8 Conditions When Research is Put Into Practice: More Lessons From Health Care

In Health Care putting research into practice can be high stakes. Changing routines and practices as a result of new findings often has direct impacts on the health, treatment or recovery of patients. A significant contribution to the study of changing practices was made in 2003 by Richard Grol and Jeremy Grimshaw who published the study:

From best evidence to best practice: effective implementation of change in patients’ care”,  The Lancet, Vol 362, October 11, 2003.

Keeping up with the pace of research

The speed of medical research provided Grol and Grimshaw with an interesting opportunity to explore the intersection of research and practice. They found that although syntheses helped physicians stay current with findings and saved time from having to read the original research papers, physicians still had difficulty keeping pace with the rapid advances in health care knowledge. In addition to physician factors, the environment (attitudes and approaches of colleagues) also played a role in evidence impacting action.

The 8 conditions research was most often put into practice was when:

  1. You don’t think the current practice works: Physicians quickly changed practice when there was existing scepticism of the benefits of an established practice (review of treatment of otitis media).
  2. It’s an easy problem to address: physicians were more likely to change practices for acute care issues than for chronic care
  3. You feel the findings are more believable and compelling (better quality of evidence)
  4. The new practice matches current values
  5. The new practice makes your life easier: “less complexity of decision-making”
  6. You have a clearer understanding of what needs to be done: “more concrete description of the desired performance”
  7. The new recommendations don’t require a lot of new skills or changes to the organization
  8. The new practice is targeted at specific obstacles to change.

Although Grol and Grimshaw were unable to find a single strategy for knowledge mobilization that was effective in every setting and condition, they provided a very useful and thought-provoking summary of strategies with respect to impact.

Effectiveness of Knowledge Mobilization Strategies:

  • Limited Effects
    • Total quality management/continuous quality improvement (1 review, 55 studies)
  •  Mixed Effects
    • Educational materials (9 reviews, 3-37 studies)
    • Conferences, courses (4 reviews, 3-17 studies)
    • Use of opinion leaders (3 reviews, 3-6 studies)
    • Education with different educational strategies (8 reviews, 5-63 studies)
    • Feedback on performance (16 reviews, 3-37 studies)
  • Mostly Effective
    • Reminders (14 reviews, 4-68 studies)
    • Computerised decision support (5 reviews, 11-98 studies)
    • Introduction of computers in practice (2 reviews, 19-30 studies)
    • Mass media campaigns (1 review, 22 studies
    • Interactive small group meetings (4 reviews, 2-6 studies)

A further review of the strategies found:

  • Education and information had short-term effects
  • Reminders had modest and sustained effects
  • Performance feedback is effective but ceases if feedback is not continued.

Does the effectiveness of these strategies surprise you?

Would you have expected reminders to be more effective than opinion leaders, feedback, conferences or educational materials? One thing that shouldn’t be surprising is that the more strategies you employ, the more likely it will be effective. Grol and Grimshaw reflected that multifaceted interventions had “pronounced effects on practice and outcomes” involving the combined use of education, written materials, feedback and reminders.

It remains to be seen whether these strategies would result in similar levels of effectiveness in an education context but it provides an interesting look at knowledge mobilization efforts. The question now to consider is, how effective are the strategies you are using?

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