Transcript Existentialism In Evidence-Based Practice : How consideration and inclusion of the inter-professional NHS workforce can improve the teaching & implementation of evidence-based.

Existentialism In Evidence-Based Practice :
How consideration and inclusion of the inter-professional NHS workforce
can improve the teaching & implementation of evidence-based practice.
iICS
Institute of Health &
Community Studies
Nick Rowe - Institute of Health & Community Studies, Bournemouth University – U.K.
EBP = E.B.H.C. ∂ E.B.M.
I-P W
Conclusions & Ideas For Further
Consideration
Support t o doct ors & nurses
(HCAs, admin et c)
Healt hcare Scient ist & AHP
Healthcare provision centres around providing the best
available treatment for ‘Mrs Jones’. Research and evidencebased 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.
23%
Support st af f (Therapy
Doct ors & Dent ist s
Assist ant s, admin et c)
9%
4%
Support t o ambulance st af f
(HCAs,maint enance et c)
1%
GP pract ice st af f
(excl doct ors)
Of the 1.3 million staff employed within the UK National
Health Service6 , ‘medics’ – (whilst instigating the majority
of treatment regimes in modern healthcare services),
comprise less than 10% of the workforce7. An ‘unseenmajority’ 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.
Cent ral f unct ions
(HR, f inance et c)
Nurses, Midwives & Healt h
Healt h Inf ormat ics
Visit ors
2%
29%
Hot el, propert y & est at es
6%
Managers & Senior Managers
3%
Qualif ed Ambulance st af f
Allied Healt h Prof essions
1%
4%
Healt hcare Scient ist s
5%
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 ‘steppingstones’ 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.
http://www.ic.nhs.uk/pubs/nhsstaff/leaflet/file
Points to ask, when promoting EBP10 :
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.
‘Medicine is a profession for
social service, and it developed
organisation in response to social
need’.
4
Jargon:
• noun . words or expressions used by a
particular group that are difficult for others
to understand.
The same message must be understood by all members
of the team. Language and level of delivery are crucial.
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 ‘lostgeneration’ of healthcare providers, yet given that
any organisations biggest asset is its workforce5, 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.
Methodology & Design
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

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 development8. In
addition, research and recent media interest has
shown that non-medical professionals often do
not feel sufficiently empowered to change or
question practice9.
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.
EXAMPLES
9
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.
How will you communicate your goal across the many
levels of service delivery ?

Career Framework for the NHS
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.
Ensure your answer is fully considered & evidence-based
– Research shows that EBP is generally held as a low
management priority.

Charles H. Mayo U.S. Physician - 1931
This poster presents the findings and resulting
conclusions of the author, drawn from an
investigation into the barriers posed to evidencebased 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.
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.
Are you and your organisation genuinely committed to
the promotion and implementation of EBP ?
Consultant Psychiatrist, Board Director
More senior staff
8
Consultant Practitioners
Nurse Consultant, Consultant SLT, Chief
Pharmacist
7
Advanced Practitioners
Head of Estates, Specialist OT/Midwife
6
Senior Practitioners
Hotel Services Manager, Community
Psychiatric Nurse, SHO, Health Visitor
5
Practitioners
New entrant Radiographer, Midwife, Nurse
Paramedic, OT, Biomedical Scientist
4
3
2
1
Senior Healthcare Assist./Technicians
Initial Entry level jobs
evidence-based practice, it is sought to implement researchbased, ‘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 = E.B.H.C. ∂ E.B.M.
I-P W
Evidence-Based Practice, delivered by an InterProfessional Workforce = a system of EvidenceBased Healthcare that supports the delivery of
Evidence-Based Medicine (to Mrs Jones… ) .
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).
Assist. Pract. (Technical Cardiology), Asst.
Pract. (Neurology), OT Technician
Assist./Assoc. Practitioners
Support Workers
Existence precedes essence ? – In communicating
Medical Sec., Senior. Housekeeper,
Therapy Assistant, HCA, ATO
Clinical Support Worker, Cook, Housekeeper
Domestic, Porter, Cadet, Care
Assistant
V. Volny, Vermilion Sea Institute.
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
8 NEWMAN M, et al., 1998. Barriers to evidenceFrom: 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]
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.
based practice. Intensive and Critical Care Nursing, 14 231-238.
Intensive and Critical Care Nursing, 14 231-238.