When it comes to evidence-based practice (EBP), we know adoption is a challenge. We also know the problem isn’t necessarily acceptance of the principle of EBP (anymore)—according to a recent survey, 75% of CMOs said EBP now enjoys broad cultural acceptance among their medical staff. So, why do over half of physicians still report not using available guidelines day-to-day?
To prepare for this year’s Physician Executive Council national meeting, we took a hard look at organizations that have differentiated themselves from the pack in moving their entire medical staffs toward greater routine practice of EBP. What were they doing differently?
Here's what we found.
How organizations pivot toward evidence-based practice
The first thing we found in our research was that health systems that have achieved higher-than-average adoption of evidence-based care have invested significant strategic thought and implementation into all the many ways in which an organization can support use of EBP at every turn.
In other words, they use not one or even several supporting best practices, but many. These practices ranged across such diverse organizational areas as effective top-level leadership behaviors to use of support staff, processes for guideline generation and revision, and much more.
In all, the tactics for shifting organizations toward broad adoption of EBP can be organized into the following four performance domains:
- Prioritization: Are opportunities to minimize variation ranked in order of expected cost/quality gains?
- Correctness: Are the guidelines trustworthy sources of the most up-to-date clinical evidence?
- Adherence: Are clinicians surrounded by effective messaging and individual-level data designed to promote adherence?
- Scalability: Is the EBP support process efficient (especially across services and sites)?
Which opportunities are we missing today?
With the tactics in hand, we developed a survey instrument to help CMOs surface opportunities for major EBP adoption gains by identifying specific practices their organization is either not doing, or not doing consistently.
A pilot cohort of CMOs used the tool (called the “Evidence-Based Practice Leadership Audit”) to rate their organization's current use of EBP-supporting tactics across the four performance domains. Respondents reported missing tactics in every domain, but the largest shortfalls were in practices that have been shown to promote adherence—particularly these practices:
- Promoting physician adherence through non-financial incentives (e.g., physician compact or linking adherence to privileges)
- Tracking physician opt-outs of clinical guidelines—and analyzing opt-out patterns to inform guideline revisions
- Providing physicians access to their individual-level data on clinical guideline adherence in a timely manner
Physician Executive Council Members, Try the Audit
As one CMO of a 14-hospital system put it: "this tool really forces you to self-evaluate. It is easy to think you are doing something well, but this really makes you face the facts."
Physician Executive Council members can be the first to use the full Evidence-Based Practice Leadership Audit to gauge their organization's current adoption of EBP-promoting practices at the 2013-2014 national meeting.
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