Developing capabilities for evidence-based management in healthcare settings June 2004

1. Developing capabilities for evidence-based management in healthcare settings June 2004 EXTRA is a trademark of the Canadian Health Services Research Foundation. EXTRA is funded by a grant from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. disclaimer

2. Armand Boudreau Organizational liaison – East Consultant in health services management Élise Comtois Executive training, CHSRF Jean-Louis Denis Academic co-ordinator CHSRF/CIHR Chair, Université de Montréal Jonathan Lomas CEO, CHSRF David Rochefort Education co-ordinator Consultant in professional development Nina Stipich Executive training, CHSRF Developing capabilities forevidence-based management in healthcare settings

3. “Evidence-based management has been defined as practicing managers incorporating evidence from well conducted studies into their decision-making.” (Bigelow & Arndt, 2004)

4. “Overall, the tightly defined, well-organized, highly quantitative, and relatively generalizable research base for many clinical professions provides a strong and secure foundation for evidence-based practice and lends itself to a systematic process of review and synthesis and to the production of guidelines and protocols.”(Walshe & Rundall, 2001)

5. “In contrast, the loosely defined, methodologically heterogeneous, widely distributed, and hard-to-generalize research base for health care management is much more difficult to use in the same way… which make the development of evidence-based management more challenging.”(Walshe & Rundall, 2001)

6. What can we expect from the implementation of an evidence-based culture in healthcare organizations? • Better interpretation of research-based evidence • Increased use of research-based evidence • Development of competencies and strategies among managers to exert demand and to interact with the research communities • Development of knowledge as a strategic asset in healthcare organizations

7. What are the strategies to promote a realistic perspective ofevidence-based management in healthcare settings?

8. Strategies to promote EBM inhealthcare settings • Focusing on change in research communities and activities • Focusing on change in decision makers’ or practitioners’ communities and activities • Focusing on communicative strategies and activities across these two communities • Integrative approach is probably more successful

9. Instruments to promote EBM in healthcare settings • Incentives in researchers’ and practitioners’ communities • Interactions between researchers’ and practitioners’ communities • Creating new organizational arrangements (e.g. consortiums…) • Developing capabilities through training programs • Synergy across different levers for change is probably more transformative

10. Investing in a training program to promote evidence-based management in healthcare settings: The Executive Training for Research Application (EXTRA) program

11. The EXTRA program • An inter-disciplinary program • An inter-professional program • A program in partnership with professional associations • A program based on a network of academic and professional resources • A program structured around a close synergy between theory and practice

12. The EXTRA program • A program focusing on the management and leadership levels rather than on clinical practice • A program designed to increase organizational as well as individual capacity • A program which requires significant organizational support and participation

13. EXTRA is based on the assumption that the implementation of an evidence-based culture in healthcare settings represents a major change for organizations and their usual decision-making process

14. Vision and mission for EXTRA VISION • A health system in which nurses, physicians, and health service executives collaborate as teams of evidence-based decision makers, optimizing the health of the Canadian population MISSION • To develop capacity and leadership to optimize the use of research-based evidence in Canadian health service organizations

15. The conception of research-based evidence behind the EXTRA program • Evidence on the factors that push for change in interventions and modes of service delivery • Evidence for the design of new interventions and modes of service delivery • Evidence on the process of implementation of innovative interventions and modes of service delivery • Evidence on factors and processes that promote the use of research-based evidence

16. EXTRA program principles • Professional development, organization enhancement • Collaborative leadership • Heterogeneity • Full support in both official languages • Continuous improvement

17. Target audience • The EXTRA program is designed for health service professionals in senior management positions • Leaders of today and tomorrow • From three professional streams: • Health service executives • Nurse executives • Physician executives

18. Learning objectives • To demystify and clarify what research-based evidence is, and how it differs from other influences on decision-making • To enhance research literacy among the fellows so that they are able to find research, appraise its quality and relevance to their decision-making settings, and identify its potential applications

19. Learning objectives • To refine leadership skills for the specific purpose of developing an organizational culture that promotes the role of research-based evidence in decision-making. • To provide tools and strategies for using research-based evidence to promote change in practice and services delivery and to facilitate change management

20. Roles and responsibilities • Partners (CNA, CMA, CCHSE, Quebec consortium) • Nominate members for advisory council; assist in program development, promotion, and marketing • Advisory council • Assists with strategic direction, monitoring, and final selection of fellows (24 per year) • CHSRF • Ensures overall program management and delivery

