Strategy for evidence- based health services a collaboration between Innlandet Hospital Trust and the Norwegian Knowledge Center for the Health Services Øystein Eiring, psychiatrist, Editor Norwegian Electronic Health Library/Mental Health, Medical Advisor.
Strategy For Evidence Based Health Services
Dec 12, 2014
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Strategy for evidence-based health services a collaboration between Innlandet
Hospital Trust and the Norwegian
Knowledge Center for the Health
Services
Øystein Eiring, psychiatrist, Editor Norwegian Electronic Health Library/Mental Health, Medical Advisor.
Menu for 30 minutes
About the Norwegian Knowledge Center
About Innlandet Health Trust
Challenges
Strategy and action plan
Summary
Norwegian Knowledge Centre for the Health Services
Founded 2004
Organised under The Directorate for Health Affairs
Scientifically and professionally independent
No authority to develop health policy or responsibility to implement policies
120 employees in Oslo
The Centre: Mission
Gathers and disseminates evidence
– about the effect and quality of methods and interventions
Uptake of evidence by the health services
The Centre: Central tasks 1
HTA reports
Systematic reviews
Overviews of overviews and early warnings
Projects that aim to improve the quality of patient information
Surveys of patients and employees experiences with health services
Support to the health services of poor countries through the provision of evidence
The Centre: Central tasks 2
Support to – the government– the regional health
authorities– the health services in
general
Host of The National Electronic Health Library
Quality Measurement and Patient Safety
Host of the National Council for Quality and Prioritization
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Access to knowledge has varied widely
National Hospital
Rural hospital
Why does the Health Library exist?
Equality: Equal access to health services implies equal access to knowledge
Quality: Quality assessment of knowledge is quality assessment of health services
Economy: National subscriptions and licenses saves time and money
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JournalsJournals
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DatabasesDatabases
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Systematic reviews
Systematic reviews
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Clinical guidelinesClinical guidelines
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Reference booksReference books
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Specialist librariesSpecialist libraries
Challenges for the knowledge center
Bein well known among even more health workers
Being known for even more relevant services
”Develop a project that targets the health trusts”
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Innlandet Health Trust…
16
Innlandet Health Trust…
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Innlandet Health Trust
Population 390 000
8 hospitals + 33 other units
8427 employees
Ann. budget CAD 1 bn
1301 beds
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Challenge: The evidence-practice gap
Interventions used without sound evidence
Interventions with sound evidence not used
The individual health worker decides
Challenge: The evidence-practice gap
”30-45 % of treatments not evidence-based”
Need more specific gap analyses– Lack of benchmarking
– Lack of indicator systems
– Lack of comparing data
Challenge: Infrastructure
Lack of computers Lack of internet access
Lack of access to paid internet resources – outside of university hospitals
1000s of clinical protocols– Quality of? In use?
Challenge: The individual health worker
Knowledge about knowledge
Awareness of EBM needs
Core EBM skills
Digital competence
Challenge: Users perspective
Increasing demand for– Transparency– Influence– Shared decision making
– Tailored information
Collaboration: trust – knowledge center
24
The four S´s model
Systems
Synopsis
Systematic reviews and guidelines
Studies
Aknowledge and identify
information need
Formulate questions
Search for literature
Critically appraise
Evaluate knowledge in context of experience, patient values and preferences
Put in practice
Individual health worker model
EPRQuality-assessed
guidelines
Quality-asessedresearch
Knowledge support
Patientinformation
Internet as transparent, common arena -Patient information mirror clinical protocols
-minimize double work -support patients as change agents
What Innlandet produces and carries through
PatientClinicianEducational institutions,
Knowledge Center, governmental agencies, Electronic Health Library
Pipeline model
Strategy in the trust: Core components
Find and create perceived needs
Build on existing structures and processes
Evidence-based knowledge support systems
Evidence-based implementation
Create good examples
Task areas
Basic infrastructure and prerequisites
Knowledge systems
The individual health worker
Task force: supportive administration
Task 1: Policy of the trust soaked in EBM
EBM one of three prioritized areas
Prominent place in quality policy
Cornerstone of inter- and intranet policy
National and regional conferences
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Task 2: Educated and enthusiastic leaders
Professional advisory boards created for all clinical fields
Given basic training in EBM
Mandate: responsible for fostering evidence-based medicine
31
Task 3: EBM policy for the library services
Formal training of librarians
EBM training by librarians Responsible for the
overall training plan
Administer toolkit for those who make protocols– Manual, courses, search ++
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Task 4: more computers and better internett access
Higher pc density
Wireless
Mobile units ie. HHC
Open zone
Flexible login
33
Task 5: Better knowledge support
In addition to the Health Library
Tender in process Will be used for
– Benchmarking– EBM clinical care pathways
– Template for better protocols
– Point-of-care support tool
34
6: New inter- and intranet services
CEO and board endorsed new policy :– Knowledge platform– Empower users through information
– Tool for cooperation and communication
– Building trust culture
35
7: Evidence based ”home made” knowledge support
Systematic and explicit knowledge search behind– Clinical protocols– Care pathways– Care plans
Process in accordance with simplified Agree
To be published on the internet
Can look to GAC
36
8. Evidence-based implementation
Selection of staff Training Coaching Evaluation of staff Evaluation of program
Facilitating administration
Systems level support
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9. Training of individual health workers
Inhouse training by librarians/clinicians
e-learning from sept 1.
”Rolls Royce” training on a secluded spot
Training trainers Training leaders Training makers of knowledge support
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10. Mass media
EBM news and EBM education– Intranet– ”PsychNews”– Paper magazine
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What is not yet fully included
Research unit
Patient information project
Monitoring unit
Nurses´ education
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Some shortcomings
EBM thinking does not permeate the wards
Depends heavily on a few enthusiasts
Lack of perceived need for EBM
Resistance from some leaders
Perspective ahead
The regional health trust now adopts strategy and action plan
Full-hearted support from CEOs paves the way ahead
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Discussion!
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Norwegian Electronic Health Library
Norwegian Electronic Health Library
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