Introduction

People living with chronic disease often have a poor quality of life, and, for the NHS, it results in a significant cost and resource burden, with people facing years of treatment. It makes sense therefore to make sure that health services are run as efficiently as possible, while maintaining or improving levels of quality. By reviewing the evidence to see what innovations have been tried and tested in other Trusts, time, effort, and money can be saved, and proven successful innovations can be applied to practice reducing the financial burden, and improving the patient experience.

Target audience

This research is aimed at commissioners, policy-makers, and academics, and provides evidence for future research collaboration between these groups, with academics bringing their research experience, and commissioners and policy-makers bringing their professional experience and skills to the table together with an understanding of local needs.

Decision-making influences

This paper provides an example from Wales where they developed “an evaluation strategy for a new evidence-based policy to manage chronic conditions alongside policy implementation.”

The authors surveyed 22 Local Health Boards to:

• Find out what influences decision-making by commissioners and service managers
• Learn how they evaluate policy implementation at local level and the challenges involved
• Understand what support is needed for evidence-based practice

The survey discovered that decision-makers use National Public Health Service information, Medline, local data, personal contacts, e.g. other commissioners or project managers, service users, local needs assessment or audits, and conference attendance to gather evidence, but not systematic reviews, meta-analyses or guidelines. It also found that financial decision-making was steered by government policy and targets or specially-funded projects, obliging commissioners to make decisions based on availability of finance rather than local needs. Other influences included personal preference informed by experiences of peers, internal and external organisational factors, and the role and experience of the people making the decisions.

Barriers to evidence-based decision-making

Survey participants identified several barriers to evidence-based decision-making, including lack of searching skills and access to relevant sources, time and financial constraints, perception of local research, and political influences. They also discussed the support solutions, such as central guidance, technical and academic support, standardised approaches, and research and evaluation frameworks. It was felt that researchers, managers, and commissioners should work together, and this would overcome some of the barriers, as the researchers would have the skills and resources to produce and/or find and access the relevant research.

Commentary

While medical research is applied to clinical practice, this study identifies a gap between research and management decision-making. This is possibly because medical research is more easily accessible via clinical databases such as Medline and Embase, whereas health management literature is more difficult to track down because it is published by a range of organisations, not necessarily associated with health but containing lessons that can be applied to the health sector. Healthcare has already learnt a lot from industry, such as Toyota with their lean management processes. As with the evidence based medicine model, health management decision-making needs to be a balance of professional expertise from within the organisation and externally from other Trusts and other industry sectors, local health needs, and academic research.

What do you think? Does this represent your experiences of policy decision-making, or do you make decisions based on the best research available?

Link

How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study (PDF)
BA Evans, H Snooks, H Howson, M Davies
Implementation Science. 2013, 8:17

Sources of health management research

• The Cochrane Effective Practice and Organisation of Care Group (EPOC)
• PDQ-Evidence for Informed Health Policymaking
• PubMed Comparative Effectiveness Reviews 
• McMaster University Health Systems Evidence 
• EPPI-Centre Evidence Library