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Get a GRIP Get a GRIP Getting Research Into Getting Research Into Practice Practice Sue Lacey Bryant Sue Lacey Bryant Whittlebury Hall Whittlebury Hall October 2007 October 2007

Getting a GRIP October 2007

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

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Page 1: Getting a GRIP October 2007

Get a GRIP Get a GRIP

Getting Research Into Getting Research Into PracticePractice

Sue Lacey BryantSue Lacey BryantWhittlebury HallWhittlebury Hall October 2007 October 2007

Page 2: Getting a GRIP October 2007

Getting research into Getting research into practice practice

““Health professionals and policy Health professionals and policy makers have access to a large makers have access to a large volume of research evidence and volume of research evidence and guidance relevant to clinical guidance relevant to clinical effectiveness”effectiveness”

Page 3: Getting a GRIP October 2007

Getting a GRIP on the Getting a GRIP on the evidenceevidence

1.1. The challengeThe challenge2.2. BarriersBarriers3.3. Tools we can Tools we can

useuse4.4. Success factorsSuccess factors5.5. Implications for Implications for

Quality: MKQuality: MK

Page 4: Getting a GRIP October 2007

1. THE CHALLENGE1. THE CHALLENGE

Page 5: Getting a GRIP October 2007

Courtesy of Bill Runciman, APSF; Data extracted from AHRQ 2006 report

Page 6: Getting a GRIP October 2007

Wrong plan nearly 50% of the timeWrong plan nearly 50% of the timeHarm a patient with 10% of admissionsHarm a patient with 10% of admissions

The harm is permanent or severe with 2% The harm is permanent or severe with 2% of admissionsof admissions

Death is associated with the harm in Death is associated with the harm in 1/300 patients1/300 patients

This amounts to 100,000 preventable This amounts to 100,000 preventable deaths since 1995 (Australia alone)deaths since 1995 (Australia alone)Costs as much as $1 million /hour Costs as much as $1 million /hour

(Australia alone)(Australia alone)

Data courtesy of Professor Jeff Richardson, CHE, Monash University Data courtesy of Professor Jeff Richardson, CHE, Monash University and Professor Runciman, Professorial Research Fellow, Patient Safety, and Professor Runciman, Professorial Research Fellow, Patient Safety,

University of AdelaideUniversity of Adelaide

UK and AustraliaUK and Australia

Page 7: Getting a GRIP October 2007

Put another wayPut another way

50% more deaths than annual 50% more deaths than annual combined total from:combined total from:

AIDS +AIDS +

Suicide +Suicide +

Motor vehicle accidents +Motor vehicle accidents +

Homicide +Homicide +

Drowning +Drowning +

Falls +Falls +

PoisoningsPoisonings

Page 8: Getting a GRIP October 2007

OR – put another wayOR – put another way

The equivalent of a jumbo jet The equivalent of a jumbo jet crashing every week with over crashing every week with over 300 UK citizens on board300 UK citizens on board

Page 9: Getting a GRIP October 2007

2.BARRIERS2.BARRIERS

• Information and technology Information and technology overloadoverload

Growing information baseGrowing information base• Specialty silosSpecialty silos

Communication issuesCommunication issues• Clinical governanceClinical governance

Plethora of guidelinesPlethora of guidelinesTrainees, locum and agency staffTrainees, locum and agency staff

• Increasing patient safety issues Increasing patient safety issues Less patient time, more referralsLess patient time, more referralsMedical errorsMedical errorsRising cost of claimsRising cost of claims

Page 10: Getting a GRIP October 2007

Reasons for resisting Reasons for resisting changechange

• Information problems Information problems • Individual decision-Individual decision-

makingmaking• Effects of stressEffects of stress• Getting the right people Getting the right people

togethertogether• The The status quostatus quo

Getting evidence into Getting evidence into practicepractice

Page 11: Getting a GRIP October 2007

Main difficulties No.

Evidence based practice 13

Time 12

Access to information 8

Resources 7

Guidelines - overload 5

Changing practice 4

Costs 4

Patient expectations 2

Other 4

AdoptingAdopting research research evidenceevidence

BaselineBaselinesurveysurvey

Page 12: Getting a GRIP October 2007

Information’s just Information’s just landing on us!landing on us!

