Making the Case for Evidence-Based Practice

Evidence-based practice is a phrase everyone in healthcare has heard and very few can define without shrinking it. It gets shrunk to doing what the research says, and that is not what it means. Over the next half hour you will get the definition, and it has three parts. Here is the problem the field exists to solve. Somewhere in the last twenty years someone published a finding that a thing done on your unit every shift does not work. It is sitting in a database you already have access to. The distance between that publication and the bedside is measured in years, and the number the literature keeps reaching is around fifteen. This is the first half of unit one. By the end you can state what evidence-based practice is and name its three components; tell external from internal evidence; name the seven steps and say why they start at zero; describe the gap and the two directions it runs in; and say why strength is level and quality together.

Three videos. The definition, the one word inside it that changes the shape of the whole thing, and what all of it is finally in service of.

The definition.

EBP 0001 What Evidence-Based Practice Is

Best evidence from a body of research, the clinician expertise brought to it, and the patient preferences and values. Three inputs. And a body of research, never a single study.

Why the word lifelong.

EBP 0002 A Lifelong Approach

A problem-solving approach taken up for a career. There is no point at which a clinician has finished being evidence-based.

What it all serves.

EBP 0003 The Quadruple Aim

Better outcomes, better patient experience, lower cost, and better clinician wellbeing. The fourth is the newest and the one most often dropped.

The word evidence splits in two. One kind is made elsewhere by people whose job is making it. The other you are generating on your unit right now, read or not.

The umbrella term.

EBP 0004 What Evidence Is

Information that supports or contradicts a position. Neutral by definition, which means it can go against what you hoped.

Evidence made to travel.

EBP 0005 External Evidence

External evidence is produced by research with generalisation as the goal. It is built to apply beyond where it was made.

Whether it reaches you.

EBP 0006 Transferability

Transferability is asked by the reader, not answered by the researcher. A study from an unlike setting may still hold, but you have to ask.

The trap for people who skip that.

EBP 0007 Measure the Way They Measured

To get the result they got, measure the way they measured. Change the instrument or the timing and it is no longer their intervention.

The evidence already on your unit.

EBP 0008 Internal Evidence

Internal evidence comes from your own setting: outcome data, quality data, patient experience. It is what tells you whether anything changed.

Who does which job.

EBP 0009 Researchers Generate, Clinicians Translate

Researchers generate external evidence. Clinicians translate it and generate internal evidence. Both are evidence work.

The process, in order. The rest of the course is organised around it. Watch for step zero, which is the one people skip and the one the others depend on.

The step before the process starts.

EBP 0010 Step Zero — A Spirit of Inquiry

A spirit of inquiry is the habit of asking why we do it this way. Without it no question is asked and the other six steps never run.

Turning curiosity into a search.

EBP 0011 Step One — Ask in PICOT Format

PICOT is a format for building a question a database can answer. Unit 2 is entirely about this step.

Finding what exists.

EBP 0012 Step Two — Search Systematically

Systematically means by a method you could write down and someone else could repeat.

Deciding whether to believe it.

EBP 0013 Step Three — Critically Appraise

Critical appraisal asks three things: validity, reliability, and applicability.

Where the three components meet.

EBP 0014 Step Four — Integrate

Integration is the step where evidence, expertise and patient preference become one decision.

Whether it worked here.

EBP 0015 Step Five — Evaluate the Outcome

Evaluating the outcome is what turns a change into internal evidence, and it is the step most often dropped.

Telling other people.

EBP 0016 Step Six — Disseminate

Dissemination is part of the process, not an extra for people who enjoy conferences.

Why the count starts at zero.

EBP 0017 Seven Steps, Numbered From Zero

Step zero is a disposition rather than a task. Numbering it zero keeps it inside the process without pretending it can be ticked off.

Why any of this is necessary. How large the distance is, how long it has been that size, and the two opposite directions it runs in.

The problem, named.

