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Using evidence-based practice to inform decision making

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Evidence-based practice in action: a case study

Providing knowledge support for senior managers

This case study is based in the north-west of England, at the Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust.

Background

The British National Health Service has seen many changes over the last ten years, resulting in a keen interest in better management and leadership. Subsequently, the Blackpool, Fylde and Wyre library service found that its clinical librarian (CL) was receiving a considerable number of requests relating to managerial rather than clinical decisions.

In order to both support these requests and not overburden the CL, who still had to carry out clinical searches, a management librarian (ML) role was developed with the aim of applying the same evidence-based principles used by the CL to management.

Service was provided at the point of need: enquiries came by telephone and e-mail, but the ML was also able to attend high-level meetings including those of the Trust board of directors, and the monthly meetings of the executive and divisional directors.

Over an eight-month period, the ML received 65 requests for information searches from senior managers. When the origin of these requests were analysed, it was found that over one-third (39 per cent) came from informal meetings, one-to-ones or informal chats before and after formal meetings. Formal meetings accounted for only 20 per cent of requests, however the librarian received many e-mail requests in the days following them.

Putting research into practice

The intention was for the ML to provide relevant evidence not only for day-to-day decisions, but also to support the change process (see Figure 1 below), so that adjustments could be based on sound evidence of what worked.

Image: Figure 1. Diagram showing the evidence-based change process © Centre for Clinical Effectiveness, 2008.

Figure 1. Diagram showing the evidence-based change process (© Centre for Clinical Effectiveness, 2008)

Evidence was drawn from a number of management journals, with a good proportion coming from the Emerald database. Changes were implemented on the basis of this research with notable results of greater efficiency and improved patient care.

As Debra Thornton, knowledge and library services manager at Blackpool Teaching Hospitals, commented:

" ... the research published in Emerald journals has been extremely valuable when gathering all the facts to support important strategic decisions. This fits with the hospital’s culture to ground its strategy in evidence-based practice. The impact so far has been highly positive for the hospital during a time of great change".

Here are some examples of searches, along with a summary of evidence and description of the changes implemented as a direct result of the research evidence.

Initiative: Can closing wards improve health care?

Evidence summary

The closing of wards can allow staff to be redirected to areas of most need, resulting in higher quality care, which in turn leads to shorter length of stay and thus lower costs.

Changes implemented

Two wards, which had been opened during the winter flu crisis and then remained open later into the year, were closed, resulting in identified savings on bank staff being brought in to cope with these additional wards.

Emerald articles referenced for evidence for this query

Gilligan, S. and Walters, M. (2008), "", Clinical Governance: An International Journal, Vol. 13 No. 1, pp. 26-34.

Panis, L.J.G.G., Verheggen, F.W.S.M., Pop, P. and Prins, M.H. (2004), "", International Journal of Health Care Quality Assurance, Vol. 17 No. 4, pp. 189-193.

Initiative: In what ways can patient experiences be used to improve safety?

Evidence summary

Using patients' own stories, told in their own words, allows nursing and medical staff to relate more closely to the patients they are treating and results in fewer errors and higher quality care.

Changes implemented

Patients' or relatives' stories are recorded on video and played back to staff at regular meetings, as well as being made available on the Trust intranet.

Impact

Patient safety has increased and the Trust won the Patient Safety Award for communication in March 2010.

Emerald articles referenced for evidence for this query

Hyde, P. (2008), "", Qualitative Research in Organizations and Management: An International Journal, Vol. 3 No. 2, pp. 147-158.

Pickles, J., Hide, E. and Maher, L. (2008), "", Clinical Governance, Vol. 13 No. 1, pp. 51-58.

Initiative: How can we best restructure hospital departments to provide optimum care, reflecting care pathways?

Evidence summary

Using the framework of a care pathway or organizing activities by patient and information flow (value streams), change can occur without the need to "manage" it directly.

Implementation

The Trust strategic development team used the evidence provided to review different hospital structures that concentrated on the flow of patients through the service. The Trust is now implementing a major restructure focusing on "scheduled care" and "unscheduled care".

Impact

Not yet known, but savings of around 5 per cent per annum of management costs are expected, as well as savings due to reduced length of stay and readmission rates.

Emerald articles referenced for evidence for this query

Crocker, T., Johnson, O. and King, S. (2009), "", Transforming Government: People, Process and Policy, Vol. 3 No. 3, pp. 289-301.

Towill, D.R. (2009), "Enabling effective change in healthcare delivery systems. Did Gerry Robinson teach us anything new?", Leadership in Health Services, Vol. 22 No. 2, pp. 176-188.

Whittle, C. and Hewison, A. (2007), "", Journal of Health Organization and Management, Vol. 21 No. 3, pp. 297-306.

To read more on the Blackpool, Fylde and Wyre Hospitals NHS Trust's initiative, visit the Emerald news page.