How to Implement Evidence-Based Healthcare

✍ Scribed by Trisha Greenhalgh

• Publisher: Wiley-Blackwell
• Year: 2017
• Tongue: English
• Leaves: 280
• Edition: 1
• Category: Library

✦ Synopsis

British Medical Association Book Award Winner - President's Award of the Year 2018

From the author of the bestselling introduction to evidence-based medicine, this brand new title makes sense of the complex and confusing landscape of implementation science, the role of research impact, and how to avoid research waste.

How to Implement Evidence-Based Healthcare clearly and succinctly demystifies the implementation process, and explains how to successfully apply evidence-based healthcare to practice in order to ensure safe and effective practice. Written in an engaging and practical style, it includes frameworks, tools and techniques for successful implementation and behavioural change, as well as in-depth coverage and analysis of key themes and topics with a focus on:

• Groups and teams 
• Organisations 
• Patients 
• Technology 
• Policy 
• Networks and systems 

How to Implement Evidence-Based Healthcare is essential reading for students, clinicians and researchers focused on evidence-based medicine and healthcare, implementation science, applied healthcare research, and those working in public health, public policy, and management.

✦ Table of Contents

Title Page
Copyright Page
Contents
Foreword
Acknowledgements
Chapter 1 Introduction
1.1 The story of this book
1.2 There is no tooth fairy …
1.3 Outline of this book
References
Chapter 2 Evidence
2.1 (Research) Evidence
2.2 Knowledge translation, knowledge transfer
2.3 Different worlds
2.4 Attributes of innovations
2.5 Ten tips for translating evidence
1. Shorten
2. Sharpen
3. Tailor
4. Narrativise
5. Visualise
6. Recruit key messengers
7. Mobilise the media
8. Blog
9. Tweet
10. Bundle
References
Chapter 3 People
3.1 Introduction
3.2 Theories of human behaviour – an eclectic selection
‘Fast’ and ‘slow’ thinking; heuristics; cognitive biases (Kahneman, Gigerenzer)
The theory of planned behaviour (Ajzen and Fishbein)
Learning domains: knowledge, skills and attitudes (Bloom)
Adult learning theory (Kolb, Knowles)
Social learning theory and self‐efficacy (Bandura)
Dynamic (‘stages of …’) change theories (Prochaska/Diclemente, Rogers, Grol)
3.3 ‘Why don’t clinicians follow guidelines?’
Michie et al.’s taxonomy of behaviour change theories
Cabana et al.’s model of barriers to physician adherence to guidelines
Grol’s three-level model for guideline adherence
3.4 Interventions aimed at changing clinician behaviour
Interventions that prompt, reward, or feed back on behaviour
Interventions that seek to improve knowledge
Interventions that promote the use of heuristics
Interventions that promote adult (on‐the‐job) learning
Interventions that promote social influence
Sequential interventions tailored to the intended adopter’s stage of change
3.5 Ten tips for influencing how people behave
1. Don’t think of people as empty buckets or blank slates
2. Think fast – and slow
3. Know your cognitive biases
4. Challenge stock theories of behaviour change
5. Get familiar with the basics of learning theory
6. Think of behaviour change as occurring in stages …
7. … and also as influenced at different levels
8. Distinguish ‘factors’ (barriers, facilitators) from explanations
9. Understand the limitations of experimental trials of interventions to change behaviour
10. Build capacity
References
Chapter 4 Groups and teams
4.1 Introduction: no man (or woman) is an island
4.2 Leadership
4.3 Facilitation and team learning
4.4 Empirical studies of leadership and facilitation
4.5 Ten tips for leading and facilitating teams
1. Understand the mathematics of group work
2. Attend to the team’s physical and material needs
3. Assess the context in which you will be working, and the implications for the preferred leadership style
4. Don’t be a wuss
5. Select your team carefully, and justify to everyone why people have been included
6. Clarify the task objectives and measures of success with your team
7. When facilitating a team, take account of task(s), context and team preparedness
8. Attend to people issues as well as task issues
9. Give plenty of feedback (both ‘hard’ and ‘soft’)
10. Attend to the cycle of team learning (single‐, double‐ and triple‐loop)
References
Chapter 5 Organisations
5.1 The diffusion of innovations model
5.2 Structural determinants of organisational innovativeness
5.3 Absorptive capacity and receptive context
5.4 Organisational readiness and the assimilation decision
Tension for change
Innovation–system fit
Assessment of implications
Support and advocacy
Dedicated time and resources
