INTERNATIONAL CONFERENCE ON INTERNATIONAL CONFERENCE ON EVIDENCE-BASED BEST PRACTICE EVIDENCE-BASED BEST PRACTICE

GUIDELINESGUIDELINES

EVIDENCE-INFORMED MANAGEMENT EVIDENCE-INFORMED MANAGEMENT DECISION-MAKING: IS IT A POSSIBILITY DECISION-MAKING: IS IT A POSSIBILITY

IN HEALTHCARE?IN HEALTHCARE?

07 June 200707 June 2007

Crucial to finding the way is Crucial to finding the way is this: this:

there is no beginning or end.there is no beginning or end.

You must make your own map.You must make your own map.

Joy Harjo Joy Harjo

A Map to the Next World: A Map to the Next World: PoemsPoems

REFLECTIONSREFLECTIONS

Setting the Context re Setting the Context re Evidence-Informed Decision-Evidence-Informed Decision-MakingMaking

What is Evidence?What is Evidence? Cautions re Status of Evidence-Cautions re Status of Evidence-

Informed Decision-MakingInformed Decision-Making Your Roles as Leaders and Your Roles as Leaders and

ChampionsChampions

APPROACHES TO APPROACHES TO EVIDENCEEVIDENCE

Decision-makersDecision-makers = evidence viewed = evidence viewed colloquially, anything that colloquially, anything that establishes a fact or gives reason for establishes a fact or gives reason for believing something, defined by believing something, defined by relevancerelevance

ResearchersResearchers = evidence viewed = evidence viewed scientifically, use of systematic and scientifically, use of systematic and replicable methods for production, replicable methods for production, defined by methodologydefined by methodology Emphasis on Emphasis on context-freecontext-free universal universal

truths (evidence based medicine)truths (evidence based medicine) Emphasis on Emphasis on context-sensitivecontext-sensitive role for role for

evidence in particular decision (applied evidence in particular decision (applied social science)social science)

WHO DEFINIITON OF WHO DEFINIITON OF EVIDENCEEVIDENCE

Findings from research and other knowledge that may serve as a useful basis for decision-making in public health and health care.

World Health Organization Europe (2004)

UK GOVERNMENT DEFINITIONUK GOVERNMENT DEFINITIONOF EVIDENCEOF EVIDENCE

The raw ingredient of evidence is information. Good quality policy making depends on high quality information, derived from a variety of sources — expert knowledge; existing domestic and international research; existing statistics; stakeholder consultation; evaluation of previous policies; new research, if appropriate; or secondary sources, including the internet. Evidence can also include analysis of the outcome of consultation, costings of policy options and the results of economic or statistical modeling.

U.K. Government Policy Hub (1999)

CHSRF DEFINITION OF CHSRF DEFINITION OF EVIDENCEEVIDENCE

Evidence is information that comes closest Evidence is information that comes closest to the facts of a matter. The form it takes to the facts of a matter. The form it takes depends on context. The findings of high-depends on context. The findings of high-quality, methodologically appropriate quality, methodologically appropriate research are the most accurate evidence. research are the most accurate evidence. Because research is often incomplete and Because research is often incomplete and sometimes contradictory or unavailable, sometimes contradictory or unavailable, other kinds of information are necessary other kinds of information are necessary supplements to or stand-ins for research. supplements to or stand-ins for research. The evidence base for a decision is the The evidence base for a decision is the multiple forms of evidence combined to multiple forms of evidence combined to balance rigour with expedience – while balance rigour with expedience – while privileging the former over the latter.privileging the former over the latter.

CHSRF (2006)CHSRF (2006)

WHY EVIDENCE IS WHY EVIDENCE IS IMPORTANTIMPORTANT

Improved patient health outcomesImproved patient health outcomes Improved population health Improved population health

outcomesoutcomes Cost containmentCost containment Quality improvementQuality improvement AccountabilityAccountability Responsiveness in a new ageResponsiveness in a new age Can it work? Can it work? Will it work? Will it work? Is it worth it?Is it worth it?

WHY EVIDENCE MUST BE WHY EVIDENCE MUST BE INTERPRETED – what, how, INTERPRETED – what, how,

whowho

Inherent uncertainly usually Inherent uncertainly usually accompanying evidence – definitive accompanying evidence – definitive studies rarestudies rare

Complexity of decisions and Complexity of decisions and improbability of evidence being improbability of evidence being comprehensivecomprehensive

Need for actors to create meaning Need for actors to create meaning and interpret evidence before it and interpret evidence before it becomes “knowledge” becomes “knowledge”

Evidence is uncertain, dynamic, Evidence is uncertain, dynamic, complex, contestable, rarely complex, contestable, rarely completecomplete

UNDERLYING PRINCIPLESUNDERLYING PRINCIPLES

AccountabilityAccountability TransparencyTransparency QualityQuality InclusivenessInclusiveness ReliabilityReliability ResponsivenessResponsiveness ExplicitnessExplicitness

CATEGORIES OF CATEGORIES OF EVIDENCEEVIDENCE

Research evidenceResearch evidence = accepted research = accepted research methodologiesmethodologies

Organizational evidenceOrganizational evidence = information = information about organization’s capacity to about organization’s capacity to complete the task, e.g., human resource complete the task, e.g., human resource requirements, availability of managerial requirements, availability of managerial expertise, reality of limited budgetsexpertise, reality of limited budgets

Political evidencePolitical evidence = public attitudes = public attitudes towards proposed policies, media towards proposed policies, media reactionreaction

Rudolph Klein (2004)Rudolph Klein (2004)

