Maria is a research fellow in the Research & Evaluation Office at Ko Awatea, Counties Manukau Health. Her role is to increase the use of research evidence within project management. Maria is interested in supporting anyone who needs guidance through the evidence integration process and also in collaborating to explore ways to improve this process and create a culture of evidence-informed decision-making at CM Health.
Maria has a background in physiotherapy and has worked in New Zealand and the United Kingdom in private practice, with hospital inpatients and outpatients, and with elite sports teams. She is about to finish a Master of Health Leadership majoring in international health at the University of Auckland next month.
Understanding and using the full body of research evidence available enables best practice decision-making in project management. The process to achieve this is known as evidence-informed decision-making (EIDM). EIDM is a deliberative process that guides decision-making using best research evidence (1). Research evidence is just one form of evidence – other sources include data, the patient voice and the context and environment in which the project takes place. The phrase evidence-informed, as opposed to evidence-based, recognises that research evidence is rarely complete enough to be directly used as-is, and conclusions need to be modified for the local context (1). Decisions which can be informed by research evidence need to be made throughout project planning and implementation, including setting project aims, choosing an intervention, selecting measurement indicators, showing program logic and choosing the implementation strategy.
Research evidence has traditionally played an integral part in clinical decision-making in healthcare. The methodology of integrating evidence in clinical decision-making originated in the 1990s with the establishment of evidence-based medicine (EBM) (2). Despite knowledge of EBM and EIDM, healthcare organisations around the world have considerable difficulty in translating research evidence into practice. Instead of being informed by evidence, decisions are routinely made by trial and error, intuition, and fashionable practice at all levels of healthcare (3, 4). Cherry-picking can occur, where information is used to back up one viewpoint, without taking into account the full body of evidence. Barriers to undertaking EIDM include a lack of understanding of the value of research evidence; a lack of knowledge of, and engagement in, the process of EIDM; a lack of skill in EIDM; a lack of human resource and teamwork; a lack of access to research literature; and a lack of time (5, 6).
In order to start building a culture of EIDM I have been fortunate to assume the role of a knowledge broker by taking part in select project teams. This involves advocating for a multidisciplinary team in project management to support evidence integration (with the library staff and data analysts); providing education on evidence integration; producing evidence syntheses; and increasing ties with academia. This incorporates knowledge translation, the process of turning knowledge into action (and thereby facilitating EIDM) through research dissemination and interaction, using social influence and facilitation (7).
Evidence integration for EIDM follows a seven-step process (Figure 1):
1. Define the question that you want to answer. This is usually in the form of a research question.
2. Search the literature. This involves getting all relevant information related to your question. The library can help you with this step.
3. Appraise the quality of the literature. You can use the Critical Appraisal Skills Program (CASP) checklists (8) for this step.
4. Synthesise the message from the literature. This may involve knowing basic statistics.
5. Adapt the findings to your local context. What is feasible with your resources?
6. Implement your project according to the literature findings. This includes taking into account the implementation strategy.
7. Assess the outcome of your project and be prepared to modify your strategy accordingly.
Evaluation takes place across the whole project cycle. The evidence integration steps are used for the key decision-points of setting the project aim, choosing the intervention, selecting measurement indicators, showing program logic and choosing the implementation strategy. After the research evidence integration process is complete it is important to disseminate your findings in order to share the results with others.
References
1. Culyer AJ, Lomas J. Deliberative processes and evidence-informed decision making in healthcare: do they work and how might we know? Evidence & Policy: A Journal of Research, Debate and Practice. 2006;2(3):357-71.
2. Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. The British Medical Journal [Internet]. 1996 [cited 2017 August 8]. Available from: http://www.bmj.com.ezproxy.auckland.ac.nz/content/312/7023/71.
3. LaRocca R, Yost J, Dobbins M, Ciliska D, Butt M. The effectiveness of knowledge translation strategies used in public health: a systematic review. BMC Public Health [Internet]. 2012 [cited 2017 September 25]; 12(751). Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-751.
4. Schreiber J, Stern P. A review of the literature on evidence-based practice in physical therapy. The Internet Journal of Allied Health Sciences and Practice [Internet]. 2005 [cited 2017 August 29]; 3(4). Available from: http://nsuworks.nova.edu/ijahsp/vol3/iss4/9/.
5. Ward M, Dobbins M, Peirson L. Lessons Learnt from Implementing an Organizational Strategy for Evidence-Informed Decision-Making. Public Health Panorama [Internet]. 2016 [cited 2017 September 11]; 2(3):[249-400 pp.]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0020/317540/8-Case-study-Lessons-learnt-implementing-organizational-strategy-evidence-informed-decision-making.pdf.
6. Durham Regional Health Department. Partnerships for health system improvement: Final report 2014 [cited 2017 September 29]. Available from: https://www.durham.ca/departments/health/pub/finalReportPHSI.pdf.
7. Cochrane Public Health. Knowledge translation 2017. Available from: http://ph.cochrane.org/knowledge-translation.
8. CASP UK. CASP checklists 2017. Available from: http://www.casp-uk.net/casp-tools-checklists.
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