Moriah E. Ellen

What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

BackgroundDecisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making.ObjectivesThe purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making.MethodsIn-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.ResultsA total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building.ConclusionsThis study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health.

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study

BackgroundMobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place.MethodsThis qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.ResultsLimited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM.ConclusionsThese results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

Engaging patients and the public in Choosing Wisely

Choosing Wisely campaigns aim to engage physicians and the public in tackling the problem of overuse in medicine.1 Choosing Wisely has been adopted by medical and other clinician societies worldwide, having now spread to approximately 20 countries. While physicians have demonstrated a high degree of interest, engaging patients and building wider public awareness is far more challenging. The belief that more testing and more treatment lead to better outcomes is widespread, and physicians rarely discuss the risks and harms of overuse with patients.2–4 Indeed, there is a marked tendency among both patients and physicians to overestimate the benefits of medical interventions and underestimate harms.5 Further, physicians’ perceptions of the unacceptability to patients of applying Choosing Wisely recommendations appear to be a major barrier towards implementation.6 There is concern that the impact of campaigns will be blunted if patients and the broader public are not receptive to the message of Choosing Wisely. Evidence demonstrates that up to 30% of all medical care adds no value to patients, and in fact can lead to harm.7 Yet, overuse persists as both clinicians and patients are victims of the ‘therapeutic illusion.’8 Choosing Wisely campaigns attempt to tackle this problem through establishing specialty-specific lists of recommendations of ‘Things Clinicians and Patients Should Question.’ A central goal of Choosing Wisely campaigns is to change patient and public knowledge and attitudes, in addition to physician practice, in order to influence the culture of medicine that has driven overuse.1 Patient and public expectations are often cited by physicians as a major cause of overuse, although the extent to whether this is true is unclear.9 The concepts of overdiagnosis, overtreatment and overuse can be confusing for laypeople, yet the consequences are serious to individuals through harm, and to society through diversion …

Views of health system policymakers on the role of research in health policymaking in Israel

BackgroundThe use of research evidence in health policymaking is an international challenge. Health systems, including that of Israel, are usually characterized by scarce resources and the necessity to make rapid policy decisions. Knowledge transfer and exchange (KTE) has emerged as a paradigm to start bridging the “know-do” gap. The purpose of this study was to explore the views of health system policymakers and senior executives involved in the policy development process in Israel regarding the role of health systems and policy research (HSPR) in health policymaking, the barriers and facilitators to the use of evidence in the policymaking process, and suggestions for improving the use of HSPR in the policymaking process.MethodsA survey and an interview were verbally administered in a single face-to-face meeting with health system policymakers and senior executives involved in the policy development process in Israel. The data collection period was from July to October 2014. The potential participants included members of Knesset, officials from Israel’s Ministry of Health, Ministry of Finance, health services organizations, and other stakeholder organizations (i.e., National Insurance Institute). The close-ended questions were based on previous surveys that had been conducted in this field. Interviews were tape recorded and transcribed. Descriptive statistics were conducted for close ended survey-questions and thematic analysis was conducted for open-ended interview questions.ResultsThere were 32 participants in this study. Participants felt that the use of HSPR helps raise awareness on policy issues, yet the actual use of HSPR was hindered for many reasons. Facilitators do exist to support the use of HSPR in the policymaking process, such as a strong foundation of relationships between researchers and policymakers. However, many barriers exist such as the lack of relevance and timeliness of much of the currently available research to support decision-making and the paucity of funding to support research use. Suggestions to improve the use of HSPR focused on improving dissemination of research findings and ensuring that the research was more relevant and timely.ConclusionsThis research demonstrated that health systems policymakers in Israel perceive having strong relationships and collaborations with researchers however there is room for improvement, e.g. partnering in research projects to ensure relevance and use. Furthermore, health system policymakers seem to be interested in receiving relevant research in a more useable format and are open to using research in decision making.

Processes, contexts, and rationale for disinvestment: a protocol for a critical interpretive synthesis

BackgroundPractical solutions are needed to support the appropriate use of available health system resources as countries are continually pressured to ‘do more with less’ in health care. Increasingly, health systems and organizations are exploring the reassessment of possibly obsolete, inefficient, or ineffective health system resources and potentially redirecting funds to those that are more effective and efficient. Such processes are often referred to as ‘disinvestment’. Our objective is to gain further understanding about: 1) whether how and under what conditions health systems decide to pursue disinvestment; 2) how health systems have chosen to undertake disinvestment; and 3) how health systems have implemented their disinvestment approach.Methods/DesignWe will use a critical interpretive synthesis (CIS) approach, to develop a theoretical framework based on insights drawn from a range of relevant sources. We will conduct systematic searches of databases as well as purposive searches to identify literature to fill conceptual gaps that may emerge during our inductive process of synthesis and analysis. Two independent reviewers will assess search results for relevance and conceptually map included references. We will include all empirical and non-empirical articles that focus on disinvestment at a system level. We will then extract key findings from a purposive sample of articles using frameworks related to government agendas, policy development and implementation, and health system contextual factors and then synthesize and integrate the findings to develop a framework about our core areas of interest. Lastly, we will convene a stakeholder dialogue with Canadian and international policymakers and other stakeholders to solicit targeted feedback about the framework (e.g., by identifying any gaps in the literature that we may want to revisit before finalizing it) and deliberating about barriers for developing and implementing approaches to disinvestment, strategies to address these barriers and about next steps that could be taken by different constituencies.DiscussionDisinvestment is an emerging field and there is a need for evidence to inform the prioritization, development, and implementation of strategies in different contexts. Our CIS and the framework developed through it will support the actions of those involved in the prioritization, development, and implementation of disinvestment initiatives.Systematic review registrationPROSPEROCRD42014013204

