How to Read a Paper: The Basics of Evidence-Based Medicine (44 page)

4.
Boundary spanners
: An organisation is more likely to adopt a new approach to practice if individuals can be identified who have significant social ties both within and outside the organisation, and who are able and willing to link the organisation to the outside world in relation to this particular practice. Such individuals play a pivotal role in capturing the ideas that will become organisational innovations. If you've got a member of staff who is well connected in relation to an aspect of evidence-based practice, make a point of drawing on their connections and expertise. Send staff out of the organisation—on conferences, visits to comparable organisations, or to quality improvement collaboratives—and when they return, capture what they have learnt by making time to listen to their stories and ideas.

A specific tool to consider when working towards the ‘evidence-based organisation’ is the idea of integrated care pathways, defined as pre-defined plans of patient care relating to a specific diagnosis (e.g. suspected fractured hip) or intervention (e.g. hernia repair), with the aim of making the management more structured, consistent and efficient [50]. I have included an example of an attempt to introduce such a pathway in section ‘Ten questions to ask about a paper describing a quality improvement initiative’. A good care pathway integrates evidence-based recommendations with the realities of local services, usually via a multi-professional initiative that engages both clinicians and managers. The care pathway states not only what intervention is recommended at different stages in the course of the condition but also whose responsibility it is to undertake the task and to follow up if it gets missed. Whilst there are many care pathways in circulation, it is often the process of developing the pathway as much as the finished product that engages staff across the organisation to focus on evidence-based care in the target condition. If your organisation is resistant to the whole concept of EBM, you might find that the process of developing one care pathway for a relatively uncontroversial condition builds a surprising amount of goodwill and buy-in to the principle of evidence-based practice, which can be drawn upon in rolling out the idea more widely.

Finally, note that the UK National Institute for Health Research Health Service and Delivery Research Programme (see
http://www.netscc.ac.uk/hsdr/
) is funding an exciting collection of empirical studies on the development, delivery and organisation of health services, many of them highly relevant to the implementation of best practice at the organisational level. There are now over 300 reports of research studies on the implementation of evidence that you can download free of charge.

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