Week 1 healthcare-research
Evidence-Based Practice (EBP): why is it your business to know?
The evidence-based movement originated in medicine, and over several decades has become a standard of practice for many other healthcare disciplines, including social care and pharmacy.
More recently, the principles of Evidence-Based Practice (EBP) have moved into the broader practices of healthcare, including Global Health (GH), as a means of improving health and healthcare outcomes.
Concerning GH, EBP appears in a range of areas such as climate change and global warming, and underpins a variety of publications by the World Health Organization (WHO) – see ‘Further reading’ below for two examples.
In this context, EBP seeks to provide the evidence necessary to implement improvement or change, to guide policy and practice, and to ensure efficient and effective service provision and outcomes.
Over the next few weeks, we will explore the concept of EBP and how it translates into GH and service improvement.
World Health Organization (2013) ‘Research priorities for the environment, agriculture and infectious diseases of poverty’. World Health Organization technical report series [online] (976) i-xiii, 1–125. available from https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_medline23687800 [14 May 2020]
World Health Organization (2018) Millennium Development Goals (MDGs) [online] available from https://locate.coventry.ac.uk/permalink/f/1ea4mrv/TN_sage_s10_1177_1049732315588501 [12 May 2020]
Introduction to the course and the course team
Welcome to Evidence-Based Practice and Research Principles. This module aims to enhance your commitment to providing high-quality services that meet the needs of your client group.
Our big questions, outlined in the previous step, are deliberately provocative to challenge the perception that research is not essential to service improvement. The challenge also resides in the preconception that there’s a very tenuous balance between service improvement / provision and research.
EBP refers to the requirement to use the best possible evidence to inform the need for a service improvement or to implement a change to any service provision. The evidence used is often found published in journals, and different types of research articles look at factors affecting events, subjects and areas specific to project, service and quality improvement issues of interest.
EBP requires practitioners to ask questions about disparate topics, and to consider what can be achieved when the right questions about a service are addressed and the right action (supported by EBP) is subsequently taken.
Evidence can be used to approach many of the problems related to service improvement: specifically, deciding on the best way to implement change or to develop a management strategy addressing the many issues which may arise in the context of GH.
This short course aims to give you an insight into some of the skills needed for engagement with and application of EBP.
The evidence explored in this short course is ‘published research’ which encompasses a range of other disciplines closely related to global healthcare. The research evidence will be addressed in more detail as you progress through this module.
During the first week of the course, you’ll be introduced to our audio case study, Johnathan: his story unfolds through scenarios, designed so that you can begin to question decisions which need to be made about how to improve the identified service.
These scenarios provide a perspective on the different types of evidence, ie the research methodology, designs and methods used in the published research, which will be explored in more detail later in this module.
In the upcoming weeks of the EBP module, you’ll begin a critical exploration of the content of the research. This will help you to enhance your understanding of how evidence can be used to provide information about a specific subject, or a service improvement you wish to investigate.
What is Evidence-Based Practice (EBP)?
Let’s start by trying to define what we mean by EBP.
In the video Simon Igo, experienced practitioner and principal lecturer in the School for Nursing, Midwifery and Health at Coventry University, explains the purpose and focus of EBP is to provide a high-quality service and, where this is problematic, to initiate an improvement or change.
The example that he uses shows how influential evidence can be in practice situations, as well as how crucial critical appraisal of the evidence is in EBP.
The scenario later in this section introduces the idea that there’s a service improvement need regarding patients waiting for test results. Not knowing when test results are ready, and not knowing or understanding why test results are delayed causes a great deal of stress and anxiety.
However, there are multiple reasons why there are delays in receiving test results. For example, there may be technical issues, administrative errors (eg misfiling test results reports), delays in getting the individual to the department to take the test, or problems with the test itself.
One of the standards of practice in service improvement is to develop a strategy to ensure mistakes and delays are not made in the diagnosis. Such mistakes can result in further delays, life-changing events regarding disease progression or errors in treatment. The following task is presented with this in mind.
Other perspectives on EBP
Research is increasingly recognised as influential in improving services; in the last decade, some country’s oﬃcials and politicians have begun to pay serious attention to research literature when forming health policies.
