scholarly journals Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care

2014 ◽  
Vol 2 (6) ◽  
pp. 1-192 ◽  
Author(s):  
Yiannis Kyratsis ◽  
Raheelah Ahmad ◽  
Kyriakos Hatzaras ◽  
Michiyo Iwami ◽  
Alison Holmes
Keyword(s):  
Health Care ◽  
Scientific Practice ◽  
National Level ◽  
Decision Makers ◽  
Infection Prevention And Control ◽  
Management Approach ◽  
Evidence Based ◽  
Research Knowledge ◽  
Making Sense ◽  
Adoption And Implementation

BackgroundAlthough innovation can improve patient care, implementing new ideas is often challenging. Previous research found that professional attitudes, shaped in part by health policies and organisational cultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little about how evidence is empirically accessed and used by organisational decision-makers when innovations are introduced.Aims and objectivesWe aimed to investigate the use of different sources and types of evidence in innovation decisions to answer the following questions: how do managers make sense of evidence? What role does evidence play in management decision-making when adopting and implementing innovations in health care? How do wider contextual conditions and intraorganisational capacity influence research use and application by health-care managers?MethodsOur research design comprised multiple case studies with mixed methods. We investigated technology adoption and implementation in nine acute-care organisations across England. We employed structured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting was infection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinical and clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technology examples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejected or discontinued.Findings(1) Access to, and use of, evidence types and sources varied greatly by profession. Clinicians reported a strong preference for science-based, peer-reviewed, published evidence. All groups called upon experiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sources and types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-level sources, and local implementation trials. (2) A sizeable proportion of professionals from all groups, including experienced staff, reported difficulty in making sense of evidence. Lack of awareness of existing implementation literature, lack of knowledge on how to translate information into current practice, and lack of time and relevant skills were reported as key reasons for this. (3) Infection outbreaks, financial pressures, performance targets and trusted relationships with suppliers seemed to emphasise a pragmatic and less rigorous approach in sourcing for evidence. Trust infrastructure redevelopment projects, and a strong emphasis on patient safety and collaboration, appeared to widen scope for evidence use. (4) Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals. (5) Doctors and non-clinical managers sourced evidence plausible to self. Nursing staff also sought acceptance of evidence from other groups. (6) We found diverse ‘evidence templates’ in use: ‘biomedical-scientific’, ‘practice-based’, ‘rational-policy’. These represented shared cognitive models which defined what constituted acceptable and credible evidence in decisions. Nurses drew on all diverse ‘templates’ to make sense of evidence and problems; non-clinical managers drew mainly on the practice-based and rational-policy templates; and doctors drew primarily on the biomedical-scientific template.ConclusionsAn evidence-based management approach that inflexibly applies the principles of evidence-based medicine, our findings suggest, neglects how evidence is actioned in practice and how codified research knowledge inter-relates with other ‘evidence’ also valued by decision-makers. Local processes and professional and microsystem considerations played a significant role in adoption and implementation. This has substantial implications for the effectiveness of large-scale projects and systems-wide policy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Catalyzing Implementation of Evidence-Based Interventions in Safety Net Settings: A Clinical–Community Partnership in South Los Angeles

2017 ◽  
Vol 18 (4) ◽  
pp. 586-597 ◽  
Author(s):  
Denise D. Payán ◽  
David C. Sloane ◽  
Jacqueline Illum ◽  
Roberto B. Vargas ◽  
Donzella Lee ◽  
...  
Keyword(s):  
Health Care ◽  
Los Angeles ◽  
Safety Net ◽  
Evidence Based ◽  
Community Partnership ◽  
South Los Angeles ◽  
Partnership Model ◽  
Clinical Community ◽  
Adoption And Implementation ◽  
Interview Guide

