Mind the gap. How job task distributions of health professional developers constitute evidence-based practice

Abstract

BACKGROUND: Development of clinical practice at a Danish neurorehabilitation centre was delegated to a group of health professional developers. Their job function lacked conceptual foundation, and it was unclear how their working tasks contributed to evidence-based practice. OBJECTIVE: Conceptual clarification of the job function and pattern analysis of activity distributions for health professional developers. METHODS: Health professional developers kept continuous time geographical diaries for two weeks. Meaningful categories were subtracted through content analysis. Patterns were analysed within activity distributions with regards to evidence-based practice. RESULTS: A total of 213 diaries were collected from 21 health professional developers of three professions (physiotherapists, occupational therapists and nurses). Each participant reported 6–13 workdays (median 10 days). Eleven main categories of work tasks emerged with 42 subcategories. Overall, 7% of total time reported was spent on external knowledge, with minimal variation between professions and contractual time allocation. CONCLUSION: Conceptual clarification of work tasks was established for health professional developers. Their work activity distributions contributed mainly to maintenance of existing level of professional knowledge rather than to implementation of new knowledge, which did not fulfil the intended responsibility for development of evidence-based practice. Educational competence boost and data-driven change of organisation structure was recommended.

Case study research: Building the occupational therapy evidence base one case at a time

“…Regarding this, Dougherty et al (12) identified two major sources of evidence to inform practice (i) internalised evidence; conferences, books, research knowledge and (ii) evidence gathered and used directly for the intervention process; observations, oral reports, and artefacts, with the latter having greater emphasis in practice. Building on this view of 'internal' knowledge as clinical expertise and 'external' knowledge from research, Honore et al (13) found occupational therapists with a clinical practice development role attributed only 7% of total time on development activity related to adding external research knowledge to practice. This highlights that whilst research and practice knowledge are both important (2,14) the use of each may be inequitable in practice.…”