Getting a GRIP October 2007

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Getting Research into Practice across the health service, a presentation by Sue Lacey-Bryant


<ul><li> 1. Get a GRIPGetting Research Into Practice Sue Lacey Bryant Whittlebury HallOctober 2007</li></ul> <p> 2. Getting research into practiceHealth professionals and policy makers haveaccess to a large volume of research evidenceand guidance relevant to clinical effectiveness 3. Getting a GRIP on the evidence1. The challenge2. Barriers3. Tools we can use4. Success factors5. Implications for Quality: MK 4. 1. THE CHALLENGE 5. Courtesy of Bill Runciman, APSF;Data extracted from AHRQ 2006report 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 patientsThis 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 ProfessorRunciman, Professorial Research Fellow, Patient Safety, University of Adelaide 7. Put another way50% more deaths than annual combined totalfrom:AIDS +Suicide +Motor vehicle accidents +Homicide +Drowning +Falls +Poisonings 8. OR put another wayThe 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 changeInformation problemsIndividual decision-makingEffects of stressGetting the right people togetherThe status quo Getting evidence into practice 11. Main difficulties No.AdoptingEvidence based practice 13 research Time12evidenceAccess to information 8Resources 7Guidelines - overload 5BaselineChanging practice 4surveyCosts 4Patient expectations2Other 4 12. Informations just landing on us!Robin weighed the NSF for the elderly, measuredits height and found it had a BMI of 86 13. View from the frontline1. Access2. Skills Low levels of baseline Inadequate access toinformationskills in using IT Low levels of baseline Lack of relevantevidence skills in critical appraisal Insufficient time for clinicians to acquire new skills 14. View from the frontline3. Funding4. HierarchyInsufficient money toProblems relating tohelp clinicians tomedical and nursingacquire new skillshierarchies5. AutonomyPerceived threats tomedical autonomy 15. 3. TOOLS WE CAN USE1. All groups involved2. Characteristics of the changethat might influence its adoption3. Readiness of health professionalsin the target group to change4. Potential external barriers to change5. 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 Organizationculture 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 ofEvidence 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 treatinghypertension alone could save at least $1.2 billionannually 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 stationsthat drive the water(knowledge) throughthe organisation The librarians are the treatment works thatensure that the knowledge is fit for purpose andavailable 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 pathwaysFramework for available tosharing clinical clinicians at theknowledge across point of carecare settingsLocalizablebenchmark forclinicalprocesses 22. 4. SUCCESS FACTORS Resources Benefits Collaboration RelevanceGetting better with evidence 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. Kings 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 forthe organization? What are the measures of success? Which staff groups are to be involved with thischange? 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 keybe used?messages? Is support available? What is the aim? What would it cost, and Is the availableis it worth doing?information suitable? Has it worked? 27. Research-to-practice pipelineBy clinicians:1. Awareness2. Acceptance3. Applicable4. Available and able5. Acted onBy patients:1. Agreed to2. Adhered toTaking 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 andcomplicated business Change must offer benefits to frontline staff 29. No magic bullets A multi-faceted approach using a range oftechniques 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 checkImplementation is the real workWhile some teams focus on developing guidelines the much harder task of implementation was sometimes under-prioritisedUse the evidence we have Getting better with evidence 32. The challenge for Quality: MK the field of quality improvement is broadlyaccepted and institutionalised now and is highlypolitically correct. What is left is the question whether it reallycontributes to a better, a more effective, efficientand patient centred care.</p>