Marjorie MacDonald (UVIC),Wanda Martin (UVIC), Laura Tomm-Bonde - - PowerPoint PPT Presentation

Evidence Informed Practice and Practice Informed Evidence: Implementation of BC Core Public Health Program on Unintentional Injury Prevention Stephanie Cram University of Victoria

Marjorie MacDonald (UVIC),Wanda Martin (UVIC), Laura

Tomm-Bonde (UVIC), Amanda Parks (IHA), Jennifer Scarr (VCH), Cindy Anderson (VIHA), Bernie Pauly (UVIC)

Funding

• CIHR Knowledge to Action Grant, M. MacDonald

and T. Hancock, 2008-2010

• “From Evidence Informed Practice to Practice

Informed Evidence”

• CIHR/PHAC Applied Public Health Chair, M.

MacDonald, 2008-2013

• BC Ministry of Health Services
• Vancouver Island Health Authority contribution

funding

Research Team

Academic Researchers

• Marjorie MacDonald UVIC
• Bernie Pauly UVIC
• Allan Best UBC
• Craig Mitton UBC
• Anne George UBC

Research Assistants

• Wanda Martin, Laura Tomm

Bonde, Stephanie Cram Decision Maker Researchers

• Trevor Hancock BC MHLS
• Roger Wheeler IHA
• Ted Bruce VCH
• Mike Pennock VIHA

Introduction

• Several National reports have identified

systematic deficiencies in the Canadian public health system, and have made recommendations to strengthen it, including the need to define essential public health functions

• As a result of these reports British Columbia has

embarked on a public health renewal process guided by a Framework for Core Functions in Public Health

Public Health in BC

• There are five health authorities in British

Columbia, and one Provincial Health Services Authority (PHSA) who provide PH Services

• In B.C. 20 core public health programs were

developed based on an evidence review and that were to be implemented in all HAs

• Model core programs were created that each

HA used to guide the development of their

• wn evidence-informed local programming

B.C. Health Services

• Each Health Authority was expected to identify the

gap between their current services and the Model Core Programs

• The implementation of core programs can be

conceptualized as a sophisticated and iterative knowledge exchange process

• Each Health Authority has established their own

knowledge exchange processes and performance improvement plans, and each has different resources allocated to the implementation of the programs

Research Purpose

To engage in a collaborative participatory process between researchers and decision makers to:

• 1. Explore the evidence-to-practice (KTA) processes in,

and factors influencing implementation of 2 core public health programs in 3 health authorities in BC

• 2. Identify KTA strategies that support evidence use in

core program implementation

• 3. Compare the process and outcomes across HAs

Methodology

• We engaged in a participatory research

approach to study the Knowledge to Action (KTA) process reflected in the knowledge exchange elements of the core programs

• Between 2008 and 2010 we conducted

interviews with individuals from three B.C. Health Authorities (HA 1, 2, and 3)

Purpose of Presentation

• To present preliminary analsyes that describe

major contexual influences on implementation of the UIPP program in three HAs in BC

• We have determined three contextual factors

that influence how evidence is uniquely taken up in the different health authorities: – Organizational Culture – Leadership – Communication

Organizational Culture

• HA1: Discourse of scarcity

– lack of innovation development for the UIPP program is seen to result from the lack of funding and resources

• HA2: Organizational culture that promotes an image of

professionalism – At this health authority hard work is valued, and workers from this health authority have internalized the idea that hard work leads to change

• HA3: Professional organizational culture

– Employees are neither motivated nor discouraged by a dominant culture. Rather employees work hard because it is what is expected of them

Leadership

• HA1: Inadequate leadership was a major issue identified

as preventing innovation development – At the time of the interviews this health authority did not have a UIPP coordinator.

• HA2: Does not have a UIPP coordinator, but because the

health authority does have a flat hierarchy, employees jointly take on the responsibilities of a program coordinator

• HA3: The UIPP coordinator has taken on most of the

responsibility for the program

Communication

• HA1: Participants highlight that

communication impedes the implementation

• f the UIP program

–Two areas of improvement: communication between upper management and frontline staff, and communication between the health authority and the community

Communication

• HA2: Through the gap analysis communication

was determined to be a factor inhibiting program implementation. –There are three types of communication identified that need to be improved: internal communication, communication with external partners, and communication with the community

Communication

• HA3: Concern with communication is not stated

to be as dire as at the other health authorities. – The UIP program coordinator serves an important role of communicating the importance of the program within the health authority. – Participants express the need to improve the communication of the program to the community

Use of Evidence

• HA1: Participants recognized the benefits of

using evidence to guide practice, but identified concerns:

– Symbolic Utilization: when evidence is gathered to back up already existing practices. – The health authority must strive to gather more practice based evidence. – The lack of funding negatively impacts data collection.

Use of Evidence

• HA2: Participants define several types of

evidence, such as epidemiological data and experimental data. A few concerns are

• utlined by participants:

– Lack of consistency with regards to using and collecting data – The health authority relies too heavily on existing data to explain policy or practice changes

Use of Evidence

• HA3: Participants from HA3 explain that

evidence is often tied to the Best Practices

• utlined in the MCPP. A few criticisms were
• utlined:

– Evidence outlined in the MCPP was not necessarily new information for IHA employees. – Accessibility of evidence – Evidence is often obsolete once it is linked to new practices or policy

Implications

• Understanding the discourses that drive

decision making and shape the culture in each

• rganization is essential to identify levers for

change

– Using the discourses to shape more positive messages and frame issues in ways that can be understood – Finding ways to subvert the dominant discourse

Implications

• Understanding the context and how it

influences core program implementation in each organization is important for identifying targets for change

• To improve implementation requires attention

specifically to leadership, communication, and

• rganizational culture

Implications

• Evidence is understood differently by different

people, and strategies to support use of evidence need to be informed by the various understandings

• f and uses for evidence by different groups
• From the practitioner perspective, evidence needs to

be relevant, accessible, and continually revised

• Use of evidence needs to be real rather than

symbolic and should be modelled by those at higher levels in the organization