TOOLS ARE NOT ENOUGH TOOLS ARE NOT ENOUGH

Building Capacity and Nurturing Organizational Contexts and Processes to Support Evidence-Informed Decision Making

Leslea Peirson MA PhD1,2 Megan Ward MHSc MD FRCP(C)3 Donna Ciliska RN

PhD1,2 Maureen Dobbins RN PhD2 David Mowat MBChB, MPH, FRCPC, FFPH3

1National Collaborating Centre for Methods and Tools, 2McMaster University School of Nursing, 3Region of Peel Public Health Department

Canadian Public Health Association Annual Conference, June 2010, Toronto ON

Presentation Outline Presentation Outline

• Organizational Context

• 2009-2019 Strategic Plan

• Evidence-Informed Decision Making Initiative

• Example of EIDM in Action

Organizational ContextOrganizational Context

• Peel Public Health (PPH)

• Mississauga, Brampton, Caledon

• 1.3M Residents

• 800 Staff (656 FTE)http://en.wikipedia.org/wiki/Regional_Municipality_of_Peel

20092009--2019 Strategic Plan2019 Strategic Plan

ONGOING PROGRAMS

4 PROGRAM PRIORITIES:Healthy

Environments, Healthy Weights

Nurturing the Next Generation

Surveillance: Data for Action

LIVINGTOBACCO FREE

5 INFRASTRUCTURE PRIORITIES:

Workforce Development

Measuring Performance

Internal/External Communications

Serving an Ethno- Culturally Diverse

Community

MAKING EVIDENCE- INFORMED DECISIONS

(EIDM)

GOVERNING PHILOSOPHY: THE PUBLIC HEALTH WAY

http://www.peelregion.ca/health/health-status-report/stay-ahead-curve/

What is EIDM?What is EIDM?

The process of distilling and disseminating the best available evidence, whether from research or from actual practice, and using that evidence to inform and improve public health practice and policy. http://www.nccmt.ca/eiph/index-eng.html

What is EIDM?What is EIDM?

1. Define Question2. Search for Evidence3. Appraise Evidence4. Synthesize Evidence5. Adapt to Local Context6. Implement Decision7. Evaluate Effectiveness

http://www.nccmt.ca/eiph/index-eng.html

What is EIDM?What is EIDM?

http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

The EIDM InitiativeThe EIDM Initiative

• Megan Ward, Associate Medical Officer of Health

• Leading and managing change

• CHSRF EXTRA Fellowship 2008-2010

• Developed suite of tools and processes to support EIDM activities

The EIDM InitiativeThe EIDM Initiative• EIDM Toolkit Working Group• EIDM Toolkit

• Conceptual Modeling• Defining a Researchable Question (e.g., PICO)• Searching the Literature (and Saving Results)• Critical Appraisal of Quantitative Evidence• Critical Appraisal of Qualitative Evidence• Synthesizing the Evidence (Data Extraction Tables)• Applicability and Transferability of Research Findings• Formulating Recommendations and Writing Reports• Manager Checklist

• Field Testing the Tools and Processes

Tools are Not EnoughTools are Not Enough

• Tools are essential, but not sufficient

• Need to build organizational and staff capacity and nurture a culture and processes that will support, sustain and increase EIDM

• The EIDM initiative has an extensive and expanding presence

NEWNEW EIDM-Related Activities 2008-2010

Divisional EIDM

Mentoring Pilot Project

Student Placements Workforce

Development Strategic Priority

New Position Manager of

Research and Education

EXTRA Project Workforce

Development + EIDM

2010-2012

Library Re-Positioned Under Public

Health

EXTRA Project EDIM Focus 2008-2010

Library Joins Consortium

Library Needs

Assessment

Expert Librarian

Consultation

Virtual Library Training

Designated Senior

Administrative Lead for EIDM

EIDM Toolkit Working Group

New Library Staff Positions

EIDM Toolkit

Commissioned Literature & Systematic

Reviews

Base Budget Funding for

Commissioned Reviews

RefWorks Pilot Project

RefWorks License

Purchase

Director Study Days

EIDM Steering Committee

Program Planning and

Evaluation Tools &

Processes

Base Budget Funding for

EIDM TrainingQualitative Research

Workshops

Conference At Home

health- evidence.ca Workshops

Conceptual Mapping

Workshops

Critical Appraisal Club

EIDM / Critical Appraisal

Workshops

EIDM Communi-

cations Strategy

Conceptual Mapping Club

Health Status Data on Intranet

“Dashboard”

Academic & Expert

Relationships

Expert Mentored Specialist-

Manager Pairs

NIPS & RIPS Learning and Development

Sessions

The Public Health Way Road Show

EIDM Link on “Pathways”

Intranet

EIDM Evaluation Planning

RefWorks Community of

Practice

EIDM in Action: EIDM in Action: Smoking Cessation CampaignSmoking Cessation Campaign

Issue IdentificationIssue Identification

?Join the

Driven to Quit Challenge!

The TeamThe Team

DivisionalManager

Project Specialist

Team Supervisor

Other Stakeholders:Tobacco Prevention TeamCampaign Partners

Defining the QuestionDefining the Question

“Are quit and win contests effective in increasingshort and/or long-term

smoking cessation rates?”

Searching for EvidenceSearching for Evidence

SPECIALIST

5050 hitsMissing 2 Cochrane Reviews

10 hours

SKILLED LIBRARIAN

Refined Search Strategy3 “nuggets” (the 2 Reviews+1 RCT)

10 minutes

Critical Appraisal of the EvidenceCritical Appraisal of the EvidenceSystematic

Review #1Systematic

Review #1Systematic Review #2

Systematic Review #2

RCTRCT

Pre-processed (and Rated Strongly) by:

Specialist Duplicates Appraisal Using CASP Tool

Specialist Appraises Using CASP Tool

40+ Members of Peel’s Critical Appraisal Club Also Assess

Applicability and TransferabilityApplicability and Transferability

http://www.nccmt.ca/pubs/2007_12_AT_tool_v_nov2007_ENG.pdf

Recommendations Recommendations and Report Writingand Report Writing

Search

Appraisal

Search

Concept Model

Question

1:2:20

Decision MakingDecision Making

AcknowledgementsAcknowledgementsCanadian Health Services Research Foundation (CADRE Postdoctoral Fellowship: L. Peirson; EXTRA Fellowship: M. Ward)

Canadian Institutes of Health Research (joint funder, CADRE Postdoctoral Fellowship: L. Peirson)

National Collaborating Centre for Methods and Tools and McMaster University School of Nursing (Postdoctoral Hosts: L. Peirson)

Peel Public Health (Postdoctoral Training and Research Setting)

Comments? Questions?Comments? Questions?

ContactLeslea Peirson

peirson@mcmaster.ca 905-525-9140 ext 20453