Symposium 10: 'Home and Away': Implementation of Joanna Briggs Institute tools and resources into NHS Scotland

Symposium lead: Jill French, NHS QIS JBI Project Manager, NHS QIS, Glasgow, Scotland, United Kingdom

Symposium chair: Penny Bond, Professional Development Officer, Practice Development Unit, NHS QIS, Edinburgh, Scotland, United Kingdom

Symposia focus

In May 2007, NHS Quality Improvement Scotland (NHSQIS) set out to implement JBI tools and resources into NHSScotland. In doing so it was seeking to support its aims of promoting and facilitating knowledge transfer, translating evidence into practice, responding to healthcare priorities and ensuring best practice is recognised and shared across the country. A national three year project was developed to implement and evaluate the impact of introducing JBI to Scottish clinicians and managers.

Objectives

  • Access, utilise and contribute to a professional international evidence base.
  • Strengthen existing national and international links.
  • Create opportunities to share experience and expertise at all levels.
  • Contribute to the practice development agenda.
  • Explore evidence utilisation and or synthesis groups across Scotland.
  • Develop a Scottish specific version of the resource, which remains evidence based but accommodates local and national requirements.

This symposium will describe the development, implementation and evaluation process and discuss factors that impact on implementation at this national level and the challenges to measuring outcomes from such a project, using a modified awareness to adherence model.

The presentations will draw on the following model:

  • The awareness level (the extent to which practitioners and others are aware of the available tools and resources).
  • The acceptance/action level (the extent to which practitioners use such tools and resources).
  • The adherence level (the extent to which such tools and resources become embedded and the outcomes for patients and patient care).

There will be four papers that cover the project:

  • Raising awareness of evidence-based tools and resources through national implementation.
  • The availability and acceptability of JBI tools and resources.
  • Facilitating use and adherence of JBI tools and resources.
  • Evaluating the project.

Source of funding: NHS Quality Improvement Scotland 

Abstract one:  Raising awareness of evidence-based tools and resources through national implementation

Penny Bond, Professional Practice Development Officer, NHSQuality Improvement Scotland, Elliot House, Elliott House 8-10 Hillside Crescent, Edinburgh EH7 5EA

This first paper will set the scene in respect of how evidence based practice is developed, both from a national perspective and within local contexts. It will describe the implementation project and the factors considered important to implementation of JBI tools and resources for enhancing evidence based practice in Scotland. Models of evidence based practice will be highlighted and the extent to which this project draws on such models discussed for example the continuum of impacts model (Nutley et al 2007), the PARIHS (Promoting Action on Research Implementation in Health Services) (Kitson et al 1998) and Awareness to Adherence models (Glasziou 2005).

The project objectives will be examined in the light of such models and the extent to which the national direction envisioned in the project can be transferred to local organisations and practitioners to enhance patient care.

References

  • Kitson A, Harvey G and McCormack B (1998) Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care. 7: 149-158.
  • Nutley S, Walter I and Davies H (2007) Using Evidence: how research can inform public services Bristol: Policy Press Glasziou P (2005) The paths from research to improved health outcomes. Editorial. ACPJournal Club 142(2);A8-A10

Abstract two: The availability and acceptability of JBI tools and resources

Tiffany Conroy, Evidence Utilisation/Clinical Tutor, The Joanna Briggs Institute (JBI), Margaret Graham Building, Royal Adelaide Hospital, Adelaide, Australia One of the key aspects of getting evidence into practice are the availability and acceptability of the resources that are available to practitioners and others. Those available through the Joanna Briggs institute will be described and discussed in relation to other tools and resources.

The approach to evidence based practice from JBI will form the basis for the presentation (Pearson et al 2005), that is:

  • Eidence translation – reviewing available international evidence.
  • Eidence transfer – putting evidence into appropriate and relevant forms for practitioners and others to use.
  • Eidence utilisation – evaluating the impact of evidence on health care practice The nature and form of the on-line JBI tools and resources will be discussed in respect to achieving the objectives of the project and the extent to which such tools and resources are applicable globally.

Acceptance of these tools and resources is an important step in the process towards use and impact on patient care. The presentation will draw on evaluations from local health services in Scotland and also from other usage in Australia and other parts of the world. References Pearson A, Wiechula R, Court A and Lockwood C (2005) The JBI Model of evidence-based health care. International Journal of Evidence based Healthcare. 3(8) 207-215.

Abstract three: Facilitating use of JBI tools and resources

Peter Wimpenny, Associate Director, Joanna Briggs Collaborating Centre for Multiprofessional Practice, The Robert Gordon University, Garthdee Campus, Aberdeen, AB10 7QG, Scotland.

This third paper in the symposium will move to the implementation of evidence and the factors which impact on using evidence in practice and the extent to which impact of evidence can be measured and fed back, to enhance care. Getting evidence into practice has been identified as a significant factor in achieving evidence based practice (Palmer and Fenner 2000). Whilst the available evidence based resources may be of high quality (for example in the form of national guidelines) this does not necessarily signal use by organisations and practitioners (Grimshaw et al 2004). Facilitation is identified as a key strategy, nationally and at a local level and was viewed as imperative if the project was to achieve its objectives. The facilitation process will be outlined and the feedback from local facilitators (due to commence October 2007) will be incorporated and presented. References Grimshaw JM. Thomas RE. MacLennan G. Fraser C. Ramsay CR. Vale L. Whitty P. Eccles MP. Matowe L. Shirran L. Wensing M. Dijkstra R. Donaldson C. (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment. 2004; 8(6); i-xi, 1-72. Palmer C and Fenner J (2000) Getting the message across. Review of research and theory about disseminating information within the NHS. Gaskell, London.

Abstract four: Evaluating the project

Sylvia Wilcock, Director, Joanna Briggs Collaborating Centre for Multiprofessional Practice, The Robert Gordon University, Garthdee Campus, Aberdeen, AB10 7QG, Scotland. There is an acceptance that practice based on the best available evidence is preferable to patients and their carers. However, measuring the extent to which this is achieved in practice is not without some challenges. JBI provides a range of evidence based materials that will provide additional support for practitioners, as they are based on international evidence and available in on-line format. Furthermore, the suite of tools available to translate (review and appraise), transfer (best practice information) and utilise evidence can assist practitioners in NHSScotland to not only access available translated and transferred evidence but also to use tools to evaluate compliance.

It has been proposed that implementation of JBI tools and resources will:

  • Increase practitioners’ access to and use of evidence, particularly that related to practice and procedural based care.
  • Increase practitioners’ utilisation of evidence and evaluation of its impact on practice through, for example on-line audits and patient outcome data.
  • Increase practitioners’ translation and transfer of evidence for use locally, nationally and internationally.
  • Contribute to enhancement and improvement of the patient’s experience through evidence use and evaluation.

The extent to which this can be measured and will be achieved in the first year of the project will be presented for discussion. The challenges of creating an appropriate evaluation approach will include the extent to which data can be gathered and is meaningful to outcomes, for example hit/download rates might be a measure of awareness but will not assist in understanding acceptance or adherence, which will require more contextual data from local facilitators and others in respect of on-the-ground usage. The extent to which national evaluation benchmarks are useful or even possible will be outlined and discussed.