Evidence

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Chapter_19___Using_Evidence_to_Influence_Health_and_Organizational_Policy.pptx.pdf

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Chapter 19

Using Evidence to Influence Health and Organizational

Policy

Chapter 19

Using Evidence to Influence Health and Organizational

Policy

Defining “Policy”

“Policy” is used to describe both the entity and the process.

As an entity—policy is a tangible result (a law or municipal code) or other governmental process that includes:

• Judicial decrees

• Position statements

• Resolutions

• Budget priorities

Other kinds of broad “health policies” are:

• Published by nongovernmental organizations

• These have impact on health policy

Defining “Policy”—(cont.)

As a process—it’s the series of actions and activities taken to bring a problem to the attention of government actors who work to address the problem.

When policy refers to “health policy,” these actions are often thought of as those targeting improvements for the health of populations.

Challenges Unique to the Relationship Between Evidence and Health Policy

Policy making is:

• Nonlinear

• Influenced by social and political factors such as:

– Partisanship

– Diverse stakeholder values

– Public opinion

– Media coverage

– Timing of congressional and legislative cycles

– Budget restraints

– Strategy and skill of players

Using Evidence: Clinical Practice vs. Policy

In clinical practice:

• Cultures and organizational structures more apt to press for practice based on evidence

In political environments:

• Pressing for policy based on evidence can have less favorable outcomes.

• Terminology in policy is “evidence-informed” policy rather than “evidence-based” policy.

• Goal: use evidence to inform, influence, or mediate dialogue between policy makers and stakeholders.

Question

Which of the following statements is false?

A. “Evidence-based” policy is the current term for using evidence to inform health policy.

B. “Policy” refers to both an entity and a process.

C. “Health policy” refers to both laws that impact population health and healthcare organization policy.

D. Nuances in clinical practice are different from nuances in the health policy world, making strategies to use evidence to drive policy different.

Answer

A. “Evidence-based” policy is the current term for using evidence to inform health policy.

Rationale: “Evidence-informed” policy is the current term for using evidence to inform health policy. “Policy” refers to both an entity and a process. “Health policy” refers to both laws that impact population health and healthcare organization policy. Nuances in clinical practice are different from nuances in the health policy world, making strategies to use evidence to drive policy different.

Evidence-Informed Health Policy Model (EIHP)

• Policy makers are more likely to respond positively to evidence when it is presented in a way that is:

– Compelling

– Understandable

– Conveyed in the context of citizen/constituent needs

The Evidence-informed Health Policy Model is adapted from the Melnyk & Fineout-Overholt Seven Steps of EBP.

Comparison of EBP and Evidence-Informed health Policy Components

Preparing Evidence for Dissemination to Policy Makers

Multiple opportunities exist to disseminate evidence in Evidence-Informed Health Policy (EIHP):

• During Step 4 (when best evidence is integrated with issue expertise and stakeholder values and ethics).

– Most likely to happen in “behind-the-scenes” negotiations/planning or task force meetings with bill sponsors or regulatory staff

• During Step 6: Policy change is framed for appropriate dissemination to affected parties.

• During Step 7: Effectiveness of policy change is evaluated and findings disseminated.

Preparing Evidence for Dissemination to Policy Makers—(cont.)

Multiple methods used to disseminate (or communicate) evidence to policy makers.

Informal methods include:

1. “Elevator speech”

2. Policy brief—typically consists of bulleted talking points

• Both are brief

• Used as one-way communication method

Formal method includes:

3. Providing testimony during a hearing

Dos and Don’ts of Using Evidence During Testimony

DO:

• Analyze the policy-maker “audience” (lawmakers or regulators?)

• Know committee membership (chair, minority leader, etc.)

• Address how the body of evidence is relevant

• Use examples from your own clinical expertise to bridge the evidence-to-practice reality

• Respond professionally to questions

• Include a reference page as an appendix to your testimony with URL links

Dos and Don’ts of Using Evidence During Testimony—(cont.)

