August 12, 2019

Writing for Harvard Business Review, Margaret Luciano, an assistant professor in the WP Carey School of Business at Arizona State University, and colleagues offer four ways hospitals can integrate evidence-based practices.

Cheat sheets: Evidence-based practice 101

Luciano's colleagues include Thomas Aloia, the chief value and quality officer in the Office of the Chief Medical Executive at MD Anderson Cancer Center, and Joan Brett, an associate professor in the WP Carey School of Business at Arizona State University.

Why hospitals have trouble with evidence-based practice

While evidence-based practice is regarded "as the gold standard in patient care," Luciano and colleagues note that research shows that hospitals and clinics can take about 17 years to adopt a practice after the release of the first systematic evidence showing it helps patients.

According to Luciano and colleagues, a big part of the challenge is adapting the practices to fit a clinic's environment.

"Leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context," they write. "Attempting to simply 'plug in' a new practice to a different hospital or clinic often conflicts with existing practices. … But deviating from the evidence-base can weaken the effectiveness of the practice and lessen the benefits."

The 4 keys to implementing evidence-based practices

With these challenges in mind, Luciano and her colleagues conducted research on organizational change and identified four approaches leaders can use to implement evidence-based practices at their organization "while staying close to the foundational evidence." Specifically, Luciano and colleagues urge leaders to:  

  1. Understand the data. While some evidence-based practices and treatments are applicable to multiple clinical contexts, in other instances, the data behind an evidence-based practice may not translate to your organization. "What if the evidence-base is constructed from different patient populations, hospitals with different structures or cultures, or countries with different regulatory environments and payment structures," Luciano and colleagues write.

    In those situations, leaders need to adapt the evidence-based practices to fit their organization. And that requires understanding the data, Luciano and colleagues write.

    For example, Luciano and colleagues recommend that leaders look at the data and consider "what is similar, what is different, and why those might matter." They add, "Leaders should also consider whether existing data is sufficient to support implementing a new practice … or if additional data should be collected to verify the efficacy."

    Even after the practice is implemented, leaders should continue the data collection process so they can reassess and make modifications as needed, according to Luciano and colleagues.

  2. Consider your resources. Similarly, every organization has different resources at their disposal, making it likely that leaders will need to modify evidence-based practices to fit the resources that are available to them, Luciano and colleagues write.

    According to Luciano and colleagues, adapting a method based on resources can shift providers' reactions from "we don't have the resources to do that" to "how can we apply these practices with the resources we do have?"

    For instance, while hospitals that don't have "sophisticated [EHRs] may not be able to implement electronic patient smart order sets," they could "still attain similar improvements in care coordination by using paper checklists," Luciano and colleagues write.

  3. Establish patient-centered goals. When implementing a new evidence-based practice, health care leaders need to identify goals based on patient-centered outcomes, according to the Luciano and colleagues. "The goal of implementing an evidenced-based practice should not be the implementation itself," they write.

    "For example, many hospitals have the goal of reducing inpatient length of stay. If the change leaders focus just on the inpatient length of stay itself, they may create a program that rushes the patient out of the hospital before they are ready," Luciano and colleagues write. "If instead the goal is to optimize recovery … the focus shifts to the patient experience, and reduction in inpatient length of stay is simply the residue of a provider and patient-friendly program."

  4. Identify your preferences. Finally, leaders should note that health care providers' personal preferences often determine whether an organization will adopt a new practice, according to Luciano and colleagues.

    "Preferences driven by subjective, idiosyncratic reasoning inhibit adopting new approaches that can attain better health outcomes, reduce expenses, and decrease errors," Luciano and colleagues write.

    For example, one health system that adopted a standardized set of tools found that physicians preferred the tools they'd been trained on, even though evidence showed the old tools were more costly and had no impact on patient outcomes.

    To ensure your team is using the best practices available, leaders need to listen to their providers and "determine why providers have certain preferences," Luciano and colleagues writes. With this understanding, leaders can create a plan to introduce the new practice that addresses providers' concerns. For example, Luciano and colleagues write that "offering training on new tools or techniques can give care providers the opportunity to ask questions about them and get more comfortable using them," they write (Luciano et al., Harvard Business Review, 8/2).

Cheat sheets: Evidence-based medicine 101

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