Presentation on theme: "Existentialism In Evidence-Based Practice : How consideration and inclusion of the inter-professional NHS workforce can improve the teaching & implementation."— Presentation transcript:
Existentialism In Evidence-Based Practice : How consideration and inclusion of the inter-professional NHS workforce can improve the teaching & implementation of evidence-based practice. Nick Rowe - Institute of Health & Community Studies, Bournemouth University – U.K. Methodology & Design This poster presents the findings and resulting conclusions of the author, drawn from an investigation into the barriers posed to evidence- based practice / healthcare, and consideration of the inter-professional workforce, within the UK National Health Service. Topical academic consultation was sought, in conjunction with healthcare providers. Manual literature searches were performed, in conjunction with wider searches of CINAHL and Medline. Conclusions & Ideas For Further Consideration In order to improve the overall efficiency of healthcare, it is vital that there is an accepted, multi-level understanding of its goals and strategies. Whilst diversity is encouraged, so as to broaden available data and the analysis to which our systems are subjected, a unified approach to teaching EBP is required, in order to prevent conflicting practice. Grass-roots empowerment, by means of encouragement to seek rationale and explanation; gives an ownership of undertaken tasks, regardless of the field of employment. Obversely, those in ‘lead’ positions must encourage questioning and critique, so as to provide and re-affirm the evidence-base that supports not only their practice, but also their directives and management. This multi-level engagement, serves to provide ‘stepping- stones’ of understanding and aid the professional development of all concerned. A subsequently improved service delivery has both operational and financial benefits, and these may reasonably be expected to be reflected in improved patient care. Points to ask, when promoting EBP 10 : Are you and your organisation genuinely committed to the promotion and implementation of EBP ? Ensure your answer is fully considered & evidence-based – Research shows that EBP is generally held as a low management priority. How will you communicate your goal across the many levels of service delivery ? The same message must be understood by all members of the team. Language and level of delivery are crucial. Do you have the resources and systems to support personal and professional development for all those involved ? Finance, time-management and access to resources are cited as common organizational barriers to implementing EBP. Even ‘waterfall’ training requires time to be allocated Existence precedes essence ? – In communicating evidence-based practice, it is sought to implement research- based, ‘factual’ information into the healthcare environment. Unless the nature of that environment is understood however, innovation and professional developments will remain primarily exclusive to their originating bodies. In ‘translating’ the languages of research and evidence-based practice, we are in-fact increasing awareness and the potential for engagement by all staff groups, throughout the sector. This may then be developed as required until the desired level is achieved. Whilst it is a fair requirement that all employments have a supporting rationale for practice; this must be relative to the levels of accountability and performance, as expected by both the wider healthcare community and the society it serves. EBP Evidence-Based Practice, delivered by an Inter- Professional Workforce = a system of Evidence- Based Healthcare that supports the delivery of Evidence-Based Medicine (to Mrs Jones… ). Discussion: Inter-professional / multi-disciplinary working requires a clear commitment to communication. Within healthcare, the traditionally perceived hierarchy places onus upon the senior management & medical staff to direct major issues. Research has shown however, that EBP is often placed as a low management priority, poorly disseminated and with inadequate structures for personal and professional development 8. In addition, research and recent media interest has shown that non-medical professionals often do not feel sufficiently empowered to change or question practice 9. The process of research continually seeks to question, review and critically analyse data and experiences. Conventional wisdom and accepted practice are not exempt from this process of examination; nor is the ‘science’ itself. If there is genuine desire to adopt an evidence-based approach to healthcare and medicine, then there also exists a need to develop new information and also to verify that which is already in-place. Thanks & Acknowledgements Thanks go to Alan Simmons of NHS Careers, for granting permission for the use of his career framework demographics, Oxford University Press, and to colleagues at Bournemouth University, for their kind support and advice in this work. References 1 IBM INSTITUTE FOR BUSINESS VALUE HEALTHCARE 2015, 2006. Win-win or lose-lose? A portrait and a path to successful transformation. Sommers,NJ 2 HOUSE of COMMONS, HANSARD, 2006. Annual Financial Returns for Strategic Health Authorities, Primary Care Trusts and NHS Trusts 1997–98 to 2004–05. Available From: www.publications.parliament.uk/pa [Accessed 08.02.2007] 3 DoH, 2006. NHS. could save £78m by improving staff productivity and managing agency staff costs /0158. Available From: www.dh.gov.uk/.../PressReleases [Accessed 08.02.2007] 4 MAYO, CH, 1931. Collected papers of the Mayo Clinic and Mayo Foundation, 23:1020. Rochester, MN 5 INVESTORS in PEOPLE, 2007. Available From: www.investorsinpeople.co.uk/IIP/Web/Case+Studies [Accessed 03.02.2007] 6 NHS INFORMATION CENTRE, 2006. Number of Staff in the NHS 2005. Available From: www.ic.nhs.uk/pubs/nhsstaff ISBN 1-84636-051-X. [Accessed 03.02.2007] 7 NHS INFORMATION CENTRE, 2006. Number of Staff in the NHS 2005. Available From: www.ic.nhs.uk/pubs/nhsstaff ISBN 1-84636-051-X. [Accessed 03.02.2007] 8 NEWMAN M, et al., 1998. Barriers to evidence- based practice. Intensive and Critical Care Nursing, 14 231-238. 9 PARAHOO, K., 2000. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal of Advanced Nursing 31(1), 89-98 10 NEWMAN M, et al., 1998. Barriers to evidence-based practice. Intensive and Critical Care Nursing, 14 231-238. Evidence-Based Practice : If we fail to engage others, … we remain separated from the wider healthcare community. Invite people on-board - (but preferably in a language they understand). EBP Healthcare provision centres around providing the best available treatment for ‘Mrs Jones’. Research and evidence- based practice (EBP) are key underpinning components in achieving a best outcome and it is with these tools that we look to refine and develop our clinical practice. Full consideration however, needs to be given to the environment in which these approaches are both applied and delivered. Of the 1.3 million staff employed within the UK National Health Service 6, ‘medics’ – (whilst instigating the majority of treatment regimes in modern healthcare services), comprise less than 10% of the workforce 7. An ‘unseen- majority’ undertake the support and implementation of clinical objectives, and yet the differing levels of professionalism, academic development and comprehension, prohibits a standard approach to developing EBP. Unless research and education is adapted to meet a range of employment strata, there is little likelihood of an engaged and integrated approach to medicine and its paramedical disciplines. EBP serves to empower and equip staff at all levels. As such, any simplification of its approach should not be viewed as the ‘dilution’ of research science, but an inclusionist approach that promotes a broader subscription to the common healthcare ethic - we all want what is best for ‘Mrs Jones’. Multi-disciplinary Working Practice is undertaken at many levels, and this may be seen within the NHS career framework. It must however be recognised that differing levels of employment, do not necessarily represent higher / lower grades of the same mechanism (as suggested by the title of the framework). Staff choose the level at which they undertake employment, and as such, the position in which they are placed within the traditional ‘hierarchy’ of healthcare, does not provide a fair measure by which their levels of commitment or comprehension can be derived. Whilst the ‘vocational’ aspect of healthcare is less visible than in past years, the desire to contribute to the well-being of ‘Mrs Jones’, still underpins the commitment of healthcare staff at all levels. The hierarchy that exists in healthcare is a necessary structural requirement, however available funds must be prioritized according to the perceived needs of society 1. With an ever complex system of Practitioners & ‘Assistant’ Practitioners being developed to undertake extended roles, it is important to focus activity for the greatest potential productivity and efficiency gains 3. Total recorded costs for NHS staffing 2004-5 were recorded at £29,974,339,0002. The NHS Unit Costs of Health & Social Care 2005 report ascribes on-going training funding to a minimum of £1,650adj. per year for all grades of doctor; yet there is no equivalent recognition for Nursing or ‘Paramedical’ professions (excepting Pharmacists), despite the requirement for Continued Professional Development (CPD), as expressed by their respective governing bodies. The broader training expenditure statistics covered within the same report show no provision for Ward Managers / Staff Nurses although primary care provides a key component of healthcare provision in the UK. This disparate approach to the education and development of healthcare staff at a central level, may have its roots in a more traditional approach to research-based practice and the perception of hierarchy in the workplace. Academic capabilities are often assumed to be directly linked to the profession and employment level of the employee, yet EBP is a common goal throughout healthcare provision. The Government approach to higher education & the widening of access to study programmes, has changed the educational demographic of those entering healthcare. As such, inter-professional working has become a key component of modern-day healthcare provision. In order for this to be effective however, there is a need for effective communication at all levels, which employs an approach to research and academic learning, that does not exclude those involved in the many ‘non-medical’ aspects of the delivery of evidence-based care. I-P W = E.B.H.C. ∂ E.B.M. Career Framework for the NHS Initial Entry level jobs More senior staff Consultant Practitioners Advanced Practitioners Senior Practitioners Practitioners Assist./Assoc. Practitioners Senior Healthcare Assist./Technicians Support Workers Domestic, Porter, Cadet, Care Assistant Medical Sec., Senior. Housekeeper, Therapy Assistant, HCA, ATO Clinical Support Worker, Cook, Housekeeper Consultant Psychiatrist, Board Director Nurse Consultant, Consultant SLT, Chief Pharmacist Head of Estates, Specialist OT/Midwife Hotel Services Manager, Community Psychiatric Nurse, SHO, Health Visitor New entrant Radiographer, Midwife, Nurse Paramedic, OT, Biomedical Scientist Assist. Pract. (Technical Cardiology), Asst. Pract. (Neurology), OT Technician 1 9 8 7 6 5 4 3 2 EXAMPLES http://www.ic.nhs.uk/pubs/nhsstaff/leaflet/file ‘ Medicine is a profession for social service, and it developed organisation in response to social need’. 4 Charles H. Mayo U.S. Physician - 1931 If this need is to be met satisfactorily; then without care, the structures of organisation and evidence evaluation may pose a barrier to the implementation & teaching of evidence-based practice. Often, the ‘science’ of research is represented in a complex manner, that deters the involvement of many fellow ‘professionals’. It should not be assumed however, that this sector are not capable of engaging in EBP, by means of progressive learning. In the past, they have been referred to as a ‘lost- generation’ of healthcare providers, yet given that any organisations biggest asset is its workforce 5, it is detrimental to the well-being and productivity of the group dynamic, to allow the situation to continue. This then has obvious implications for the efficacy and efficiency (financial and operational) of service delivery. As such, it is important to work with and engage those resources readily available, at a level that can be understood, and developed upon. Jargon: noun. words or expressions used by a particular group that are difficult for others to understand. I-P W = E.B.H.C. ∂ E.B.M. V. Volny, Vermilion Sea Institute.