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Abstract. Aims. The aim of this program is to develop, implement and maintain a service to ... policy makers to use the best available evidence to improve healthcare. In 2008 ... managers' and 'Senior Medical Staff' email list-serves. The results ...
PUTTING KNOWLEDGE TO WORK - DEVELOPMENT OF AN EVIDENCE DISSEMINATION SERVICE AT SOUTHERN HEALTH

Catherine Voutier Centre for Clinical Effectiveness, Southern Health Clayton, Victoria, Australia

Abstract Aims The aim of this program is to develop, implement and maintain a service to capture, disseminate and utilise evidence to inform decision-making related to health technologies and clinical practice within Southern Health, the largest health service in Victoria. The Evidence Dissemination Service is part of a wider program addressing introduction of new safe, effective and cost effective procedures and review of potentially harmful, ineffective or inefficient procedures in current practice Methods A four-step evidence-based change methodology (identify the need for change, develop a proposal for change, implement the proposal and evaluate the change) was used to develop the Evidence Service. At each step in the model, evidence is sought from the literature, health service personnel and consumers. Issues of sustainability are also addressed. A literature review and formal needs analysis was undertaken, a taxonomy was developed for classification, and the processes were piloted and refined. Results We developed a framework as part of the proposal for change to identify potential sources of information and methods of capture, storage, processing, dissemination and utilisation. We sought feedback and received executive support and endorsement for the development of our proposal as an organisation-wide process to inform decision-making at clinical, management and policy-making levels.

Conclusions An evidence-based approach to process change can be used to develop, implement and evaluate a system to capture, disseminate and utilise evidence in decision-making. The successes, failures and challenges encountered will be presented.

Introduction Southern Health is the largest metropolitan hospital network in Victoria. It has a catchment of over 865,000, performs over a million episodes of care a year and has a workforce of approximately 12,300. Southern Health provides an integrated primary, secondary and tertiary health service, delivering over 200 comprehensive care programs across the network. The Centre for Clinical Effectiveness (CCE) at Southern Health is an evidence-based practice centre and its role is to promote and support health professionals, managers and policy makers to use the best available evidence to improve healthcare. In 2008, Southern Health commenced a new project addressing the introduction of new safe, effective and cost effective procedures and review of potentially harmful, ineffective or inefficient procedures in current practice. This project is being undertaken by a CCE project group and the Evidence Dissemination Service forms part of the support services that will underpin these processes. Methods The four-step evidence-based change methodology developed by CCE was used to develop the Evidence Dissemination Service [Fig 1].

A

Apply the principles of evidence-based decision-making

  

Seek evidence (research literature, public health data & local information) Consult health service personnel (clinicians, educators, managers, policy makers) Consult consumers (patients, other health providers)

Step 1 Identify need for change

Step 2 Develop proposal for change

B •

Step 3 Implement change

Step 4 Evaluate extent & results of change

Ensure sustainability, avoid duplication and integrate with existing systems

Document and investigate the change process in an action research approach



Fig. 1 © 2008 Centre for Clinical Effectiveness

This methodology covers four steps: identify the need for change, develop a proposal for change, implement the proposal and evaluate the change. Each step contains a range of activities which are undertaken to achieve the desired outcome. The objective of this project is to develop, implement and maintain a service to capture, disseminate and utilise evidence to inform decision-making related

to health technologies and clinical practice within Southern Health. A Steering Committee of senior hospital executives, clinical staff and consumer representatives brings their perspectives to each step.

Results Step One – Identify the Need for Change There is growing pressure on health systems to allocate resources in the most effective way possible. These issues involve all clinical and corporate decision-makers across the entire hospital network, spanning professional groups, programs and settings. Resource allocation decisions made within health services are frequently not based on the best available evidence. Gathering evidence to support the acquisition or phasing out of health technologies requires awareness of the available resources and knowledge and skills in acquisition of information. This expertise is usually not available in local health services and decisionmakers do not have the time required to investigate the resources they are aware of. Need for an Evidence Dissemination Service A detailed needs analysis was undertaken. A systematic review of the literature informed the development of a local needs assessment survey. An electronic questionnaire was initially distributed via the health service ‘All managers’ and ‘Senior Medical Staff’ email list-serves. The results of the needs analysis will be published separately. The information gathering activities confirmed the need for an Evidence Dissemination Service, identified the information requirements of local health service decision-makers and provided baseline data for subsequent evaluation. An essential part of the evidence-based change methodology is to establish that no duplication of existing services occurs. Currently, there is no existing information service at Southern Health that gathers evidence in a systematic way to inform decision-making at health service level. This project requires such a service to underpin decisions for resource allocation.

Step Two – Develop a Proposal for Change Once establishing that there was a need for an Evidence Dissemination Service and that current services did not meet decision-makers needs, the next step was to develop what such a service could look like. This included decisions as to what sort of information would be used and how it would be re-packaged.

Development of a framework A framework to identify potential sources of information and methods of capture, storage and dissemination was developed and then populated. This exercise provided a bird’s eye view of what information was available where, when and how. Risk management Each resource identified in the framework was analysed using a risk management approach. This enabled potential problems to be identified and possible solutions planned. Establishment of taxonomy A targeted information service requires taxonomy to ensure that information is findable and able to be appropriately distributed. We investigated various schemas and decided to combine elements of ICD10, MeSH and internal classifications. Pretesting A decision was made to pretest the new processes before implementing across the organisation. The pretesting activities are focused on one department that relies heavily on health technologies and on several committees that make decisions about resource allocations. The evaluation will aid in further development of the service and of the project as a whole.

Conclusion The value of evidence in decision-making is recognised by Southern Health in its support of the resource allocation project. The Evidence Dissemination Service is one of the support services that will underpin this project. Coming up with an appropriate name for the Evidence Dissemination Service has been a problem. The generic ‘Evidence Dissemination Service’ is still being used until a better replacement is found. After the evaluation of the pilot, we may be closer in finding a name. The process in which the Evidence Dissemination Service has developed has not been a steady move from one work section to the next. Rather, many sections have been in development simultaneously and required integration and coordination. Development of the taxonomy brought its own challenges. We sought to avoid duplication but no one existing schema met our needs.

The aims and objectives of the Evidence Dissemination Service have undergone extensive revision and refining as we work out what exactly we will be providing with the resources we have. In our presentation we will expand on the information given in this document.