INTERNATIONAL CONFERENCE ON EVIDENCE-BASED BEST PRACTICE GUIDELINES EVIDENCE-INFORMED MANAGEMENT DECISION-MAKING: IS IT A POSSIBILITY IN HEALTHCARE? 07 June 2007

Crucial to finding the way is this: there is no beginning or end. You must make your own map. Joy Harjo Joy Harjo A Map to the Next World: Poems A Map to the Next World: Poems

REFLECTIONS T Setting the Context re Evidence- Informed Decision-Making T What is Evidence? T Cautions re Status of Evidence- Informed Decision-Making T Your Roles as Leaders and Champions

APPROACHES TO EVIDENCE T Decision-makers = evidence viewed colloquially, anything that establishes a fact or gives reason for believing something, defined by relevance T Researchers = evidence viewed scientifically, use of systematic and replicable methods for production, defined by methodology TEmphasis on context-free universal truths (evidence based medicine) TEmphasis on context-sensitive role for evidence in particular decision (applied social science)

WHO DEFINIITON OF EVIDENCE Findings from research and other knowledge that may serve as a useful basis for decision-making in public health and health care. World Health Organization Europe (2004)

UK GOVERNMENT DEFINITION OF EVIDENCE The raw ingredient of evidence is information. Good quality policy making depends on high quality information, derived from a variety of sources — expert knowledge; existing domestic and international research; existing statistics; stakeholder consultation; evaluation of previous policies; new research, if appropriate; or secondary sources, including the internet. Evidence can also include analysis of the outcome of consultation, costings of policy options and the results of economic or statistical modeling. U.K. Government Policy Hub (1999 )

CHSRF DEFINITION OF EVIDENCE Evidence is information that comes closest to the facts of a matter. The form it takes depends on context. The findings of high-quality, methodologically appropriate research are the most accurate evidence. Because research is often incomplete and sometimes contradictory or unavailable, other kinds of information are necessary supplements to or stand-ins for research. The evidence base for a decision is the multiple forms of evidence combined to balance rigour with expedience – while privileging the former over the latter. CHSRF (2006) CHSRF (2006)

WHY EVIDENCE IS IMPORTANT T Improved patient health outcomes T Improved population health outcomes T Cost containment T Quality improvement T Accountability T Responsiveness in a new age T Can it work? T Will it work? T Is it worth it?

WHY EVIDENCE MUST BE INTERPRETED – what, how, who T Inherent uncertainly usually accompanying evidence – definitive studies rare T Complexity of decisions and improbability of evidence being comprehensive T Need for actors to create meaning and interpret evidence before it becomes “knowledge” T Evidence is uncertain, dynamic, complex, contestable, rarely complete

UNDERLYING PRINCIPLES T Accountability T Transparency T Quality T Inclusiveness T Reliability T Responsiveness T Explicitness

CATEGORIES OF EVIDENCE T Research evidence = accepted research methodologies T Organizational evidence = information about organization’s capacity to complete the task, e.g., human resource requirements, availability of managerial expertise, reality of limited budgets T Political evidence = public attitudes towards proposed policies, media reaction Rudolph Klein (2004) Rudolph Klein (2004)

CATEGORIES OF EVIDENCE T Context-free scientific evidence = medically oriented effectiveness research T Context-sensitive scientific evidence = social science oriented research T Colloquial evidence = expertise, views and realities of stakeholders Lomas, et al (2005) Lomas, et al (2005)

CONTEXT-SENSITIVE SCIENTIFIC EVIDENCE T Attitudes T Implementation T Organizational capacity T Forecasting T Economics/finance T Ethics

COLLOQUIAL EVIDENCE T Resources T Expert and professional opinion T Political judgment T Values T Habits and traditions T Lobbyists and pressure groups T Pragmatics and contingencies of situation

DELIBERATIVE PROCESS A deliberative process is a tool for producing guidance based on heterogeneous evidence. It is a participatory process that includes representation from experts and stakeholders, face-to-face interaction, criteria for the sources of scientific evidence and their weight, and a mechanism for eliciting colloquial evidence while making it subsidiary to the science. CHSRF (2006)

ARGUMENTS FOR DELIBERATIVE PROCESSES T T Eliciting and Combining Evidence T T Democratic Governance T T Creating Acceptable Guidance

SUCCESS OF DELIBERATIVE PROCESSES T Presence of strong chairperson T Different types of evidence T Engagement of scientific and decision- making communities T Explicit process of exclusion/inclusion T Face-to-face discussions T Appropriate timelines for questions T Mechanism to elicit values of participants T Venue for expressing minority views

CAUTIONS RE EVIDENCE INFORMED DECISION-MAKING T It is early days yet for evidence-informed decision-making. T Evidence-informed decision-making and change management are intertwined. T “Evidence” is more than research in “evidence-informed decision-making.” T Evidence-informed decision-making is sustained through personal relationships. T There is need for an evidence-informed decision-making infrastructure.

INFLUENCING THE FUTURE T Hold the vision T Know your strengths T Develop new skills/competencies T Envision creatively the ways T Build on the best T Be patient but persistent T Be collaborative but challenging

WALKING THE LABYRINTH

CHSRF REFERENCES J. Lomas, T. Culyer, C. McCutcheon, L. McAuley & S. Law, “Conceptualizing and Combining Evidence for Health System Guidance,” May J. Lomas, T. Culyer, C. McCutcheon, L. McAuley & S. Law, “Conceptualizing and Combining Evidence for Health System Guidance,” May “Weighing up the evidence: Making evidence- informed guidance accurate, achievable, and acceptable,” A Summary of the Workshop held on September 29, “WHAT COUNTS? Interpreting evidence-based decision-making for management and policy,” Report of the 6th CHSRF Annual Invitational Workshop, Vancouver, British Columbia, March 11, Received Wisdoms: How health systems are using evidence to inform decision-making, CHSRF, 2007.

BLESSING May the light of your souls guide you. May the light of your souls May the light of your souls guide you. May the light of your souls bless the work that you do with the secret love and warmth of your hearts. May you see in what you do the beauty of your own souls. May the sacredness of your work bring healing, light and renewal to those who work with you and to those who see and receive your work. May your work never weary you. May it release within you wellsprings of refreshment, inspiration and excitement.

May you be present in what you do. May you never become lost in bland absences. May the day never burden. May dawn find you awake and alert, approaching your new day with dreams, possibilities and promises. May evening find you gracious and fulfilled. May you go into the night May you be present in what you do. May you never become lost in bland absences. May the day never burden. May dawn find you awake and alert, approaching your new day with dreams, possibilities and promises. May evening find you gracious and fulfilled. May you go into the night blessed, sheltered and protected. May your souls calm, console and renew you. Adapted from Adapted from John O'Donoghue, Anam Cara John O'Donoghue, Anam Cara