Clinical Effectiveness

1

• Clinical Effectiveness?
• Practice Development ?
• Allied Health Professions
• Clinical Effectiveness and Practice Development
  Network

2
Scottish Quality Agenda

• Patients and the public expect the NHS to
  provide high quality care and treatment and they
  expect this to be available consistently across
  Scotland
• (Scottish Executive Partnership for Care
  2003)

3
What is Clinical Effectiveness ?

• Reassurance that
• you
• are providing
• the best
• Treatment Advice/Support/Care
• to your patients or clients

4
What is Clinical Effectiveness?

• The right person (competent)
• Doing
• The right thing (evidence based)
• In
• The right way (skills and competence)
• At
• The right time (when patient needs them)
• In
• The right place (location)
• With
• The right Results (health gain)

5
Clinical Effectiveness

• Evidence based health care and clinical
  guidelines aim to promote effectiveness and
  thereby improve quality of care
• often this will necessitate a change in
  behaviour on the part of the health professional
  so that practices deemed by good research
  evidence to be less effective or cost effective
  are replaced by those shown to be more effective
• Effective Health Care Bulletin Feb 1999 5 ( 1)

6
What is Practice Development?

• Practice development is a continuous process of
  improvement designed to promote increased
  effectiveness in person-centred care. It is
  brought about by enabling health care teams to
  develop their knowledge and skills and in doing
  so transform the culture and context of care. It
  is enabled and supported by facilitators who are
  committed to a systematic, rigorous and
  continuous process of change that will free
  practitioners to act in new ways that better
  reflect the perspectives of both service users
  and service providers
• Manley 2000

7

Core Elements

• Clinical Effectiveness Practice Development
• Effectiveness
• Clinical improvement
• Patient centered
• Transform/change
• Care/Practice

8
Theory V Practice

• Theory
• Evidence
• Objective
• Methodology
• Researchers
• Qualitative
• Scientific

• Practice
• Attitudes
• Behaviours
• Values
• Beliefs
• Needs/Wants
• Carer/Pt relationship
• Competency

9
NHS QIS Practice Development Unit

• The Practice Development Unit utilises a range
  of approaches to enable individuals, teams and
  organisations to improve the quality of health
  care and the patient experience in a modernising
  NHS.
• The Practice Development Unit aims to
  influence the culture of practice by
• Promoting facilitating knowledge transfer
• Translating evidence into practice
• Responding to national/local healthcare
  priorities and
• Ensuring best practice is recognised shared
  across the country.

10
Best Practice

• What is it?
• How do you find it?
• How do you implement it ?

11
Achieving Clinically Effective Practice

• Asking The Questions
• Finding the Evidence
• Using the Evidence
• Changing the Way We Work

12
Asking the Questions

• How do you know the treatments /interventions you
  are using are having a beneficial effect on
  patients/users?
• How do you know what patients/users want from
  your service?
• How do you know if the patients /user are
  satisfied with your service?
• How do you or your department critically review
  your service?

13
Finding the Evidence

• What guidance/advice is available from your
  peers/other departments?
• What guidance/advice is available from your
  professional body/other professions?
• What can you find on www?
• What national guidance is available?
• SIGN, NICE, Cochrane
• What does literature say?

14
Using the Evidence

• Do you understand the evidence?
• Is it quality assured?
• What support do you need?
• Audit funding ,advice
• Do colleagues agree with need to change based on
  evidence?

15
Changing the way you work

• How do you carry out a baseline audit/evaluation?
• Do you understand the change/redesign
  methodology?
• Do you need to run a pilot project?
• Who do you need to talk to?
• Stakeholder analysis

16
Changing the way you work

• How do you implement?
• How do you measure benefit?
• How do you share your results with colleagues?

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What do others say? peers, other depts, SIGs,
call to CE networks www.show.scot.nhs.uk/cesahp
If No...
Where to look for evidence
What does your professional body
say? Suggest Website, phone resource centre,
If No...
Tell the CE Network!
What national guidance is there? SIGN, NICE,
Cochrane, DARE
If No...
What does the literature say? SHS, Crewe Rd,
prof. body
Develop Implement Evaluate Review
If No...
Review of literature Metanalysis, Systemic
Review, Individual
THEN.
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Use the support available

• AHP CE Networks
• Professional Bodies
• Departments/Divisions
• Managers
• CE Facilitators local
• Clinicians
• E-library
• Websites

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Useful web sites

• www.show.scot.nhs.uk/cesahp
• www.modern.nhs.uk
• www.cci.scot.nhs.uk
• www.sign.ac.uk
• www.york.ac.uk/inst/crd
• www.nhshealthquality.org

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• Great health care professionals do not make a
  great healthcare.
• Great health care professionals interacting
  well with all of the other elements of the health
  care system make great health care
• Don Berwick 2002