““Robin weighed the NSF for the Robin weighed the NSF for the elderly, measured its height and elderly, measured its height and found it had a found it had a BMIBMI of 86” of 86”

Page 13: Getting a GRIP October 2007

View from the frontlineView from the frontline1. 1. AccessAccess• Inadequate Inadequate

access to access to informationinformation

• Lack of relevant Lack of relevant evidenceevidence

2. Skills2. Skills• Low levels of Low levels of

baseline skills in baseline skills in using ITusing IT

• Low levels of Low levels of baseline skills in baseline skills in critical appraisal critical appraisal

• Insufficient time Insufficient time for clinicians to for clinicians to acquire new acquire new skillsskills

Page 14: Getting a GRIP October 2007

View from the frontlineView from the frontline

3. Funding3. Funding

Insufficient money Insufficient money to help clinicians to help clinicians to acquire new to acquire new skillsskills

4. Hierarchy4. Hierarchy

Problems Problems relating to relating to medical and medical and nursing nursing hierarchieshierarchies

5. Autonomy5. Autonomy Perceived Perceived threats to threats to medical medical autonomyautonomy

Page 15: Getting a GRIP October 2007

3. TOOLS WE CAN USE3. TOOLS WE CAN USE

1. All groups involved 1. All groups involved

2. Characteristics of the change2. Characteristics of the change

that might influence its adoptionthat might influence its adoption

3. Readiness of health professionals3. Readiness of health professionals

in the target group to changein the target group to change

4. Potential external barriers to 4. Potential external barriers to changechange

5. Likely enabling factors 5. Likely enabling factors

(including resources and skills)(including resources and skills)

Page 16: Getting a GRIP October 2007

Tools we can use: Tools we can use: Barriers scaleBarriers scale

• Benefits of changeBenefits of change• Quality of Quality of

researchresearch• Access to research Access to research • ResourcesResources• Organisational Organisational

cultureculture• Staffing issuesStaffing issues• Personal feelingsPersonal feelings

• AdopterAdopter• OrganizationOrganization• InnovationInnovation• Communication Communication processprocess

Page 17: Getting a GRIP October 2007

Tools we can use: Survey Tools we can use: Survey monkeymonkey• Online surveyOnline survey• Different types of question Different types of question

- single answer, multiple - single answer, multiple answers, or a matrix answers, or a matrix

• Mandatory questionsMandatory questions• Conditional logic to direct Conditional logic to direct

usersusers• View results online View results online • Download as a *.csv file Download as a *.csv file • Make results available Make results available

onlineonline

Page 18: Getting a GRIP October 2007

•80% of physicians changed their care 80% of physicians changed their care as a result of evidence* - as a result of evidence* - as follows:as follows:

•Avoided hospitalisation in 12%Avoided hospitalisation in 12%•Reduced overall length of stay in hospital Reduced overall length of stay in hospital in 19%in 19%

•Changed diagnostic tests in 51% and drug Changed diagnostic tests in 51% and drug choices in 45%choices in 45%

•AvoidedAvoided additional tests or procedures in additional tests or procedures in 49%49%

•Adhering to evidence-based guidelines for Adhering to evidence-based guidelines for treating hypertension alone could save at treating hypertension alone could save at least $1.2 billion annually in US**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:

Tools we can use: the Tools we can use: the power of Evidencepower of Evidence

Page 19: Getting a GRIP October 2007

Tools we can use:Tools we can use: Knowledge managementKnowledge management• Public Public HealthHealth professionals professionals

are the ‘pumping stations’ are the ‘pumping stations’

that drive the ‘that drive the ‘waterwater’ ’

(knowledge) through (knowledge) through

the organisationthe organisation• The librarians are the ‘treatment The librarians are the ‘treatment

works’ that ensure that the knowledge works’ that ensure that the knowledge is fit for purpose and available in the is fit for purpose and available in the right quantities to be consumed’right quantities to be consumed’

Page 20: Getting a GRIP October 2007

Tools we can use:Tools we can use: Information teamInformation team• Suppporting journal clubs Suppporting journal clubs • Supporting service review and developmenSupporting service review and developmen• Supporting patient engagement workstreamSupporting patient engagement workstream• Best evidence, best practice, models of Best evidence, best practice, models of

serviceservice• Information skills trainingInformation skills training• ““Alerts”Alerts”• Access to resourcesAccess to resources• Promoting use of the Map of medicinePromoting use of the Map of medicine• Sharing information: intranet / internetSharing information: intranet / internet

