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TOOLS ARE NOT ENOUGH TOOLS ARE NOT ENOUGH
Building Capacity and Nurturing Organizational Contexts and Processes to Support Evidence-Informed Decision Making
Leslea Peirson MA PhD1,2 Megan Ward MHSc MD FRCP(C)3 Donna Ciliska RN
PhD1,2 Maureen Dobbins RN PhD2 David Mowat MBChB, MPH, FRCPC, FFPH3
1National Collaborating Centre for Methods and Tools, 2McMaster University School of Nursing, 3Region of Peel Public Health Department
Canadian Public Health Association Annual Conference, June 2010, Toronto ON
Presentation Outline Presentation Outline
• Organizational Context
• 2009-2019 Strategic Plan
• Evidence-Informed Decision Making Initiative
• Example of EIDM in Action
Organizational ContextOrganizational Context
• Peel Public Health (PPH)
• Mississauga, Brampton, Caledon
• 1.3M Residents
• 800 Staff (656 FTE)http://en.wikipedia.org/wiki/Regional_Municipality_of_Peel
20092009--2019 Strategic Plan2019 Strategic Plan
ONGOING PROGRAMS
4 PROGRAM PRIORITIES:Healthy
Environments, Healthy Weights
Nurturing the Next Generation
Surveillance: Data for Action
LIVINGTOBACCO FREE
5 INFRASTRUCTURE PRIORITIES:
Workforce Development
Measuring Performance
Internal/External Communications
Serving an Ethno- Culturally Diverse
Community
MAKING EVIDENCE- INFORMED DECISIONS
(EIDM)
GOVERNING PHILOSOPHY: THE PUBLIC HEALTH WAY
http://www.peelregion.ca/health/health-status-report/stay-ahead-curve/
What is EIDM?What is EIDM?
The process of distilling and disseminating the best available evidence, whether from research or from actual practice, and using that evidence to inform and improve public health practice and policy. http://www.nccmt.ca/eiph/index-eng.html
What is EIDM?What is EIDM?
1. Define Question2. Search for Evidence3. Appraise Evidence4. Synthesize Evidence5. Adapt to Local Context6. Implement Decision7. Evaluate Effectiveness
http://www.nccmt.ca/eiph/index-eng.html
The EIDM InitiativeThe EIDM Initiative
• Megan Ward, Associate Medical Officer of Health
• Leading and managing change
• CHSRF EXTRA Fellowship 2008-2010
• Developed suite of tools and processes to support EIDM activities
The EIDM InitiativeThe EIDM Initiative• EIDM Toolkit Working Group• EIDM Toolkit
• Conceptual Modeling• Defining a Researchable Question (e.g., PICO)• Searching the Literature (and Saving Results)• Critical Appraisal of Quantitative Evidence• Critical Appraisal of Qualitative Evidence• Synthesizing the Evidence (Data Extraction Tables)• Applicability and Transferability of Research Findings• Formulating Recommendations and Writing Reports• Manager Checklist
• Field Testing the Tools and Processes
Tools are Not EnoughTools are Not Enough
• Tools are essential, but not sufficient
• Need to build organizational and staff capacity and nurture a culture and processes that will support, sustain and increase EIDM
• The EIDM initiative has an extensive and expanding presence
NEWNEW EIDM-Related Activities 2008-2010
Divisional EIDM
Mentoring Pilot Project
Student Placements Workforce
Development Strategic Priority
New Position Manager of
Research and Education
EXTRA Project Workforce
Development + EIDM
2010-2012
Library Re-Positioned Under Public
Health
EXTRA Project EDIM Focus 2008-2010
Library Joins Consortium
Library Needs
Assessment
Expert Librarian
Consultation
Virtual Library Training
Designated Senior
Administrative Lead for EIDM
EIDM Toolkit Working Group
New Library Staff Positions
EIDM Toolkit
Commissioned Literature & Systematic
Reviews
Base Budget Funding for
Commissioned Reviews
RefWorks Pilot Project
RefWorks License
Purchase
Director Study Days
EIDM Steering Committee
Program Planning and
Evaluation Tools &
Processes
Base Budget Funding for
EIDM TrainingQualitative Research
Workshops
Conference At Home
health- evidence.ca Workshops
Conceptual Mapping
Workshops
Critical Appraisal Club
EIDM / Critical Appraisal
Workshops
EIDM Communi-
cations Strategy
Conceptual Mapping Club
Health Status Data on Intranet
“Dashboard”
Academic & Expert
Relationships
Expert Mentored Specialist-
Manager Pairs
NIPS & RIPS Learning and Development
Sessions
The Public Health Way Road Show
EIDM Link on “Pathways”
Intranet
EIDM Evaluation Planning
RefWorks Community of
Practice
The TeamThe Team
DivisionalManager
Project Specialist
Team Supervisor
Other Stakeholders:Tobacco Prevention TeamCampaign Partners
Defining the QuestionDefining the Question
“Are quit and win contests effective in increasingshort and/or long-term
smoking cessation rates?”
Searching for EvidenceSearching for Evidence
SPECIALIST
5050 hitsMissing 2 Cochrane Reviews
10 hours
SKILLED LIBRARIAN
Refined Search Strategy3 “nuggets” (the 2 Reviews+1 RCT)
10 minutes
Critical Appraisal of the EvidenceCritical Appraisal of the EvidenceSystematic
Review #1Systematic
Review #1Systematic Review #2
Systematic Review #2
RCTRCT
Pre-processed (and Rated Strongly) by:
Specialist Duplicates Appraisal Using CASP Tool
Specialist Appraises Using CASP Tool
40+ Members of Peel’s Critical Appraisal Club Also Assess
Applicability and TransferabilityApplicability and Transferability
http://www.nccmt.ca/pubs/2007_12_AT_tool_v_nov2007_ENG.pdf
Recommendations Recommendations and Report Writingand Report Writing
Search
Appraisal
Search
Concept Model
Question
1:2:20
AcknowledgementsAcknowledgementsCanadian Health Services Research Foundation (CADRE Postdoctoral Fellowship: L. Peirson; EXTRA Fellowship: M. Ward)
Canadian Institutes of Health Research (joint funder, CADRE Postdoctoral Fellowship: L. Peirson)
National Collaborating Centre for Methods and Tools and McMaster University School of Nursing (Postdoctoral Hosts: L. Peirson)
Peel Public Health (Postdoctoral Training and Research Setting)
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