How can we develop an evidence based culture?

1. How can we develop an evidence based culture? Prepared by Dr. Hoda Abd El Azim

2. Learning Outcomes (ILOs) • Define culture and organization culture. • Define evidence based culture. • List components of more good decision. • Statethe process of evidence based health care. • Identify process for diagnosis the challenges to changing practice. • Discuss the common complexities associated with nursing and research use. • List the forces working for and against an evidence based organizational culture. • Discuss different approaches for changing behavior.

3. What is the culture? Culture shapes the beliefs and behaviors of people in the work place. Without an awareness of the impact of culture on the implementation and utilization of research evidence then strategies for change will almost certainly fail.

4. What is an organizational culture? Is an umbrella term for all social interactions in a hospital, clinic or service, where should the clinician look to focus their efforts at change.

5. What is evidence based culture? EBC is the characteristics or features of organizations and systems that support the use of evidence based practice Research evidence is more likely to be used in organizations that have a culture which encourages innovation, experimentation, and the development of critical appraisal skills .

6. What is the more good decision?

7. What are the process of evidence based health care? The process of evidence based health care is based around five key stages: • Converting health care problems into focused health care clinical questions. • Searching for the best available research evidence. • Critically appraising the evidence retrieved. • Implementing the evidence. • Auditing the implementation.

8. How can you diagnosis the challenges to changing practice? In order to introduce evidence into practice, diagnosis needs to be made of the challenges faced. Diagnosis process includes: • Identifying all the groups involved in, affected by, or influencing the proposed change in practice. • Assessing the characteristics of the proposed change.

9. Diagnosis process: cont. • Assessing the willingness of the health professional to change. • Identifying external barriers to change. • Identifying enabling factors including resources and skills.

10. Another methods for diagnosing the challenges to changing practice • Surveying key groups of stakeholders (such as senior staff, managers and clients representatives). • Adapting ward meeting or clinical supervision sessions so that potential problems can be identified. • Establishing a focus group of (professional, managers, patient) to identify relevant barriers.

11. 4. Recognition of barriers at various levels as the following: • Barriers related to values, skills and awareness of practitioner wishing to use research. • Barriers associated with the organization • The qualities or characteristics of research itself • The way in which research is presented and made accessible.

12. What are the common complexities associated with nursing and research use? Which anyone considering change in health service environment may wish to consider • Professional cultural • Information related • Environment • Individual

13. 1. Professional culture e.g. • Nurse need to recognize that some forms of research evidence are better at answering some forms of clinical questions than others. • Nurse have unique insight into patients’ beliefs and behaviors and such information is important informing much of nursing practice.

14. 2. Information related (sources) • Good quality information reducing the improbability associated with clinical decision making • Less volume but higher quality information more useful than a shelf of ageing textbooks. • Teaching sessions , study days could be adapted so that information related to clinical questions (based on real life clinical problems). • Moreover the training of staff in the use of resources such as Cochrane library, best evidence

15. 3. Environmental • Nurses working in different specialties. • Solution developed in one setting or with one organization group may not be directly transferable to another health care environment. • A supportive professional and administrative environment significantly the use of research based evidence. • A supportive administrative environment associated with satisfaction among workforce (workers).

16. 4. Individual decision maker • Knowledge and education achievement • Increases confidence in the use of research material in practice. • Valuing research • A nurse attitude towards research and use research based evidence in decision. • Valuing change • Individual have diverse value related to issues of change

17. What are the forces working for and against an evidence based organizational culture? Peer support Unsupportive peers Innovationinmanagement Rigidity or Tradition Continuing professional development (CPD) Stasis or lack of CPD Information access Low skills or levels of access Research availability Inappropriate or irrelevant research available

18. Discuss approaches for planning to changing behavior? • Social marketing approach This model has six stages: 1. Research the groups you wish to target and identify the resources you have available to help you achieve the change.

19. 2. Select the raw materials for change you want to introduce. • Identifying possible change agents. • Systems to work through. • Available skills in the staff • Break down the staff group into subgroups based on (degree of motivation for change, confidence with handling research based information). 3. Develop and direct the materials used to facilitate the change.

20. 4. Implement the change 5. Evaluation: (for judging how far the change has progressed and whether or not the groups involved have reached their objectives). 6. Feedback: the results of the intervention are used to strengthen the implementation and refine the change strategy.

21. 2. Precede proceed (begin) approach It is the steps that should precede any change and the ways in which organizations should proceed with the change. Stages of this models • Recognizing the problem. • Isolating those factors which contribute to the presence of the problem.

22. What are the common factors which contribute to the presence of the problem? • Predisposing: (the perceptions, attitudes, motivations and beliefs of stakeholders involved with the change. • Enabling:resources such as skills, knowledge and funds. 3. Reinforcing: rewards or incentives even if only in the form of positive feedback. The change is implemented and evaluated with reference to the actual behavior change observed.

23. 3. General approach • Continuing education • Clinical guidelines (promoting the delivery of evidence based health care).

24. How you developing evidence based ward literature? Existing condition: • Nurse have limited time available for consulting written source of information. • Many resources out of date and not evidence based. • Need a lot of money in compiling these inadequate resources.

25. Suggestion to improve condition • Practice or community team maintaining paper based resources in practice environment. • They concentrate on compiling only clearly evidence recourse. • Electronic information technology this provide important source of quality assured information.

26. Thank you