions useful, but this information was not always available in the format required. This paper provides insights into how public health staff perceive economic modelling, and explores how they use this type of evidence when making public health practice and policy decisions.</sec>

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Training needs and supports for evidence-based decision making among the public health workforce in the United States

BMC Health Services Research ◽

10.1186/s12913-014-0564-7 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 30

Author(s):

Rebekah R Jacob ◽

Elizabeth A Baker ◽

Peg Allen ◽

Elizabeth A Dodson ◽

Kathleen Duggan ◽

...

Keyword(s):

Public Health ◽

United States ◽

Decision Making ◽

Health Workforce ◽

The United States ◽

Training Needs ◽

Public Health Workforce ◽

Evidence Based ◽

The Public ◽

Evidence Based Decision Making

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Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00007019 ◽

2009 ◽

Vol 24 (4) ◽

pp. 298-305 ◽

Cited By ~ 14

Author(s):

David A. Bradt

Keyword(s):

Public Health ◽

Decision Making ◽

Evidence Based Medicine ◽

Strategic Decision ◽

Systematic Research ◽

Evidence Based ◽

Clinical Expertise ◽

Strength Of Evidence ◽

Based Medicine ◽

Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

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The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.942 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C E Chronaki ◽

A Miglietta

Keyword(s):

Public Health ◽

Decision Making ◽

Policy Development ◽

Digital Health ◽

Resource Planning ◽

Public Health Emergency ◽

Evidence Based ◽

Public Health Emergencies ◽

The Impact ◽

Evidence Based Decision Making

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking. The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.

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