There’s a long-touted assertion that it takes approximately 17 years for evidence to transition to practice in healthcare. In many cases, it takes even longer than that, and it will continue to do so until we ensure that the research answers two definitive questions: So what will be the outcome(s) of the study when completed? So what difference will that study make in improving healthcare quality, costs, or patient outcomes?
Real Evidence About Evidence
For 25 years, I published an extensive amount of literature about randomized controlled trials of a program I created titled Creating Opportunities for Parent Empowerment (COPE). Consisting of a series of educational CD-ROMS and workbooks, it was designed for the parents of preterm infants and critically-ill children to help reduce the duration of their children’s hospital stay, to improve interactions with their infants and children, and to decrease the associated depression and anxiety of premature birth and critical illness. Although I had been publishing for more than two decades about how all of these metrics improved with implementation of the program, not one hospital or healthcare system implemented it until I demonstrated a “so what” outcome.
Through a clinical trial funded by the National Institutes of Health/National Institute of Nursing Research, we were able to show that preemies whose parents received the COPE program had a 4-day shorter length of stay (LOS) than those who did not, and a decrease in 8 days of LOS for preterm babies less than 32 weeks. This resulted in a cost savings of approximately $5000 per infant. Based on this data, if the parent of every premature infant participated in the program, the U.S. healthcare system stood to save from $2.5 to $5 billion (yes, billion) per year. As you can well imagine, once we published those results, my phone rang off the hook.
Don’t Be Insane. Stop Doing What You’ve Always Done If It Isn’t Working
Insanity is defined as repeating an action and expecting different results. As the shift toward value-based medicine continues, we must accelerate evidence-based practice (EBP) in an effort to answer “so what” outcomes. That’s because outcomes affect impact; impact on patients as well as on the providers and the health system itself. Whether it’s continuing to schedule nurses for 12-hour shifts or waking patients every 2 hours to take vitals, these outdated and costly procedures remain the status quo, all in the name of “it’s what we’ve always done,” despite the amount of available evidence to the contrary. It is unsustainable for healthcare practices to continue in this fashion. However, what can be sustained is a commitment to evidence-based practice (EBP) at all levels of a hospital or healthcare system, and it all begins and continues with culture.
Change the Perception of Change
Some people believe that the only person that likes change is a baby with a wet diaper. While we’d all like to believe that we’re not that change averse, without a crisis in front of us, we’re unlikely to readily accept change. When it comes to EBP, culture is a key answer. To sustain a culture of EBP, a health system must develop a team vision with a strategic plan that outlines specific written goals. The system must watch for “change fatigue” in their employees while implementing the plan, countering with recognition and rewards linked to the consistent utilization of EBP. This means there must be administrative role modeling and support, providing an environment that promotes a spirit of inquiry within the staff and bolstering a commitment to EBP. There also must be a critical mass of EBP mentors, clinicians who are equipped with strong knowledge and skills in EBP along with a solid background in individual and organizational change, who work with point-of-care staff on a daily basis.
It All Adds Up
Even with all these elements in play, it’s not enough to just have evidence. There’s a simple equation to keep in mind:
Strength of Evidence + Quality of Evidence = Confidence to Act
That’s where Hayes comes in. It takes a company providing fiercely unbiased reports on the strength and quality of evidence, using systematic reviews conducted with scientific rigor, to provide healthcare systems with the confidence to establish a culture of evidence-based practice. As value-based medicine becomes the new normal, hospitals will want to avoid financial penalties while also increasing their volume by providing proven and cost-effective treatments. “So what?” is a costly question. Look to Hayes to help find the answer.
Want more information about how to sustain Evidence-Based Practice in your health system? The second of our three-part Evidence-Based Practice Webinar Series, co-presented with Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC, takes place on Monday, November 7, 2016. To watch the recording of the previous session, as well as to register for the next two Webinars, click here.