This study is a process evaluation of a clinical–community partnership that implemented evidence-based interventions in clinical safety net settings. Adoption and implementation of evidence-based interventions in these settings can help reduce health disparities by improving the quality of clinical preventive services in health care settings with underserved populations. A clinical–community partnership model is a possible avenue to catalyze adoption and implementation of interventions amid organizational barriers to change. Three Federally Qualified Health Centers in South Los Angeles participated in a partnership led by a local community-based organization (CBO) to implement hypertension interventions. Qualitative research methods were used to evaluate intervention selection and implementation processes between January 2014 and June 2015. Data collection tools included a key participant interview guide, health care provider interview guide, and protocol for taking meeting minutes. This case study demonstrates how a CBO acted as an external facilitator and employed a collaborative partnership model to catalyze implementation of evidence-based interventions in safety net settings. The study phases observed included initiation, planning, and implementation. Three emergent categories of organizational facilitators and barriers were identified (personnel capacity, professional development capacity, and technological capacity). Key participants and health care providers expressed a high level of satisfaction with the collaborative and the interventions, respectively. The CBO’s role as a facilitator and catalyst is a replicable model to promote intervention adoption and implementation in safety net settings. Key lessons learned are provided for researchers and practitioners interested in partnering with Federally Qualified Health Centers to implement health promotion interventions.

Estimating Downstream Budget Impacts in Implementation Research

2020 ◽  
Vol 40 (8) ◽  
pp. 968-977
Author(s):  
Todd H. Wagner ◽  
Alex R. Dopp ◽  
Heather T. Gold
Keyword(s):  
Health Care ◽  
Time Horizon ◽  
Impact Analysis ◽  
Decision Makers ◽  
Care Utilization ◽  
Evidence Based ◽  
Improvement Program ◽  
Cost Estimates ◽  
Health Care Decision ◽  
Care Decision

Health care decision makers often request information showing how a new treatment or intervention will affect their budget (i.e., a budget impact analysis; BIA). In this article, we present key topics for considering how to measure downstream health care costs, a key component of the BIA, when implementing an evidence-based program designed to reduce a quality gap. Tracking health care utilization can be done with administrative or self-reported data, but estimating costs for these utilization data raises 2 issues that are often overlooked in implementation science. The first issue has to do with applicability: are the cost estimates applicable to the health care system that is implementing the quality improvement program? We often use national cost estimates or average payments, without considering whether these cost estimates are appropriate. Second, we need to determine the decision maker’s time horizon to identify the costs that vary in that time horizon. If the BIA takes a short-term time horizon, then we should focus on costs that vary in the short run and exclude costs that are fixed over this time. BIA is an increasingly popular tool for health care decision makers interested in understanding the financial effect of implementing an evidence-based program. Without careful consideration of some key conceptual issues, we run the risk of misleading decision makers when presenting results from implementation studies.

Receptive rationing: reflections and suggestions for priority setters in health care

2015 ◽  
Vol 29 (6) ◽  
pp. 701-710 ◽  
Author(s):  
Iestyn Williams
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
Design Methodology ◽  
Decision Makers ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Content Type ◽  
Setting Process ◽  
External Stakeholders ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to take forward consideration of context in health care priority setting and to offer some practical strategies for priority setters to increase receptiveness to their work. Design/methodology/approach – A number of tools and methods have been devised with the aim of making health care priority setting more robust and evidence based. However, in order to routinely take and implement priority setting decisions, decision makers require the support, or at least the acquiescence, of key external parties. In other words, the priority setting process requires a receptive context if it is to proceed unhindered. Findings – The priority setting process requires a receptive context if it is to proceed unhindered. Originality/value – This paper develops the concept of legitimacy in the “authorising environment” in priority setting and describes strategies which might help decision makers to create a receptive context, and to manage relationships with external stakeholders.

EUR-ASSESS Project Subgroup Report on Dissemination and Impact

1997 ◽  
Vol 13 (2) ◽  
pp. 220-286 ◽  
Author(s):  
Alicia Granados ◽  
Egon Jonsson ◽  
H. David Banta ◽  
Lisa Bero ◽  
Ann Bonair ◽  
...  
Keyword(s):  
Health Care ◽  
Health Technology ◽  
Decision Makers ◽  
Evidence Based ◽  
Health Care Technology ◽  
Economic Implications ◽  
Care Technology ◽  
Support Decision Making ◽  
Use Of Health Care ◽  
Definite Solution

The objective of health technology assessment (HTA) is to support decision making in health care. HTA does not claim to provide a definite solution to a health care problem, but to assist decision makers with evidence-based information about the clinical, ethical, social, and economic implications of the development, diffusion, and use of health care technology.

scholarly journals Call for information, call for quality in mental health care

2012 ◽  
Vol 22 (1) ◽  
pp. 9-13 ◽  
Author(s):  
A. Lora
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Systems ◽  
National Level ◽  
Quality Measurement ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Clinical Indicators

