Barriers to using evidencebased practice to produce quality improvement'

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Barriers to using evidence-based practice to
produce quality improvement.

• Dr. Mary Seddon
• Head of Quality, Division of Medicine, Middlemore
  Hospital

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(No Transcript)
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Barriers (1) accepting that there is a problem
Substantial opportunity to improve quality of
care overuse getting ineffective
care underuse not getting necessary care
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Barriers (2) Evidence unavailable

• New techniques rapidly adopted before RCTs e.g.
  cardiac artery stenting
• The art of medicine cannot always be reduced to
  an effectiveness question.

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Barriers (3) Evidence available but difficult to
use

• Lack of generalisability leads to scepticism
• RCTs exclude patients with multiple medical
  problems
• Under-represent elderly and women

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Barriers (3)Evidence available but difficult to
use

• Rapidly increasing medical knowledge and
  complexity of care
• Many clinicians poorly trained in critical
  appraisal and cost-effectiveness analysis
• Inability to keep up-to-date

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Volume of new information a major barrier
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the availability of good evidence appears to
have a positive but limited benefit in
optimising the delivery of health care Nick
Freemantle
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Barriers to improving quality of care (4) General

• Medical training issues individual performance,
  hierarchical, unwilling to show
  weakness/ignorance.
• Pressure on resources money, time, people,
  enthusiasm
• Fragmentation of care primary/secondary within
  hospitals individual disciplines
  (medicine/nursing)
• Reliance on the person approach to improvement

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Barriers to improving quality of care (5) New
Zealand

• Quality assurance as the primary response to
  quality problems
• Lack of commitment to an integrated information
  system across the care continuum.
• Top-down (MoH, DHB, Managers), those who hold the
  purse strings, talk about the importance of
  evidence-based care to produce quality
  improvement, but do not fund the necessary
  infrastructure.
• Focus on financial rather than quality bottom
  line
• Trust