Strategy for evidence-based health services

a collaboration between Innlandet Hospital Trust and the Norwegian Knowledge Center for the Health Services

ystein Eiring, psychiatrist, Editor Norwegian Electronic Health Library/Mental Health, Medical Advisor.

Menu for 30 minutes

About the Norwegian Knowledge Center
About Innlandet Health Trust Challenges Strategy and action plan Summary

Norwegian Knowledge Centre for the Health Services

Founded 2004
Organised under The Directorate for Health Affairs

Scientifically and professionally independent

No authority to develop health policy or responsibility to implement policies 120 employees in Oslo

The Centre: Mission

Gathers and disseminates evidence
about the effect and quality of methods and interventions Uptake of evidence by the health services

The Centre: Central tasks 1

HTA reports
Systematic reviews Overviews of overviews and early warnings Projects that aim to improve the quality of patient information Surveys of patients and employees experiences with health services Support to the health services of poor countries through the provision of evidence

The Centre: Central tasks 2

Support to
the government the regional health authorities the health services in general

Host of The National Electronic Health Library Quality Measurement and Patient Safety

Host of the National Council for Quality and Prioritization

Access to knowledge has varied widely

Rural hospital

National Hospital
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Why does the Health Library exist?

Equality: Equal access to health services implies equal access to knowledge Quality: Quality assessment of knowledge is quality assessment of health services Economy: National subscriptions and licenses saves time and money

Journals

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Databases

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Systematic reviews

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Clinical guidelines

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Reference books

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Specialist libraries

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Challenges for the knowledge center

Bein well known among even more health workers Being known for even more relevant services Develop a project that targets the health trusts

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Innlandet Health Trust

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Innlandet Health Trust

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Innlandet Health Trust

Population 390 000
8 hospitals + 33 other units 8427 employees

Ann. budget CAD 1 bn

1301 beds
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Challenge: The evidence-practice gap

Interventions used without sound evidence Interventions with sound evidence not used The individual health worker decides

Challenge: The evidence-practice gap

30-45 % of treatments not evidence-based Need more specific gap analyses

Lack of benchmarking Lack of indicator systems Lack of comparing data

Challenge: Infrastructure
Lack of computers Lack of internet access Lack of access to paid internet resources outside of university hospitals

1000s of clinical protocols Quality of? In use?

Challenge: The individual health worker

Knowledge about knowledge

Awareness of EBM needs

Core EBM skills Digital competence

Challenge: Users perspective

Increasing demand for

Transparency Influence Shared decision making Tailored information

Collaboration: trust knowledge center

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The four Ss model

Systems Synopsis

Systematic reviews and guidelines

Studies

Individual health worker model

Aknowledge and identify information need Put in practice Formulate questions

Evaluate knowledge in context of experience, patient values and preferences Critically appraise

Search for literature

Pipeline model
Internet as transparent, common arena -Patient information mirror clinical protocols -minimize double work -support patients as change agents Qualityasessed research

Quality-assessed guidelines

Knowledge support

EPR

Clinician
Educational institutions, Knowledge Center, governmental agencies, Electronic Health Library

Patient

Patient information

What Innlandet produces and carries through

Strategy in the trust: Core components

Find and create perceived needs Build on existing structures and processes Evidence-based knowledge support systems Evidence-based implementation Create good examples

Task areas
Basic infrastructure and prerequisites
Knowledge systems

The individual health worker

Task force: supportive administration

Task 1: Policy of the trust soaked in EBM

EBM one of three prioritized areas Prominent place in quality policy Cornerstone of interand intranet policy National and regional conferences

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Task 2: Educated and enthusiastic leaders

Professional advisory boards created for all clinical fields Given basic training in EBM Mandate: responsible for fostering evidencebased medicine

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Task 3: EBM policy for the library services

Formal training of librarians EBM training by librarians
Responsible for the overall training plan

Administer toolkit for those who make protocols

Manual, courses, search ++
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Task 4: more computers and better internett access

Higher pc density
Wireless Mobile units ie. HHC

Open zone
Flexible login
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Task 5: Better knowledge support

In addition to the Health Library Tender in process Will be used for
Benchmarking EBM clinical care pathways Template for better protocols Point-of-care support tool
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6: New inter- and intranet services

CEO and board endorsed new policy :
Knowledge platform Empower users through information Tool for cooperation and communication Building trust culture

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7: Evidence based home made knowledge support

Systematic and explicit knowledge search behind
Clinical protocols Care pathways Care plans

Process in accordance with simplified Agree

To be published on the internet

Can look to GAC
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8. Evidence-based implementation
Selection of staff Training Coaching Evaluation of staff Evaluation of program Facilitating administration Systems level support
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9. Training of individual health workers

Inhouse training by librarians/clinicians e-learning from sept 1. Rolls Royce training on a secluded spot Training trainers Training leaders Training makers of knowledge support
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10. Mass media

EBM news and EBM education
Intranet PsychNews Paper magazine

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What is not yet fully included

Research unit
Patient information project Monitoring unit Nurses education
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Some shortcomings
EBM thinking does not permeate the wards Depends heavily on a few enthusiasts Lack of perceived need for EBM Resistance from some leaders

Perspective ahead
The regional health trust now adopts strategy and action plan Full-hearted support from CEOs paves the way ahead

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Discussion!

Norwegian Electronic Health Library

Norwegian Electronic Health Library

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