CATEGORIES OF CATEGORIES OF EVIDENCEEVIDENCE

Context-free scientific evidenceContext-free scientific evidence = = medically oriented effectiveness medically oriented effectiveness researchresearch

Context-sensitive scientific Context-sensitive scientific evidenceevidence = social science oriented = social science oriented researchresearch

Colloquial evidenceColloquial evidence = expertise, = expertise, views and realities of stakeholdersviews and realities of stakeholders

Lomas, Lomas, etet alal (2005) (2005)

CONTEXT-SENSITIVE CONTEXT-SENSITIVE SCIENTIFIC EVIDENCESCIENTIFIC EVIDENCE

AttitudesAttitudes ImplementationImplementation Organizational capacityOrganizational capacity ForecastingForecasting Economics/financeEconomics/finance EthicsEthics

COLLOQUIAL EVIDENCECOLLOQUIAL EVIDENCE

ResourcesResources Expert and professional Expert and professional

opinionopinion Political judgmentPolitical judgment ValuesValues Habits and traditionsHabits and traditions Lobbyists and pressure groupsLobbyists and pressure groups Pragmatics and contingencies Pragmatics and contingencies

of situationof situation

DELIBERATIVE PROCESS

A deliberative process is a tool for producing guidance based on heterogeneous evidence. It is a participatory process that includes representation from experts and stakeholders, face-to-face interaction, criteria for the sources of scientific evidence and their weight, and a mechanism for eliciting colloquial evidence while making it subsidiary to the science.

CHSRF (2006)

ARGUMENTS FOR DELIBERATIVE PROCESSES

Eliciting and Combining Evidence

Democratic Governance Creating Acceptable Guidance

SUCCESS OF SUCCESS OF DELIBERATIVE DELIBERATIVE

PROCESSESPROCESSES Presence of strong chairpersonPresence of strong chairperson Different types of evidenceDifferent types of evidence Engagement of scientific and decision-Engagement of scientific and decision-

making communitiesmaking communities Explicit process of exclusion/inclusionExplicit process of exclusion/inclusion Face-to-face discussionsFace-to-face discussions Appropriate timelines for questionsAppropriate timelines for questions Mechanism to elicit values of Mechanism to elicit values of

participantsparticipants Venue for expressing minority viewsVenue for expressing minority views

CAUTIONS RE EVIDENCE CAUTIONS RE EVIDENCE INFORMED DECISION-MAKINGINFORMED DECISION-MAKING

It is early days yet for evidence-informed It is early days yet for evidence-informed decision-making.decision-making.

Evidence-informed decision-making and Evidence-informed decision-making and change management are intertwined.change management are intertwined.

““Evidence” is more than research in Evidence” is more than research in “evidence-informed decision-making.”“evidence-informed decision-making.”

Evidence-informed decision-making is Evidence-informed decision-making is sustained through personal relationships.sustained through personal relationships.

There is need for an evidence-informed There is need for an evidence-informed decision-making infrastructure.decision-making infrastructure.

INFLUENCING THE INFLUENCING THE FUTUREFUTURE

Hold the visionHold the vision Know your strengths Know your strengths Develop new Develop new

skills/competenciesskills/competencies Envision creatively the waysEnvision creatively the ways Build on the bestBuild on the best Be patient but persistent Be patient but persistent Be collaborative but Be collaborative but

challengingchallenging

WALKING THE WALKING THE LABYRINTHLABYRINTH

CHSRF REFERENCESCHSRF REFERENCES

J. Lomas, T. Culyer, C. McCutcheon, L. J. Lomas, T. Culyer, C. McCutcheon, L. McAuley & S. Law, “Conceptualizing and McAuley & S. Law, “Conceptualizing and Combining Evidence for Health System Combining Evidence for Health System Guidance,” May 2005.Guidance,” May 2005.

“Weighing up the evidence: Making evidence-informed guidance accurate, achievable, and acceptable,” A Summary of the Workshop held on September 29, 2005.

“WHAT COUNTS? Interpreting evidence-based decision-making for management and policy,” Report of the 6th CHSRF Annual Invitational Workshop, Vancouver, British Columbia, March 11, 2004.

Received Wisdoms: How health systems are using evidence to inform decision-making, CHSRF, 2007.

BLESSINGBLESSING

May the light of your souls guide you. May the light of your souls guide you. May the light of your souls May the light of your souls

bless the work that you do bless the work that you do with the secret love and warmth of your with the secret love and warmth of your

hearts. hearts. May you see in what you do May you see in what you do

the beauty of your own souls. the beauty of your own souls. May the sacredness of your work May the sacredness of your work bring healing, light and renewal bring healing, light and renewal

to those who work with you to those who work with you and to those who see and receive your work. and to those who see and receive your work.

May your work never weary you. May your work never weary you. May it release within you wellsprings of May it release within you wellsprings of

refreshment, inspiration and excitement.refreshment, inspiration and excitement.

May you be present in what you do. May you be present in what you do. May you never become lost in bland May you never become lost in bland

absences. absences. May the day never burden. May the day never burden.

May dawn find you awake and alert, May dawn find you awake and alert, approaching your new day with dreams, approaching your new day with dreams,

possibilities and promises. possibilities and promises. May evening find you gracious and fulfilled. May evening find you gracious and fulfilled.

May you go into the night May you go into the night blessed, sheltered and protected. blessed, sheltered and protected.

May your souls calm, console and renew May your souls calm, console and renew you.you.

Adapted fromAdapted from John O'Donoghue, John O'Donoghue, Anam CaraAnam Cara