Capacity to evaluate the innovation
5.5 Implementation: balancing ‘hard’ and ‘soft’ efforts
SMART objectives
Staff involvement and commitment
Human resources
Tools and techniques
Intra-organisational networks
Extra-organisational networks
5.6 Routinisation and sustainability
5.7 Ten tips for promoting organisational innovation
To build your organisation’s general capacity to innovate
To support the introduction of a specific innovation
References
Chapter 6 Citizens
6.1 Citizens, the public, lay people – who are they (we)?
6.2 Lay involvement in research: how much and on whose terms?
6.3 ‘We ask the questions’: moving beyond a  researcher‐focused EBHC
6.4 Conducting research with (as opposed to on) patients
6.5 Communicating research: whose literacy is the problem?
6.6 Ten tips for improving citizen involvement in research
1. Persuade yourself that citizen involvement matters
2. Use the right terminology
3. Understand what excellent looks like
4. Prioritise research questions that patients themselves pose
5. Conduct research with, not on, patients
6. Go further: co-create research
7. Learn to write (and speak) in plain English
8. Involve patients, citizens and the lay media in disseminating research findings
9. Get out more
10. Invite the public in
References
Chapter 7 Patients
7.1 Is the EBHC movement biased against patients?
7.2 Implementing evidence with patients in the clinical encounter
7.3 Self-management and how to support it
7.4 Patient involvement in service improvement
7.5 Ten tips for improving evidence‐based patient care
Clinical care
Service improvement
Research
References
Chapter 8 Technology
8.1 The myth of technological determinism
8.2 Apps to support evidence‐based (self‐)management?
8.3 Why do patients resist technologies?
8.4 Why do clinicians resist technologies?
8.5 Ten tips for using technologies to support EBHC
1. Get real about where you lie on the geek spectrum
2. Move beyond technological determinism
3. Stop and think before designing an app
4. Learn more about how patients live with illness
5. Take randomised trials of technology‐on versus technology‐off with a pinch of salt
6. Read more about design
7. Study tasks and processes in organisations
8. Take a course in ethnography
9. Learn, and apply, the principles of sociotechnical design in organisations
10. If you want technology‐supported change, resource it
References
Chapter 9 Policy
9.1 Evidence-based policy: beyond ‘barriers and facilitators’
9.2 How does policymaking actually happen?
9.3 Value-based healthcare – and how values shape evidence
9.4 Ten tips for closer alignment between research and policy
1. Recognise the wide range of evidence that gets used by policymakers
2. Get your head round why most research is not useful to policymakers
3. Learn and apply some health economics
4. Consider the four ways in which research evidence is actually used by policymakers
5. Build relationships with policymakers
6. Produce policy-relevant summaries of evidence
7. Be aware of the power of framing – and develop frame awareness
8. Value data – but remember that all data are value‐laden
9. Work actively to bridge the ‘two cultures’ divide
10. Seek to influence research policy
References
Chapter 10 Networks
10.1 Networks and knowledge
10.2 Social network analysis
10.3 Professional communities of practice and ‘mindlines’
10.4 Patient communities and the work of living with illness
10.5 Ten tips for improving networks and networking
1. Extend your definition of what knowledge is
2. Revisit the section on how policymakers use evidence
3. Know your social influencers
4. Note the important principle of homophily
5. Acknowledge social influence as a social process, not an experimental variable
6. Harness the strength of weak ties for spreading ideas
7. Support professional communities of practice
8. Value mindlines
9. Support patient/carer communities
10. Learn from patient/carer communities
References
Chapter 11 Systems
11.1 Complex (adaptive) systems
11.2 Realist evaluation and review
11.3 Actor-networks
11.4 Multi-stakeholder health research systems
11.5 Ten tips for working with complex systems
1. Loosen up
2. Identify simple rules that drive actors
3. Consider embeddedness
4. When introducing order, look for disorder
5. Abandon the quest for a transferable ‘effect size’
6. Ask, ‘What works for whom in what circumstances?’
7. Map the actors in the network
8. Identify boundary objects
9. Understand the organisational actors in the multi‐stakeholder research system
10. Consider how to co‐create value for each disparate stakeholder
References
Appendix A Frameworks, tools and techniques
Appendix B Psychological domains and constructs relevant to the implementation of EBHC
Index
EULA