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 Decision Maker Researchers • Marjorie MacDonald UVIC • Trevor Hancock BC MHLS • Bernie Pauly UVIC • Roger Wheeler IHA • Allan Best UBC • Ted Bruce VCH • Craig Mitton UBC • Mike Pennock VIHA • Anne George UBC Research Assistants • Wanda Martin, Laura Tomm Bonde, Stephanie Cram
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 own 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 of 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 outlined 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 outlined in the MCPP. A few criticisms were outlined: – 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 organization 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 organizational culture
Implications • Evidence is understood differently by different people, and strategies to support use of evidence need to be informed by the various understandings of 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
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