The quality of routine mental health care is not optimal, it can vary greatly from region to region and among providers; in many occasions, it does not correspond to the standards of evidence-based mental health. To bridge this gap, the promotion of a systematic use of the information available for quality assurance would be most helpful, but measuring the quality of mental health care is particularly challenging. Quality measurement can play a key role in transforming health care systems, and the routine measurement of quality, using clinical indicators derived from evidence-based practice guidelines, is an important step to this end. In Italy, the use of clinical indicators is still sporadic: over the last 5 years only three projects have been aimed at analysing, in a structured way, the quality of care in severe mental illness, and two of these were led by the Italian Society of Psychiatric Epidemiology. Not only in Italy but also at global level there is an urgent need for the implementation of mental health information systems that could lead to a substantial improvement in information technology. Once this has been achieved, a common set of clinical indicators, agreed upon at the regional and national level and useful for benchmarking and for comparing mental health services, could be defined. Finally, using the implementation strategies, a system of quality improvement at both regional and local levels will be built.

scholarly journals Translating a global reference diet to national settings: a data platform for healthy and sustainable diets

2020 ◽  
Vol 30 (Supplement_5) ◽  
Keyword(s):  
National Level ◽  
Decision Makers ◽  
Evidence Based ◽  
Scientific Publications ◽  
Regional Office ◽  
Sustainable Diets ◽  
Training Materials ◽  
Key Stakeholders ◽  
Data Platform ◽  
Key Issues

Abstract In October 2019 the WHO Regional Office for Europe hosted a meeting of experts from across Europe, representing a range of sectors including academia, government, NGOs, procurement and professional cooking. The aim of the meeting was to highlight and prioritise key issues and discuss the actions needed to address these, the resources needed and the stakeholder engagement necessary to drive change. One key outcome is the development of a data platform for healthy and sustainable diets. This tool will enable countries to use their own data to adapt their own diets on a national and subnational level to the evidence-based global reference diet developed by recent scientific publications. Training materials will be developed alongside the data platform to enable key stakeholders and decision makers to build capacity in their own countries. The platform will empower policymakers within countries to develop and introduce national level initiatives to improve diets in terms of health and sustainability.

scholarly journals Proposal of a Holistic Model to Support Local-Level Evidence-Based Practice

2010 ◽  
Vol 10 ◽  
pp. 1520-1529
Author(s):  
Said Shahtahmasebi ◽  
Luis Villa ◽  
Helen Nielsen ◽  
Hilary Graham-Smith
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Practice ◽  
Local Level ◽  
Policy Formation ◽  
Decision Makers ◽  
Evidence Based ◽  
Holistic Model ◽  
Local Evidence ◽  
External Evidence

In response to a central drive for evidence-based practice, there have been many research support schemes, setups, and other practices concentrating on facilitating access to external research, such as the Centre for Evidence Based Healthcare Aotearoa, the Cochrane Collaboration, and the York Centre for Reviews and Dissemination. Very little attention has been paid to supporting internal research in terms of local evidence and internal research capabilities. The whole evidence-based practice movement has alienated internal decision makers and, thus, very little progress has been made in the context of evidence informing local policy formation. Health and social policies are made centrally based on dubious claims and often evidence is sought after implementation. For example, on record, most health care practitioners appear to agree with the causal link between depression and mental illness (sometimes qualified with other social factors) with suicide; off the record, even some psychiatrists doubt that such a link is applicable to the population as a whole. Therefore, be it through misplaced loyalty or a lack of support for internal researchers/decision makers, local evidence informing local decision making may have been ignored in favour of external evidence. In this paper, we present a practical holistic model to support local evidence-based decision making. This approach is more relevant in light of a new approach to primary health care of “local knowledge” complementing external evidence. One possible outcome would be to network with other regional programmes around the world to share information and identify “best” practices, such as the “Stop Youth Suicide Campaign”(www.stopyouthsuicide.com).

scholarly journals Evidence-based practice by physiotherapists in UAE: Investigating behavior, attitudes, awareness, knowledge and barriers

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253215
Author(s):  
Hamda AlKetbi ◽  
Fatma Hegazy ◽  
Arwa Alnaqbi ◽  
Tamer Shousha
Keyword(s):  
United Arab Emirates ◽  
Evidence Based Practice ◽  
Quality Of Healthcare ◽  
Decision Makers ◽  
Evidence Based ◽  
Research Knowledge ◽  
Knowledge And Skills ◽  
Knowledge And Practice ◽  
Key Terms