DON’T:

• Use medical jargon or research terms

• Cite individual research studies—focus on the relevant BODY of evidence

• Get to the point

• Become defensive or emotional during testimony delivery or questioning

• Express evidence in a way that could be misinterpreted as a “turf battle”

• Respond to a question you don’t know the answer to with a simple “I don’t know.” Instead, say “That’s a great question. I will be happy to find out and get back to you.”

Question

Which of the following is appropriate behavior when testifying on a policy issue?

A. If you don’t know the answer to a question, simply state, “I don’t know.”

B. Use examples from your own clinical expertise to bridge the evidence-to-practice reality.

C. Be very detailed in your description of the body of evidence.

D. Cite individual research studies.

Answer

B. Use examples from your own clinical expertise to bridge the evidence-to-practice reality.

Rationale: Using examples from your own clinical expertise to bridge the evidence-to-practice reality, making the issue more “real.” Don’t

• State “I don’t know” If you don’t know the answer to a question.

• Give a lot of detail in your description of the body of evidence; get to the point.

• Cite individual research studies. Instead, discuss the BODY of evidence.

Using Evidence to Influence Organizational Policy

EBP should be the foundation for all organizational policy

The EBP competencies:

• Help organizations establish expectations for clinicians

• Develop mechanisms to build EBP knowledge and skill

• Measure achievement of each competency

• Hold clinicians accountable to this professional expectation

EBP is an effective strategy to contribute to improved care through utilization of best evidence to drive organizational policy decisions.

Successful Policy Committee Structures and Processes

• Committee infrastructure: charter, checklists, and membership

– Put structures in place to:

• Identify purpose and processes

• Assure representation of all departments who will be impacted by the policies

• Policy committee leadership

– Need visible, tangible committee leadership

– Responsibilities include

• Engagement of committee members

• Promoting and sustaining an effective EBP culture

Competency assessment for policy committees

• EBP competencies set expectation for committee member expertise.

• Engage EBP experts from within and outside the organization to provide needed EBP education.

Operationalizing a collaborative interprofessional policy committee

• Creating an interprofessional collaborative provides a platform to foster interprofessional collaboration and engagement.

Successful Policy Committee Structures and Processes—(cont.)

Challenges and Change Management

Time: Anticipate need to review policies every 3 years

• Anticipate time needed to engage in EBP to support sound policy creation/review

– Time to search databases

– Time to appraise and synthesize literature

Committee member variation in skill and confidence

• Engage EBP experts to provide needed education.

• Engage EBP mentors to provide support/guidance.

Changes in committee membership

Question

Which of the following is NOT a consideration when applying EBP to organizational policy?

A. The EBP expertise of policy committee members

B. The time needed to manage utilization of EBP to guide organizational policy review

C. Appointing a strong lead for the policy review committee; preferably a physician

D. Utilizing EBP experts and mentors to provide needed education

Answer

C. Appointing a strong lead for the policy review committee; preferably a physician

Rationale: Appointing a strong lead for the policy review committee, preferably a physician, is not a consideration. Any leader who is able to navigate the challenges of leading an interprofessional committee is appropriate. Other considerations to keep in mind when utilizing EBP to organizational policy include assessing the EBP expertise of committee membership, planning for the time needed to manage utilization of EBP to guide organizational policy review, and utilizing EBP experts and mentors to provide needed education to committee members.

Slide 1
Defining “Policy”
Defining “Policy”—(cont.)
Slide 4
Using Evidence: Clinical Practice vs. Policy
Question
Answer
Evidence-Informed Health Policy Model (EIHP)
Slide 9
Preparing Evidence for Dissemination to Policy Makers
Preparing Evidence for Dissemination to Policy Makers—(cont.)
Dos and Don’ts of Using Evidence During Testimony
Dos and Don’ts of Using Evidence During Testimony—(cont.)
Question
Answer
Using Evidence to Influence Organizational Policy
Successful Policy Committee Structures and Processes
Slide 18
Challenges and Change Management
Question
Answer