1/15/2024 0 Comments Evidence based decisionsResource-related adaptations shift the reactions to evidence-based practices from “we don’t have the resources to do that” to “how can we apply these practices with the resources we do have?” Adaptations require understanding the purpose or goal of the new practice to determine the appropriate substitutes. Accordingly, they may need to substitute and/or pair other medications to achieve equivalent effects. For example, for many smaller hospitals, costs prohibit administering the same brand name drugs as major academic research hospitals. Are the specific resources used in the original implementation not feasible or desirable in one’s local context? Resources include infrastructure, supplies, space, and staff. Sometimes organizations need to adapt based on resources. Look at your resources: How can we make substitutes without compromising results? Notably, even after the adapted evidence-based practice is implemented, more data should be collected to enable ongoing reassessment and making adjustments if needed. Therefore, additional research was needed to understand whether the practice needed to be modified for a patient population that tends to be more frail and have a higher risk for falls. However, most of the initial research was conducted on young-adult patients, as opposed to elderly patients. For example, enhanced recovery practices advocate for early patient ambulation after surgery. Leaders should also consider whether existing data is sufficient to support implementing a new practice (either in the original or modified form), or if additional data should be collected to verify the efficacy before a widespread roll-out. When adapting evidence-based practices to the local context, it is important to consider what is similar, what is different, and why those might matter. 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? Some practices will be more generalizable than others (e.g., the evidence to support the importance of hand hygiene applies across most contexts), and understanding the data helps to objectively determine appropriate modifications (e.g., changing certain medication dosages based on patient age and BMI). Sometimes you need to adapt a practice because the data behind it doesn’t match your own context. Understand the data: How relevant is the evidence-base to our local context? In practice the move to standardization and best practices reduces rather than creates risks, as they often replace idiosyncratic or outdated practices and preferences. It is also important to consider any legal or professional guidelines that may restrict options. Each of these approaches has its own opportunities and challenges, and for any to succeed, it is necessary to understand the local context and the people in it. These approaches are based on an organization’s 1) data 2) resources 3) goals and 4) preferences. Leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context.īased on our research on organizational change and our conversations with hundreds of healthcare providers, we’ve outlined four approaches to help health care leaders adapt evidence-based practices while staying close to the foundational evidence. But deviating from the evidence-base can weaken the effectiveness of the practice and lessen the benefits. Attempting to simply “plug in” a new practice to a different hospital or clinic often conflicts with existing practices and meets resistance from care providers. Why such a long delay when patient health is on the line? Part of it is the challenge of adapting practices to fit the environment. Evidence-based practice is held as the gold standard in patient care, yet research suggests it takes hospitals and clinics about 17 years to adopt a practice or treatment after the first systematic evidence shows it helps patients.
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