Is evidence the ‘silver bullet’ for healthcare improvement leading to real-world health outcomes?

How to do we make sure that knowledge and evidence is used correctly to produce tangible outcomes for people in our community?

The World Health Organisation (WHO) thinks that policy-makers, hospitals and other evidence-based organisations “require valid evidence to support time-sensitive decisions regarding the coverage, quality, efficiency, and equity of health systems.” [1]

This means that the scope of evidence use within a health system like a hospital or within government/policy decision-making is quite significant.  It also means that the timely delivery of “evidence products” is essential. 

Tricco et al. (2017) emphasises that “systematic reviews and other types of evidence syntheses are increasingly employed to inform policy-making and produce guidance for health systems. However, the time and cost to produce a systematic review is often a barrier to its use in decision-making. Rapid reviews are a timely and affordable approach that can provide actionable and relevant evidence to strengthen health policy and systems.” [1] [2]

Systematic and rapid reviews are examples of evidence products that have the capacity to influence decision-making.  While barriers have been identified to commissioning evidence products (e.g. time and money), the best health system is one where research is “carried out as an integrated and systematic part of decision-making and implementation process” [3]. 

Monash Health, Victoria's largest public hospital and health service, is an example of an organisation that is committed to systems-level change through knowledge translation, innovation and evidence use. 

What is a learning healthcare system and why is Monash Health an example of one?

The Institute of Medicine (2007) has defined a learning healthcare system as one “designed to generate and apply the best available evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care” [4].  Monash Health is an example of a learning healthcare system because they actively seek to apply the best available evidence.  An enabler of this practice is the Monash Health Centre for Clinical Effectiveness, a service with a 20-year history of providing evidence products and services within Monash Health.  Some of these include:

  • Establishing clinical and organisational best practice

  • Production of evidence products: (e.g. systematic reviews)

  • Active in working group and steering committee participants through presentation of the evidence which includes discussion

  • Project work and guideline support and development

  • Supporting policy and process development or modifications.

In the last 5 years, Monash Health Centre for Clinical Effectiveness has developed over 120 evidence-based products, and attended a similar number of committee meetings and evidence presentations.  Monash Health actively engages in being a healthcare system that uses timely and accurate evidence, and the Monash Health Centre for Clinical Effectiveness serves as a central component to evidence provision to enable it to remain clinical leaders in the field.

More information about the Monash Health Centre for Clinical Effectiveness is available at http://monashhealth.org/health-professionals/cce/ and team details are here.

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About the author:

Dr Heather Morris was awarded her doctorate in 2018 and has recently moved to the Monash Centre for Health Research and Implementation from Deakin University.  She is currently working on secondment to the Centre for Clinical Effectiveness (CCE) as an evidence analyst, specifically participating in the production of evidence products and centre evaluation.  Her academic experience is significant including work on a randomised trial, multi-disciplinary engagement across universities, international collaborations and the production of academic papers.  As an academic, her research interests include community engagement, specifically with parents, early childhood social and emotional development, obesity prevention and supporting maternal outcomes.  These interests have largely been developed following the birth of her two children when post-graduate study began.  Her work with (CCE) has demonstrated how effective the use of quality evidence is in changing the lives of people in our community.

Email: heather.morris@monash.edu    

Phone: 03 8572 2375

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References

1.     Andrea C. Tricco, Etienne V. Langlois and Sharon E. Straus (2017) World Health Organization, Alliance for Health Policy and Systems Research. Rapid reviews to strengthen health policy and systems: a practical guide

2.     Moore, G., Redman, S., Rudge, S., & Haynes, A. (2018). Do policy-makers find commissioned rapid reviews useful? Health research policy and systems, 16(1), 17.

3.     Abdul Ghaffar, Etienne V Langlois, Kumanan Rasanathan, Stefan Peterson, Lola Adedokun & Nhan T Tran. Bulletin of the World Health Organization 2017; 95:8 http://www.who.int/bulletin/volumes/95/2/16-189126/en/

4.     The Learning Healthcare System: Workshop Summary. Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Olsen LA, Aisner D, McGinnis JM, editors. Source Washington (DC): National Academies Press (US); 2007.

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