Evidence-Based Research Interview
Evidence-based practice entails the incorporation of various components aimed at improving the quality of life and health outcomes. The external evidence includes randomized controlled trials, systematic reviews, clinical practice guidelines, and best practice. The external evidence helps in supporting changes in clinical practice. The internal evidence includes quality improvement projects that are health care institution-based, clinical expertise, and outcome management initiatives. The other component of evidence-based practice is accounting for the preferences and values of patients. The interview with the health care leader provided information on the experiences associated with using evidence-based research to drive changes in a medical facility.
The health care leader was involved in the implementation of several changes to guarantee the provision of quality care to patients. The health care leader supported the adoption of medication therapy management that was pharmacist-led to reduce the cost of care. It is reasonable for the medical facility to involve its pharmacists in carrying out medication therapy management to make healthcare affordable. In particular, the pharmacists would help the facility realize better patient outcomes because of the advice they will be offering to them. The second change involved the optimization of sepsis care to improve early recognition as well as outcomes. Sepsis is a medical condition that is potentially life-threatening and is caused by the response of the body to an infection. The body usually releases chemicals to fight the infection. If the response of the body to the released chemicals is out of balance, it results in sepsis. The condition is said to be responsible for a significant number of deaths in the United States. Early identification of the condition can be challenging as the physical response of the patients resembles non-specific symptoms. Thirdly, the leader wanted to boost the change and readiness competencies of the staff to reduce clinical variation successfully. The medical facility needs to reduce clinical variation by employing robust analytics and strong physician champions to support its improvement efforts. The health care leader argued that implementing these changes would go a long way in ensuring that patients at the facility received quality care.
The health care leader felt that extensive research had been conducted on the benefits of the changes the facility wanted to implement. The studies had indicated positive outcomes for the health facilities that had implemented these changes. The analysis supported the unique impact that pharmacists were having on patient outcomes thanks to the pharmacist-led MTM. The health care leader stated that there was a reduction in the cost of care by $2,085 per patient within six months after implementing the program (Health Catalyst, 2019). Additionally, more than $595,000 extrapolated out from the more than 283 patients enrolled in the program. The leader added that there were a decrease in hospital admissions and emergency department visits by 12% and 10%, respectively, per 1,000 members (Health Catalyst, 2019). Lastly, the program lowered the average medication count in a statistically significant way. The comprehensive approach involving early recognition of sepsis and treatment led to substantial improvements in outcomes. The mortality for patients suffering from severe septic shock and sepsis experienced a reduction of 1% (Health Catalyst, 2019). Patients under the evidence-based protocols showcased a reduction in mortality by 9% compared to those not under the program. The program led to a decrease in the length of stay in the emergency department for patients with severe septic shock and sepsis by 4% (Health Catalyst, 2019). The leader added that the early recognition and treatment program assisted in reducing the number of patients being admitted to the emergency department. Lastly, the move to boost change and readiness competencies helped in establishing an implementation and prioritization approach that led to outcomes improvement.
The health care leader stated that the facility has never rejected research findings without determining whether they are true or false. Whenever new findings emerge regarding the effectiveness of implementing a particular change, the facility usually conducts separate trials to determine its validity. The experiment may involve a few patients who willingly consent to take part in the trial. According to the health care manager, it would be wrong to write off a study’s findings without ascertaining whether it was true or false. It would be wrong to reject a study’s findings, especially if it can positively impact the processes of a medical facility. The manager stated that the medical facility usually adopts a study’s recommendations if the results from its trial correspond to those in the initial study. However, sometimes the findings may not be valid, and the facility will have no option but to reject it. The facility could reject the findings of research if there were flaws in the presentation, procedures, or analysis of the collected data. It may include the absence of control groups, non-conformity with recognized methodology and procedures, or the use of statistically invalid analysis. Therefore, the health facility has measures to guide its decision to reject or accept the findings of a study.
The health facility faced numerous concerns and resistance from its employees when implementing the changes. The changes meant that the health practitioners working at the facility had to alter the way they performed their duties. Some of the practitioners argued that the disruptions were not necessary since they had been providing the best care using the current programs. Implementing the pharmacist-led MTM, improving early recognition, and boosting change and readiness competencies was sure to take some time. The manager indicated that the health practitioners at the facility were worried that the implementation period would take long, leading to instability and uncertainty (Al-Abri, 2007). The presence of instability and uncertainty has the potential of causing fatigue among the employees due to the changes. The fatigue may evoke psychological uncertainty, unwillingness, and resistance to change, emotional exhaustion, and increased tendencies of employees quitting their jobs (Mares, 2018). There were concerns among the health practitioners that the facility’s administration was pressuring them and using its power to force the changes.
The findings from the interview apply to the components associated with evidence-based research. The changes being implemented by the health facility were advised by external evidence on their effectiveness. The changes were beneficial after they had been adopted in other health facilities. The health care manager stated that the programs were quality improvement projects that were intended to act as outcome management initiatives. In particular, they were intended to lower the cost of care, allow for early identification of sepsis, and to reduce clinical variation. The implementation of the programs put into consideration the preferences and values of patients. The leader provided a critical analysis of the findings of available research, basing them in the health facility’s context. The interview further consolidated the argument regarding the importance of judgment and perspectives of patients and clinicians in evidence-based practice.
References
Al-Abri, R. (2007). Managing change in health care. Oman Med J., 22(3): 9-10.
Health Catalyst. (2019). The top six examples of quality improvement in healthcare. Health
Catalyst, Retrieved from https://www.healthcatalyst.com/insights/top-examples-quality-improvement-healthcare
Mares, J. (2018). Resistance of health personnel to changes in healthcare. Kontakt, 20: e262
e272.