Information support to evidence based management: the unappreciated in pursuit of the non-existent

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Information support to evidence based management
the unappreciated in pursuit of the non-existent

• Andrew Booth, Senior Lecturer in Evidence Based
  Healthcare Information, ScHARR, University of
  Sheffield.

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The English country gentleman galloping after a
fox - the unspeakable in pursuit of the inedible
- Oscar Wilde
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A Reminder

• Evidence is welcomed for its apparent
  objectivity, whereas
• In reality, evidence involves value judgements
  and subjectivity
• And is value-laden with respect to
• The Nature of Evidence
• Its Context and
• Its Audience

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What is Evidence?

• Evidence is a lot more than research, and it
  includes a lot of contextual information. Nota
  way to end todays healthcare debates, but
  rathera way of raising the level of dialogue
  around important decisions.
• Evidence-informed decision-making may be a
  better term than evidence-based decision-making.
• Evidence-based decision-making is a value-laden
  process, as is the construction of the meaning of
  evidence. Recognizing the role that values play
  will lead to a greater level of transparency and
  understanding, helping to improve the quality of
  policy and management decisions.
• Canadian Health Services Research Foundation
  Workshop, 2004

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SOURCE HEALTH SERVICES RESEARCH AND...
Evidence-Based Decision-Making
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Exhibit 1

• We looked at 144 proposals. Only 6.2 per cent
  were supported by strong evidence. For 21.2 per
  cent there was fair evidence and for 38.1 per
  cent there was poor evidence. Search not possible
  for 16.8 per cent of the proposals.
• There was a moderate correlation between how good
  the evidence was and how the proposal was scored
  initially for health gain (p lt 0.001). But by the
  end of priority setting process no correlation
  between strength of evidence and priority ranking
  (p 0.97).
• Research evidence did appear to influence initial
  assessment of proposals. However, it had no
  effect on the final priority choices made in the
  DHA purchasing plan.
• Dixon, Booth and Perrett, J Public Health Med.
  1997 19(3)307-12.

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Exhibit 2

• 124 decisions identified (two-thirds concerned
  organisation of care). Evidence existed for less
  than half (48.4) the decisions, with 33.9
  favouring decision and 14.5 where evidence was
  equivocal or unfavourable. Relevant
  non-randomised quantitative studies and
  qualitative studies were identified for only half
  of a subset of ten decisions. Evidence from
  economic evaluations only identified for one
  decision.
• Johnstone Lacey. J Health Serv Res Policy. 2002
  7(3)166-9.

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Exhibit 3 - Systematic Review

• 24 studies including 2041 interviews with health
  policy-makers.
• Facilitators included personal contact (13/24),
  timely relevance (13/24), and the inclusion of
  summaries with policy recommendations (11/24).
• Barriers were absence of personal contact
  (11/24), lack of timeliness or relevance of
  research (9/24), mutual mistrust (8/24) and power
  and budget struggles (7/24).
• Two-way personal communication, (most common
  suggestion), may improve appropriate use of
  research evidence, but it might also promote
  selective (inappropriate) use of research
  evidence.
• Innvaer et al, 2002

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The Research-Transfer Paradox

• Researchs best chance at being used in
  decision-making depends on how unlike research
  its presentation can be.
• Emotion, trust, storytelling and careful
  rationing are crucial ingredients to successful
  research transfer.

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When two tribes go to war ( Hollywood FGT,1984)

• MANAGERS
• Active
• See the big picture
• Are Selective
• Emphasise Outcomes and Deliverables
• Like stories
• Set agendas
• Have a limited attention sp
• Have a profound aversion to circumlocution

• LIBRARIANS
• Reflective
• Focus on the detail
• Aim to be Comprehensive
• Emphasise Structure and Process
• Like facts
• Respond to agendas
• Will stick at it to the bitter end and then
  some!
• Use jargon

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Bad news, Good news

• Managers generally are not evidence based
• BUT
• This means that we do not need to use evidence
  based tactics and approaches to influence them
• which is GOOD
• Because I have yet to find any evidence that
  proves that our libraries are cost-effective!

