Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting

Abstract

BackgroundThis is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately.MethodsLiterature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes.ResultsSurveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed.ConclusionHealth service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2388-8) contains supplementary material, which is available to authorized users.

Bibliometric Review of the Knowledge Base on Healthcare Management for Sustainability, 1994–2018

“…More specifically, author co-citation analysis revealed three schools of thought in the SHM literature: (1) sustainable change in health care services, (2) innovations in managing health care operations, and (3) prioritizing and allocating resources for sustainability. The science map of the SHM literature highlighted both the micro-level focus on healthcare management in organizations [11,13,49,63,66], as well as macro-level issues in healthcare systems [70][71][72][73][74][75][76][77].…”

“…Key authors include five Australian scholars: Harris with 77 co-citations [70][71][72][73][74][75][76][77], Allen with 53 co-citations [70][71][72][75][76][77], King with 44 co-citations [70][71][72][75][76][77], Elshaung with 42 co-citations [74,[78][79][80], and Mitton with 42 co-citations [78,81]. Key literature within this School centers on a series of 11 research papers published under the acronym, 'SHARE' or 'Sustainability in health care by allocating resources effectively' [70,[72][73][74][75][76][77][82][83][84]. These papers investigated the process of disinvestment in the Australian health services network using an evidence-based approach.…”

A Framework for Conceptualizing Evidence Needs of Health Systems

“…Although authors do not use the term "learning health system" in the papers, it is clear that the goal of the project is to create a system that implements evidence, learns from the implementation, and feeds that learning back into the system and larger health care community. 25,64,65 In summary, gaps exist between the needs of health systems and traditional evidence synthesis products in terms of topics covered, formats in which the synthesis is presented, and time for production. Evidence synthesis programs can support health systems by providing rapid, focused and layered summaries, addressing a broad range of topics of relevance to health systems, and by including contextual and operational evidence from local sources when available.…”

A Framework of Evidence-Based Decision-Making in Health System Management: Applying Best-Fit Framework Synthesis

“…Based on the present findings, most of the previous studies only referred to some part of the components and steps of the EBDM in HSM and neglected the other parts or they were not sufficiently comprehensive (37)(38)(39)(40)(41)(42)(43)(44)(45)(46). However, the findings of each previous study completed some parts of the framework which presented in this study.…”

“…The present findings showed that in the fourth main step, "evidence acquisition and integration", the most important sub-step is "finding the sources for seeking the evidence" (35,(45)(46)(47)55,63,65).…”