Transferring research from researchers to knowledge users: the importance of relationships and getting them right

Health system reform efforts around the world focus on evidence-informed decision making as a critical element to creating high-performing health systems. Although the use of evidence to inform policy is limited, over the last decade, significant achievements have been made in supporting the use of evidence to inform policy making and decision making, in high, low and middle income countries. Knowledge transfer and exchange (KTE) has emerged as a paradigm to address many of the challenges and barriers associated with transferring evidence into policy and to start closing the ‘know-do’ gap. KTE is defined as ‘the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health.’ However, the uptake of evidence is challenging and numerous barriers exist that impede the implementation of evidence-informed decision making. Scholars point to the importance of relationships when linking research and policy, but they rarely articulate why – from a theoretical perspective – relationships are important, nor do they create a platform for a deeper understanding of how to use relationships effectively to transfer evidence into practice. Within the business literature, inter-organizational relationships have been studied for decades with a traditional focus on fixed organizational traits (such as the effect of internal organizational characteristics, resource dependency or uncertainty on types of cooperation). Building on existing research, Heide and Miner examined the role of relationships and focused on ongoing interaction as a factor influencing the success of inter-organizational relationships. Interactive theorists suggest that cooperation comes from the commitment between two or more ‘players’, and that over time, the players care about the ‘other’ and cooperate out of altruism. In their paper, Effects of Anticipated Interaction and Frequency of Contact on Buyer-Seller Cooperation, Heide and Miner explored whether the interaction patterns may themselves affect cooperation between players in an industrial purchasing setting. Heide and Miner identified four types of cooperation: (1) flexibility with one another or adjusting behaviour to accommodate the needs of the other, (2) information exchange or disclosing information to the other, (3) shared problem solving or relying on the other in order to solve issues together, and (4) restraint in the use of power or refraining from exploiting the other. Using a game theory approach based on the Prisoner’s Dilemma, where players can gain more from cooperation than from non-cooperation, Heide and Miner hypothesized that three factors would influence the degree of cooperation: (a) the extendedness of a relationship or how far into the future each party believes it will continue the relationship, (b) frequency or the expected amount of interaction between players; and (c) tolerance of performance ambiguity or the level of difficulty a player faces in evaluating the other party’s products and outcomes. The authors hypothesized that an increase in the first two factors would lead to an increase in cooperation, but a decrease in the third factor would lead to a decrease in cooperation. Heide and Miner tested these hypotheses by examining purchasing relationships between industrial suppliers and original equipment manufacturers whose

The role of nurses and nurse leaders on realizing the clinical, social, and economic return on investment of nursing care

There is a limited understanding of the significance and the potential contribution that nursing can make through practice, policy, science, and profession to the global health agenda. In this article, we present some of the evidence to demonstrate the clinical, social, and economic returns on investment in nursing. We conclude by addressing the issues that nurse and system leaders need to address in order to achieve these returns on investments, and unless nurses get involved at the leadership level, these returns on investment will not be attained.

Corporate Social Responsibility and Hospitals: US Theory, Japanese Experiences, and Lessons for other Countries

This paper examines the role that corporate social responsibility can play in advancing hospital management. Corporate social responsibility is the integration of social and environmental concerns within business operations. The authors discuss how corporate social responsibility can help hospitals and provide suggestions to hospitals in deciding which corporate social responsibility initiatives to pursue.

How nurses can contribute to combating antimicrobial resistance in practice, research and global policy

Seemingly the stuff of science fiction, antimicrobial resistance has become a threat to global health, prompting the World Health Organization (WHO) to state “[Antimicrobial resistance] is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country” (WHO, 2014). Antimicrobial resistance develops when microorganisms evolve so that they are no longer susceptible to the medications used to kill them. This is a natural phenomenon which is profoundly accelerated through the misuse of medicinesantibiotics, antimalarials, antiparasitics and antifungalson animals and humans. The Organization for Economic Cooperation and Development (OECD) estimates that resistant “superbugs” already kill 700,000 people a year, and will kill 10 million annually by 2050 if recent trends continue, displacing cancer as a leading cause of death (O’Neill, 2016). Patients with drug-resistant infections consume more resources, are sick for longer, and are at risk of severe outcomes even if they do survive. Additionally, the productivity of the families and communities of the ill also suffer, both on a personal and economic level. Policy efforts exist to reduce the use of medicines outside as well as within the healthcare sector. As antimicrobial resistance is caused by and affects many groups across different contexts there is no single template for a fully comprehensive solution.

supporting chronic pain management across provincial and territorial health systems in canada: Findings from two stakeholder dialogues

Chronic pain is a serious health problem affecting one in five Canadians. To provide better care for patients affected by chronic pain, there is a need to identify how provinces and territories across the country can strengthen its management. In this report, the authors summarize key findings from two stakeholder dialogues that addressed the support of chronic pain management by health system decisionmakers and across health systems. An overview of examples of the progress that has been made since the dialogues is also provided.