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

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

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

3. Getting a GRIP on the evidence
1. The challenge
2. Barriers
3. Tools we can use
4. Success factors
5. Implications for
Quality: MK

4. 1. THE CHALLENGE

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

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 patients
This 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 Professor
Runciman, Professorial Research Fellow, Patient Safety, University of Adelaide

7. Put another way
50% more deaths than annual combined total
from:
AIDS +
Suicide +
Motor vehicle accidents +
Homicide +
Drowning +
Falls +
Poisonings

8. OR – put another way
The 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 change
• Information problems
• Individual decision-making
• Effects of stress
• Getting the right people together
• The status quo
Getting evidence into practice

11. Main difficulties No.
Adopting Evidence based practice 13
research Time 12
evidence Access to information 8
Resources 7
Guidelines - overload 5
Baseline Changing practice 4
survey Costs 4
Patient expectations 2
Other 4

12. Information’s just landing on us!
“Robin weighed the NSF for the elderly, measured
its height and found it had a BMI of 86”

13. View from the frontline
1. Access 2. Skills
• Low levels of baseline
• Inadequate access to
information skills in using IT
• Low levels of baseline
• Lack of relevant
evidence skills in critical
appraisal
• Insufficient time for
clinicians to acquire
new skills

14. View from the frontline
3. Funding 4. Hierarchy
Insufficient money to Problems relating to
help clinicians to medical and nursing
acquire new skills hierarchies
5. Autonomy
Perceived threats to
medical autonomy

15. 3. TOOLS WE CAN USE
1. All groups involved
2. Characteristics of the change
that might influence its adoption
3. Readiness of health professionals
in the target group to change
4. Potential external barriers to change
5. 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
• Organization culture
• 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 of
Evidence
• 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 treating
hypertension alone could save at 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:

19. Tools we can use:
Knowledge management
• Public Health professionals
are the ‘pumping stations’
that drive the ‘water’
(knowledge) through
the organisation
• The librarians are the ‘treatment works’ that
ensure that the knowledge is fit for purpose and
available 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 pathways
•Framework for available to
sharing clinical clinicians at the
knowledge across point of care
care settings
•Localizable
benchmark for
clinical
processes

22. 4. SUCCESS FACTORS
 Resources
 Benefits
 Collaboration
 Relevance
Getting 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. King’s 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 for
the organization?
 What are the measures of success?
 Which staff groups are to be involved with this
change?

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 key be used?
messages? • Is support available?
• What is the aim? • What would it cost, and
• Is the available is it worth doing?
information suitable? • Has it worked?

27. Research-to-practice pipeline
By clinicians:
1. Awareness
2. Acceptance
3. Applicable
4. Available and able
5. Acted on
By patients:
1. Agreed to
2. Adhered to
Taking 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 and
complicated business
 Change must offer benefits to frontline staff

29. No magic bullets
• “A multi-faceted approach using a range of
techniques 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 check
Implementation is the real work
While some teams focus on developing guidelines
the “much harder task of implementation was
sometimes under-prioritised”
Use the evidence we have
Getting better with evidence

32. The challenge for Quality: MK
• “the field of quality improvement is broadly
accepted and institutionalised now and is highly
politically correct.”
• “What is left is the question whether it really
contributes to a better, a more effective, efficient
and patient centred care.