Building capacity for evidence informed decision making in public health: a case study of organizational change Leslea Peirson et al (2012)

Evidence Informed Decision Making (EIDM)? “Intentional and systematic processes of bringing the best available scientific evidence on specific questions together with other relevant information to help weigh options and inform decisions that will affect priorities, polices, programs and practices”

A Model for Evidence-Informed Decision Making in Public Health

EIDM for public health in Canada • Six National Collaborating Centres for Public Health established in 2005 to translate scientific evidence for policy makers and practitioners • EIDM part of the 2008 national core competency for public health • Ontario PH standards emphasized EIDM as foundation for all mandated programs and services • Regional Health Authority in Eastern Canada invested in tools, trainings and mentoring for EIDM • Alberta rehabilitation service organization created a Time Grants program for EIDM • No formal evaluation….

Study aim… • To explore and inform the early implementation of Peel Public Health’s long term strategic initiative to build organization and staff capacity for EIDM • To present the findings related to critical factors and dynamics involved in the organization’s transformation to advance EIDM objectives

Setting and context • Peel Public Health (PPH) • 800 staff • 1,3 million residents

• Strategic Plan 2009-2019 emphasized • • • • •

EIDM Workforce Development Performance Management Communication Ethno-Cultural Diversity

Design • Qualitative case study • Period 2008-2010 • Two sets of semi-structured interviews and FGD with 70 informants • Review of 137 documents • Thematic analysis

Results: EIDM activities • Trainings and skills enhancement workshops • Developing methods and tools for conducting literature reviews • Creating clubs/forums to share knowledge • Restructuring library and expanding service capacity • Creating and supplementing EIDM related positions • Accessing external expertise • Commissioning literature reviews • Committing significant base budget funding to EIDM

Results: key barriers • Inadequate access to databases and full-text articles • Limited EIDM knowledge and skills • Difficulties allocating sufficient time for EIDM

Results: critical factors and dynamics • • • • • •

Vision and strong leadership Position staff in new working relationship Proficiencies of EIDM skills Significant fiscal and technological resources Cultural shift: doer -> thinker-doer Ensure evidence and information is current, comprehensive, accessible, usable and evaluable • Communication strategy to raise awareness, provide updates, maintain transparency • Careful monitoring, management and evaluation of change

Results: critical factors and dynamics • Leadership • Organizational structure • Human resources • Organizational culture • Knowledge management • Communication • Change management

Discussion • Findings similar to literatures on system transformations • What does this paper add? • Long term involvement of a consistent group of senior leaders • Commitment of significant long-term core funding for EIDM activities and salaries

• Reinforce the utility of change management framework • Highlight importance of addressing negative/positive reactions • Reinforce the notion that EIDM cannot be pursued by an organization in isolation • Demonstrate complexity and expansiveness of activities, factors and dynamics for pursuing EIDM

Limitation • Single site case study • Informants only include staff most involved • Focus on first two years of a 10-year initiative

Shift of strategic priorities? PPH Strategic Plan 2009-2013

PPH Strategic Plan Update 2014-2019

• EIDM • Ethno-cultural diversity • Workforce development • Communication • Performance management

• End-to-End Public Health Practice • Ethno-cultural diversity • Workforce development

Shift of emphasis in public health?

Evidence based

Evidence informed

End-toend?

What is the evidence on evidence based informed policy making? Newman et al (2013)

Cochrane update: building capacity in evidence-informed decisionmaking to improve public health Pettman et al (2013)

The Myth of Research-based Policy & Practice Hammersley (2013)

Evidence-based medicine: a movement in crisis? Greenhalgh et al (2014)