Evidence-based practice (EBP) is an important factor determining the quality of healthcare. The field of physiotherapy is still limited by indirect access in several countries including the United Arab Emirates (UAE) which creates added pressure to justify the merit in its practitioner’s capabilities. This study explores the behavior, attitudes, awareness and knowledge towards EBP among practicing physiotherapists in the UAE. It also enquires about their perception of the barriers in the implementation of EBP. Using a questionnaire survey of 258 physiotherapists, results show that the awareness of EBP is limited to a few terms including EBP, systematic literature review, and random trials while other terms associated with scientific studies are not known well. The attitude towards EBP was found to be significantly related to the knowledge of EBP (r = 0.208) and the perception of barriers to it (r = 0.156). The EBP behavior was found positively related to its knowledge (r = 0.134) and the perception of barriers (r = 0.216). The physiotherapists prefer to use their own experience and books and research articles to apply EBP but do not consider their peers to be as worthy sources as the others. However, their attitudes towards EBP are largely positive though their perception of barriers grows with better knowledge and understanding of EBP. The barriers in the implementation of EBP are a lack of research knowledge and skills, time, support, and resources which indicate opportunities for the decision-makers to improve the adoption of EBP among these professionals. This study concluded that although physiotherapists in the UAE claim awareness about EBP, their knowledge is limited to a few key terms whereas, attention is needed to improve EBP knowledge and practice.

Summary of Evidence-Based Practices for Bloodstream Infection Prevention Across the Health Care Continuum of Care for Vascular Access Clinicians: Addressing the 3 Common Sources of Health Care-Associated Infection Transmission

2016 ◽  
Vol 21 (2) ◽  
pp. 72-74 ◽  
Author(s):  
J. Hudson Garrett
Keyword(s):  
Health Care ◽  
Vascular Access ◽  
Infection Prevention ◽  
Critical Role ◽  
Bloodstream Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Evidence Based ◽  
Clinical Environment ◽  
Core Element

Abstract Infection prevention and control is a core element of patient safety and in the reduction of central line-associated bloodstream infections. These deadly infections can cause a mortality rate of approximately 12%–25% in inpatient populations. Bloodstream infections can in many cases be prevented through the adoption of evidence-based standards from organizations such as the Centers for Disease Control and Prevention and the Association for Vascular Access. Vascular access professionals play a critical role in infection prevention in patient care by practicing frequent hand hygiene, maintaining a clean and sanitary clinical environment of care, and performing proper skin antisepsis before the insertion of a vascular access catheter. Each of these interventions contributes to the overall goal of eliminating central line-associated bloodstream infections in these very vulnerable patients.

Data Warehouse Facilitating Evidence-Based Medicine

2010 ◽  
pp. 174-207 ◽  
Author(s):  
Nevena Stolba ◽  
Tho Manh Nguyen ◽  
A Min Tjoa
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Decision Support Systems ◽  
Knowledge Base ◽  
Data Warehouse ◽  
Support Systems ◽  
Medical Data ◽  
Decision Makers ◽  
Evidence Based ◽  
Healthcare Decision

In the past, much effort of healthcare decision support systems were focused on the data acquisition and storage, in order to allow the use of this data at some later point in time. Medical data was used in static manner, for analytical purposes, in order to verify the undertaken decisions. Due to the immense volumes of medical data, the architecture of the future healthcare decision support systems focus more on interoperability than on integration. With the raising need for the creation of unified knowledge base, the federated approach to distributed data warehouses (DWH) is getting increasing attention. The exploitation of evidence-based guidelines becomes a priority concern, as the awareness of the importance of knowledge management rises. Consequently, interoperability between medical information systems is becoming a necessity in modern health care. Under strong security measures, health care organizations are striking to unite and share their (partly very high sensitive) data assets in order to achieve a wider knowledge base and to provide a matured decision support service for the decision makers. Ontological integration of the very complex and heterogeneous medical data structures is a challenging task. The authors’ objective is to point out the advantages of the deployment of a federated data warehouse approach for the integration of the wide range of different medical data sources and for distribution of evidence-based clinical knowledge, to support clinical decision makers, primarily clinicians at the point of care.

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