Page 21: Getting a GRIP October 2007

•Framework for sharing clinical knowledge across care settings

•Evidence based care pathways available to clinicians at the point of care

•Localizable benchmark for clinical processes

Page 22: Getting a GRIP October 2007

4. SUCCESS FACTORS4. SUCCESS FACTORS

Resources Resources

BenefitsBenefits

CollaborationCollaboration

Relevance Relevance

Getting better with evidence

Page 23: Getting a GRIP October 2007

Influencing behaviourInfluencing behaviour

Identifying local priorities for changeIdentifying local priorities for change Exploring barriers to changeExploring barriers to change Gaining commitment, building Gaining commitment, building

coalitionscoalitions Incentives for changeIncentives for change Effective communicationEffective communication Supporting/managing changeSupporting/managing change Monitoring changeMonitoring change

Experience, evidence and everyday practice. King’s Fund

Page 24: Getting a GRIP October 2007

Getting the message Getting the message acrossacross Information Information Context:Context: Local priorities, Local priorities,

Involvement, Involvement, Overcoming Overcoming barriersbarriers

Process:Process:Leadership,Leadership,

CollaborationCollaboration CommunicationCommunication

Page 25: Getting a GRIP October 2007

Key questions for Key questions for managersmanagers Who wants the change?Who wants the change? Why?Why? What is its importance for the What is its importance for the

service and for the organization?service and for the organization? What are the measures of success?What are the measures of success? Which staff groups are to be Which staff groups are to be

involved with this change?involved with this change?

Page 26: Getting a GRIP October 2007

How to put evidence into How to put evidence into practicepractice• What is the purpose?What is the purpose?• Who can help?Who can help?• What is the situation?What is the situation?• Who should be Who should be

involved?involved?• What are the key What are the key

messages?messages?• What is the aim?What is the aim?• Is the available Is the available

information suitable?information suitable?

• What are the barriers?What are the barriers?• Are things on track?Are things on track?• What are the options?What are the options?• Which strategies Which strategies

should be used?should be used?• Is support available?Is support available?• What would it cost, What would it cost,

and is it worth doing?and is it worth doing?• Has it worked?Has it worked?

Page 27: Getting a GRIP October 2007

Research-to-practice Research-to-practice pipeline pipeline

By clinicians:By clinicians:1.1. Awareness Awareness 2.2. Acceptance Acceptance 3.3. Applicable Applicable 4.4. Available and Available and

able able 5.5. Acted on Acted on

By patients:By patients:1.1. Agreed to Agreed to 2.2. Adhered toAdhered to Taking the paths from research to improved health outcomes

Page 28: Getting a GRIP October 2007

5. LESSONS FOR 5. LESSONS FOR QUALITY:MKQUALITY:MK Analyse the local situationAnalyse the local situation There will always be unplanned There will always be unplanned

consequencesconsequences Getting evidence into practice is a Getting evidence into practice is a

lengthy and complicated businesslengthy and complicated business Change must offer benefits to Change must offer benefits to

frontline stafffrontline staff

Page 29: Getting a GRIP October 2007

No magic bulletsNo magic bullets

• ““A multi-faceted approach using a A multi-faceted approach using a range of techniques can be range of techniques can be successful”.successful”.

• ““A costly and messy process”A costly and messy process”• “ “ A group of complex inter-related A group of complex inter-related

tasks.”tasks.”

Experience, evidence and everyday practice

Page 30: Getting a GRIP October 2007

Changing clinical Changing clinical behaviourbehaviour

Be flexibleBe flexible Tailor the approachTailor the approach Start smallStart small Build incrementallyBuild incrementally Use existing channelsUse existing channels Build on previous workBuild on previous work Target enthusiasts Target enthusiasts

first first  AND it takes several AND it takes several

yearsyears

Page 31: Getting a GRIP October 2007

Reality checkReality check

Implementation is the real work Implementation is the real work

While some teams focus on developing While some teams focus on developing guidelines the “much harder task of guidelines the “much harder task of implementation was sometimes implementation was sometimes under-prioritised”under-prioritised”

Use the evidence we have Use the evidence we have Getting better with evidence

Page 32: Getting a GRIP October 2007

The challenge for The challenge for Quality: MK Quality: MK • ““the field of quality improvement is the field of quality improvement is

broadly accepted and institutionalised now broadly accepted and institutionalised now and is highly politically correct.” and is highly politically correct.”

• ““What is left is the question whether it What is left is the question whether it really contributes to a better, a more really contributes to a better, a more effective, efficient and patient centred effective, efficient and patient centred care.care.