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Why cant a librarian be more like a manager

• We DONT have to change WHAT we do (although we
  can extend and refine it)
• We DO need to change HOW WE PRESENT it
• Grab attention
• Summarise
• Synthesise
• Digest
• Energise (Do this, not Read this)
• Tell stories

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Evidence Based Decision making

• Four characteristics
• transparency
• reliability
• inclusiveness and
• Explicitness
• Criticised for the privileging of research
  evidence over organizational evidence and
  political evidence (Klein, 2004).
• But correcting the imbalance?

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Researchers
Users
Decision makers
Knowledge Brokers
A solution needs to get research evidence to
decision-makers and (hopefully) improve the
prestige of information/knowledge workers
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Bridging the Gap

• Knowledge Exchange (formerly Knowledge Transfer)
• Knowledge Brokering

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Knowledge exchange

• Knowledge exchange is collaborative
  problem-solving between researchers and decision
  makers that happens through linkage and exchange.
  
• Effective knowledge exchange involves interaction
  between decision makers and researchers and
  results in mutual learning through the process of
  planning, producing, disseminating, and applying
  existing or new research in decision-making.

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Knowledge Exchange/Transfer Products

• Evidence Boost
• http//www.chsrf.ca/mythbusters/index_e.php
• Myth busters
• http//www.chsrf.ca/mythbusters/index_e.php

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Knowledge Exchange/Transfer Methods

• Communication Notes
• http//www.chsrf.ca/knowledge_transfer/resources_e
  .php
• Developing a dissemination plan
• Dealing With the Media
• Designing a Great Poster
• How to Give a Research Presentation to Decision
  Makers
• Reader-Friendly Writing - 1325
• Self-Editing - Putting Your Readers First

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Knowledge brokering - 1

• Knowledge brokering links decision makers and
  researchers, facilitating their interaction so
  that they are able to better understand each
  other's goals and professional cultures,
  influence each other's work, forge new
  partnerships, and promote the use of
  research-based evidence in decision-making.

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Knowledge Brokering - 2

• Includes
• finding the right players to influence research
  use in decision-making,
• bringing these players together,
• creating and helping to sustain relationships
  among them,
• and helping them to engage in collaborative
  problem-solving.

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Bridging the gap

• KNOWLEDGE BROKERS (the artists formally/formerly
  known as librarians)
• Active (Brokers)
• See the big picture (Understanding the research
  and management worlds)
• Are Selective (Targeting of messages and
  audiences)
• Emphasise Outcomes and Deliverables (Succinct
  action points)
• Use stories (Use anecdotal approaches good
  practice/cases)
• Set agendas (Implications of research)
• Capture limited attention spans
  (Marketing/Communication)
• Concise messages (Avoiding jargon)

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Requisite Tasks and Abilities

• Understanding of both the research and decision
  making environments (evidence management!)
• Ability to find and assess relevant research
• Entrepreneurial skills (networking,
  problem-solving skills, innovative solutions,
  etc)
• Mediation and negotiation
• Understanding of the principles of adult learning
• Communication skills
• Credibility

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Questions for Discussion

• Are we up to the challenge?
• If not, would we like to be?
• If so, what training is required?
• Is such training available?

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Resources

• Canadian Health Services Research Foundation
  Knowledge Transfer Exchange
• http//www.chsrf.ca/knowledge_transfer/index_e.php
  
• RCN Knowledge Utilisation Site
• http//www.rcn-ku.org.uk/
• Chair on Knowledge Transfer and Utilisation
• http//kuuc.chair.ulaval.ca
• Research To Policy (McMaster University)
• http//www.researchtopolicy.ca
• Davis D et al. The case for knowledge
  translation shortening the journey from evidence
  to effect. BMJ. 2003 Jul 5327(7405)33-5.