When contemplating other perspectives on EBP, consider its influence in settings such as those highlighted in the Millennium Development Goals (MDGs) and by the Department for International Development (DFID). The process of implementing EBP here is often complicated: in the evaluation of the research, the data use informs decisions about changes and improvement, particularly in programmes designed to improve the quality and humanitarian outcomes in services.
However, some of these complex and challenging factors are common to public sector services in general, which will be further explored in Week 2 of the module.
Choose two and retrieve them from the journals accessible through the Coventry University Library service, Locate:
Elliott. H, and Popay. J (2000) ‘How are policymakers using evidence? Models of research utilisation and local NHS policymaking’. Journal of Epidemiology and Community Health 54 , 461–468.
Hanney. S. R., and González-Block, M. A. (2009) ‘Evidence-informed health policy: are we beginning to get there at last?’. Health Research Policy and Systems 7, 30.
Smith. K, and Joyce. K (2012) ‘Capturing complex realities: understanding efforts to achieve evidence-based policy and practice in public health’. Evidence and Policy 8 (1), 57–78.
The nature of evidence
In this step, we begin to explore actual service performance and identify where it stands in comparison to where it should be. This step is essential to the decision-making required, concerning the quality of the evidence and its use for informing plans to improve operations and processes.
Much attention has been focused on research and initiatives promoting the use of evidence to reduce inappropriate and unwanted practices which impact on service users with degrees of clinical severity. Furthermore, the assessment of services and impetus for the provision of quality care is another area where the application of evidence is visible.
Guidelines and policy used to direct clinical practice and related decision-making has evolved, from recommendations primarily based on expert opinion or expert judgement to recommendations informed by research evidence.
Consider the nature of the evidence used to support practice – for example, the impact of delayed results on the diagnosis of a condition. The information you may find can be anecdotal, such as that presented in the scenario above, or may appear in a blog or a media chatroom. The expressed anxiety and worry are no less real or significant because they are anecdotal.
However, are they credible or valid? There are published discussions which are presented as expert opinion, and there is also research evidence addressing the subject of anxiety, worry and other mental health issues caused as a result of delays in health service provision.
A primary goal of service improvement is ‘needs and opportunities’: a need to close the gaps caused by problems with existing (or new) services and, in doing so, meeting the needs of those to whom services are delivered.
In this context, an essential aspect of EBP is to carry out improvements to service provision, by applying the best available research evidence to improve or influence the effectiveness of the service, or to provide information and knowledge to meet service beneficiaries’ needs. This leaves practitioners with some significant responsibilities in the following areas:
Finding the available evidence
Developing the skills to appraise the quality of the literature
Understanding what constitutes the best evidence
Implementing the evidence in support of practice
Where do you go to find the evidence?
Finding quality evidence is central to effective EBP. The development of this skill is vital for locating and accessing the many forms and sources of evidence required to engage with this type of practice.
Below is a list of specialist research databases. Identify what the abbreviations/ acronyms stand for (for example, BNI: British Nursing Index) and the type of speciality each database caters for (eg nursing, psychology):
PsycInfo EMBASE Cochrane BNI ERIC
Practising your skills
Now that you’ve reviewed a few potentially relevant research databases, you have a chance to practise your search skills.
There are several steps you can revisit to identify a subject of interest related to service improvement or the healthcare service provided:
Step 1.1 EBP: Why is it your business to know?
Step 1.4 What is Evidence-Based Practice
Step 1.6 The nature of evidence (this also raises several issues around service provision)
Review of the week
This week, we’ve begun to develop some of the critical skills you’ll need to begin to apply evidence to your area of practice.
The literature details multiple quality variations in healthcare services locally, nationally and worldwide. These publications have heightened policymakers’ interest in identifying strategies to evaluate, reduce or eradicate such variations and improve services.
To do this, evidence directly relevant to the situation at hand needs to be integrated with the other influencing factors (as highlighted in Step 1.5) to maximise the likelihood of achieving an effective outcome. Exploring the content of the research evidence helps to significantly improve your knowledge, which is critical to the quality improvement of the service(s) provided.
This week, in support of your learning, you have:
Met our protagonist Johnathan and others in his social circle
Explored the definition of EBP
Addressed some of the vital skills you’ll need to develop, in order to apply the evidence in service improvement
In Week 2, we’ll explore in more detail how to appraise the evidence and how it’s used to support the service improvement decision-making process.
Week 2 research-methodology
Week 3 empirical-and-secondary-research-methods