What do we mean by evidence-informed practice?

Alison PetchWhat works in dementia care?

April 8 2008

What works in dementia care?Will extracare housing support someone with dementia for the rest of their life ?How will the acute hospital ward manage the person with dementia admitted for a heart operation ?Does reminiscence therapy make a difference ?What forms of support really help carers ?Which design features assist people with dementia ?Do short term breaks assist people with dementia and their carers ?

Definition

the best available research evidence about what is effectivepractice wisdom (the fruits of operational experience)the views of service users

Terminology

Why we refer to evidence-informed practice rather than evidence-based practice

‘evidence does not take decisions, people do’

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The nature of ‘evidence’ – Taylor, 2008

Evidence-based practiceHealth careSimple interventionsHierarchy of evidence

Evidence-informed practiceSocial careComplex, multi-faceted interventionsA variety of evidenceThe user voice

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The nature of ‘evidence’ – Taylor, 2008

Evidence-basedhierarchy

GuidelinesSystematic reviewsRCTsOther experimentsDescriptiveExpert consensusRespected opinion

Evidence-informedrange

Organisational knowledgePractitioner knowledgeUser knowledgeResearch knowledgePolicy knowledge

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But …

Different questions need different types of evidence

All evidence needs to be critically appraised and reviewed

Evidence-informed practice

Implies Asking challenging questions about practiceKnowing how and where to find researchUnderstanding key messages about what worksReflecting on experiences in order to learn

Evidence-informed practice (2)

Implies Measuring the impact your work is having for usersListening to what users have to say about servicesBeing explicit about how all these factors affect proposals and decisionsSharing knowledge and best practice with others

Knowledge management Knowledge Management is the ‘creation and subsequent

management of an environment which encourages knowledge to be created, shared, learnt, enhanced, organised and utilised for the benefit of the organisation and its customers’

(Specialist Library for Knowledge Management Aug 2005)

Knowledge management …

is about getting the

right information to theright people at theright time …

Why is KM important

‘Time and resources are often wasted because different organisations, teams, individuals, repeat practices and develop new methods over and over again rather than sharing what they know through reliable local regional and national networks !’

Evidence Story One

Types of evidence

National researchNationally identified good practice modelsLocal / in-house evaluationsData on short-term outcomes for usersData on long-term outcomes for usersViews of service usersResults against national PIsResults against local PIsViews of professional social care colleaguesViews of other professional colleagues

Common obstacles

Inadequate access to research

Lack of knowledge/skills about accessing research

Low levels of critical appraisal skills and lack of guidance on research quality

Lack of IT skills and access

Lack of or limited resources

Common obstacles 2Lack of support from colleagues – failure to value research at an organisational level

Culture of acting before reflecting

Poor communication of research

Perceived threats to professional autonomy, practitioner skills and experience

Beliefs and attitudes

Common obstacles 3

Lack of professional credit for disseminating research

Lack of relevant and timely evidence

Practitioners’ perceptions of research

Higher value placed on other sources of information

Statutory requirements/policies

Barnardo’s Evidence Guide

Common enablersAccessible, user friendly research evidence focused on practice questions

Active and timely dissemination of relevant research evidence (eg information-sharing networks)

Opportunities for discussion of research findings (eg journal clubs)

Development of resources to make research more accessible to practitioners (eg e-alerts, pre-appraised research summaries)

Common enablers 2

Training and staff development including opportunities for interaction with colleagues and experts

Collaboration between practice and producers of research

Practitioners engaging in continuing professional development and reflective practice

Common enablers 3

Support for practitioners to ‘try out’ research findings and conduct their own research

Culture of support and enthusiasm

Strong leadership and commitment to working in an evidence-informed way

Barnardo’s Evidence Guide

RiPfA – an approach to evidence

embedding evidence at the heart of policy and practicefocus on outcomes important to service userspartnership working – with other professions and other agenciesinvolvement of service users

Six strands

Learning eventsPublicationsNetwork exchangeChange projectswww.ripfa.org.ukJoint activity with research in practice

‘Firm Foundations’ for EiP

Giving a strategic leadSetting expectations that policy and practice will be evidence-informedEncouraging learning from researchImproving access to researchProviding support to agency research

Evidence Story Two

Outcomes …

Providing the options most likely to be effectiveHaving confidence that what is being provided is likely to have the desired impactBeing able to share with individuals and their carers the evidence on effectiveness, enabling them to make informed choicesEmpowering front-line practitioners in their support practicesEnhancing well-being for all living with dementia