21. Dr. Jean Rochon, Chair and Former Minister, Department of Health and Social Services, Quebec Dr. Christopher C. Carruthers, Chief of Staff, The Ottawa Hospital, and President of the Canadian Society of Physician Executives Mr. K.J. Fyke, Health Policy Consultant, Victoria, BC Dr. W. David Helms, President and CEO, AcademyHealth, Washington, D.C. Dr. Edouard Hendriks, CEO, Regional Health Authority 4, Edmunston, NB Dr. John Horne, COO, Health Sciences Centre, Winnipeg, MB Dr. Judith Kazimirski, Vice President Medicine, Capital District Health Authority, Halifax, NS Ms. Wendy Nicklin, VP Nursing, Allied Health, Clinical Programs and Patient Safety, The Ottawa Hospital and Member of the Academy of Canadian Executive Nurses Dr. Judith Ritchie, Associate Director for Nursing Research, McGill University Health Centre Mr. John Vogelzang, President and CEO, David Thompson Health Region, Red Deer, AB Advisory council members

22. Program format • Five core program components: • Away-from-home residency sessions • Intervention projects undertaken in fellows’ home organizations • Educational activities between residency sessions • Network building • Post-program support and activities

23. Support team for fellows • Organizational sponsor to facilitate and support all aspects of the program in fellows’ home organizations • Academic mentor to provide curriculum advice, assist with intervention project • Decision-maker mentor to help with the implementation of the intervention project

24. EXTRA mentoring model • Regional “pools” of mentors • Mentors will include both research experts and decision-maker mentors • Mentors are matched with fellows to form a mentoring team • Regular check-in points and assessment of the fellows’ progress

25. Intervention projects as a vehicle for application and integration • A structured activity relating to a specific policy, program, or administrative issue/problem within fellow’s organization • An intervention which aims to create demand for and commitment to the use of research-based evidence in an organization • A problem/issue of sufficient scope to generate change in the organization • A systematic analysis of available evidence to support the design and implementation of the intervention

26. Curriculum framework • Module 1: Demystifying the research world • How research is designed and conducted • Identification, assessment, and exploitation of various evidence sources • Definition, potential, and shortcomings of evidence-based decision-making and policy • Current trends in research policies and their implication for health organizations • Credibility of fellows in their roles as research advocates

27. Curriculum framework • Module 2: Promoting the use of research-based evidence in healthcare organizations • Strategies to promote the use of research and evidence • Political factors and policy influence on the use of research and evidence • Strategies for managing politics and policy • Linkages between the nature of evidence and its application in organizational decision-making

28. Curriculum framework • Module 3: Becoming a research champion • Leadership issues related to the role of research advocates • Personal capabilities required of a research champion • Dealing with issues of inter-professional collaboration • Communication and diplomacy skills

29. Curriculum framework • Module 4: Using research-based evidence to create and manage change • The influence of organizational cultures and politics on the design and application of research and evidence • Applying the concept of “communities of practice” to assess the dynamics of evidence use in an organizational context • Identifying change management strategies to encourage research implementation

30. Curriculum framework • Module 5: Sustaining change in an organizational context • Exemplary cases of evidence use • Validity of strategies developed in other organizational contexts • Strategies for integrating knowledge management and performance management functions in fellows’ health organizations • Fellows’ organizational strategies for promoting research use

31. Curriculum framework • Module 6: Synthesis • A week dedicated to the presentation of fellows’ intervention projects, attended by academics and practitioners • Strategies for post-program learning and interaction among fellows will also be developed

32. Accreditation • Successful completion will earn fellows a program diploma • Canadian College of Health Service Executives will offer certification • Fellows will be able to accrue continuing education credits

33. Evaluating the EXTRA program • Guaranteed decade-long intake period • Ongoing evaluation to ensure its adaptability to changing needs focusing on: • Formative evaluation of all aspects of EXTRA • Residency sessions • Web-based learning • Nature and extent of related KT and use of evidence in and among the home organizations • Overall evaluation, including broader impact

34. Challenges in implementing EXTRA • Implementing effective decentralized units for various program components • Co-ordinating various program components • Ensuring true commitments from fellow’s organization • Building synergy across program cohorts of participants

35. Challenges in implementing EXTRA • Sustaining enthusiasm and commitment after program closure • Learning from the evaluative study • Setting up appropriate governance structure to respond to these previous challenges • Create a professional network with people across the country • Fostering the use of the EXTRA desktop as a learning resource in the program.

36. For more information • Visit www.chsrf.ca/extra/