EBP 0018 The Research–Practice Gap

The distance between what research has established and what happens in practice.

How wide the gap is.

EBP 0019 Fifteen Years, and Closing Slowly

Around fifteen years, and closing slowly. The entry dates its own figure, which is why a different number from a different report does not contradict it.

A target set and missed.

EBP 0020 The 2020 Goal That Was Missed

The aim was that ninety percent of clinical decisions would be evidence-based by 2020. It was not met.

What was being aimed at.

EBP 0021 A Learning Healthcare System

A system in which practice generates evidence and evidence changes practice, continuously.

The gap running one way.

EBP 0022 Practices Without Evidence Persist

Practices with nothing behind them continue because they are established.

And the other way.

EBP 0023 Supported Practices Go Unused

Practices with good evidence behind them go unused because they are new. Same failure, opposite direction.

The word for stopping something.

EBP 0024 Deimplementation

Harder than adoption, because it tells colleagues that work they have been doing was unnecessary.

Moving findings toward practice.

EBP 0025 Translational Research

Translational research studies the movement of findings from bench toward bedside.

Studying the movement itself.

EBP 0026 Implementation Science

Implementation science studies what makes evidence get adopted.

The definition taken apart. This is what stops evidence-based from collapsing into the phrase the research says so.

The first component.

EBP 0027 Component One — External Evidence

The best available from a body of research, appraised rather than assumed.

The second.

EBP 0028 Component Two — Clinical Expertise

What you know about this patient, and what your setting can actually deliver.

The third, and the one treated as a formality.

EBP 0029 Component Three — Patient Preferences and Values

Patient preferences and values, present while the options are still open rather than consulted at the end for agreement.

Three videos on strength. The middle one carries more weight than any other entry in this unit.

When you have enough to act.

EBP 0030 How Much Evidence Is Enough?

There is no fixed number of studies. The judgement is about the body, not the count.

The entry to remember from this topic.

EBP 0031 Level Plus Quality Equals Strength

Strength is level and quality together. A level-one study executed badly is not strong evidence.

Why there is no single ranking.

EBP 0032 Levels Are Question-Specific

Levels are specific to the question being asked. The hierarchy for an intervention question does not rank the evidence for a meaning question.

The history explains why the infrastructure looks as it does. One physician, one case, and the institutions that followed.

The person the database is named for.

EBP 0033 Archie Cochrane

He argued that healthcare should be organised around what has actually been shown to work.

The scale of what he proposed.

EBP 0034 Reviews Across Every Specialty

Systematic reviews across every specialty. An infrastructure, not a study.

The case that made the argument stick.

EBP 0035 The Case That Made the Argument

Antenatal corticosteroids for preterm labour: the evidence existed for years while the synthesis went undone.

What was built in response.

EBP 0036 The Cochrane Collaboration

The Cochrane Collaboration, and the database of systematic reviews it produces.

Who else took it up.

EBP 0037 Task Forces and Guideline Bodies

Task forces and guideline bodies, which turn syntheses into recommendations.

How institutions came to be judged on it.

EBP 0038 Recognition Programmes

Recognition programmes made evidence-based practice something an organisation is assessed on rather than something individuals do quietly.

That is the first half of unit one, against the outcomes you were given at the start. Evidence-based practice is a lifelong problem-solving approach integrating best evidence from a body of research, clinician expertise, and patient preferences and values. Three components, and the third is not a courtesy. External evidence is generated elsewhere to generalise, so you ask whether it transfers. Internal evidence is generated here, and it is what tells you whether what you changed actually changed. Seven steps, numbered from zero, because step zero is a disposition rather than a task, and when it is missing no question is ever asked. The gap runs around fifteen years and in two directions: unsupported practices that persist, and supported practices that go unused. And strength is level and quality together. The level tells you what question the design can answer; the quality tells you whether to believe this one. Part B takes up what stops this happening on a real unit, what makes it happen anyway, and the three things most commonly believed about evidence-based practice that are not true.