Dear Colleagues,
We are just about to run our first workshop on Managing Change iN
Evidence Based Practice. We are planning on starting the day with the
following scenario as a stimulus for discussion. In the spirit of
this discussion list I thought I'd pass it by you for any comments or
observations first.
We would be grateful to hear suggestions from you if there are any points
about getting evidence into practice that we could bring out in relation to
specific parts of this scenario. How do you teach this?
I should emphasise that this scenario is hypothetical - but then I
would say that wouldn't I!
Andrew
Exercise 1. Scenario - A Stroke of Luck?
The Chief Executive of your Trust comes back from a management
conference filled with enthusiasm for a new approach to stroke
rehabilitation (Managing Effective Stroke Services) currently being
piloted in a neighbouring hospital. Catching the Head of Therapy
Services in a corridor he says "We need to get our act together, and
quickly - otherwise we'll be the laughing stock of the Region. I want
you to get this approach up and running within the next month and I
want to see measurable improvements when we meet for your appraisal in
six months' time".
The Head of Therapy Services, although more than a little perturbed by
the threat to her performance related pay, is fairly new to her post
and therefore very keen to impress. At a meeting of the Senior OTs and
Physios that same week she tables an item for discussion under Any
Other Business. All of the senior staff are able to recount specific
instances where the existing Stroke Rehabilitation process has broken
down - quite clearly it "needs fixing". One of the Senior Physios has
in her briefcase a copy of a recent 50 page document she has
downloaded off the Internet from the South Wellington Evidence
Enhanced Therapies Federal Association, a New Zealand confederation of
Private Nursing Home Care Providers. Apparently they have been using
the M.E.S.S. approach to stroke rehabilitation for at least 9 months
and have produced some draft guidelines on how it should work. As the
guidelines seem to be evidence-based the Senior Physio agrees to get
them photocopied and distributed to all whom were present at the
meeting.
The Head of Therapy Services spends a frantic but productive weekend
reading through the guidelines and drafting a covering statement for
all the staff. Her intention is to get copies of the documents into
every office and ward covered by her department by early Monday
morning. Sure enough by ten a.m. that same morning, thanks to a
super-efficient secretary and high-tech photocopier, every member of
staff has a copy within thirty feet of where they are working.
Buoyed by her success, and mindful of her responsibility to let other
professions know of the changes to working practice, the Head of
Therapy Services drafts a short letter for hospital medical staff and
for local GPs. Having read that GPs receive up to 30 kg of guidelines
through the post each year she decides not to bother them with the
full guideline so instead she includes the World Wide Web address in
the letter and makes sure that a copy is deposited in each local
medical library. A chance meeting with the Trust's newly recruited Web
site developer who is looking for "stuff to put on the hospital
intranet" leads to the covering statement being converted into
Hypertext Mark Up Language (HTML) complete with a link to the New
Zealand Web site.
Over the next six months the Head of Therapy Services receives monthly
reports on the average time to discharge of the new stroke
rehabilitation system. Sure enough, by the time that her appraisal
comes around the average time to discharge has been reduced by 40%
compared with the last month prior to the new system. The Chief
Executive is delighted, the Head of Therapy Services gets her
performance related pay and returns to her office to tackle some of
the other issues that occupy her busy working week:
To Do
1. Meet with Personnel Manager re: three senior vacancies
2. Attend Therapy Assistants meeting to address unspecified
grievances. 3. Reply to request from Chairman of local Stroke
Association for urgent meeting 4. Write strong letter to medical
consultants complaining that junior medical staff are ignoring
M.E.S.S. 5. Send out reminder letter to GPs concerning World Wide Web
address for M.E.S.S. guidelines. 6. Plan audit to look at unexpected
increase in stroke readmissions 7. Write up M.E.S.S. stroke project
for Trust newsletter and, possibly, "Therapy Weakly" 8. Meet with
Public Relations Officer to decide how to handle the "Dishonorable
Discharge" scare story 9. Do literature search on M.E.S.S. approach
for article, particularly to find recent reference to first M.E.S.S.
trial.
1. Looking in detail at the above scenario attempt to identify which
elements of the implementation of change made it the success that it
proved to be.
2. Given that the project seems to have achieved what both the Chief
Executive and the Head of Therapy Services intended, are there any
improvements that you would suggest to "fine tune" implementation.
Andrew Booth BA MSc Dip Lib ALA
Director of Information Resources
School of Health & Related Research (ScHARR)
Regent Court
30 Regent Street
SHEFFIELD
S1 4DA
Tel: 0114 222 5420 or 5214 Fax: 0114 272 4095
The author of Netting the Evidence:
http://www.shef.ac.uk/~scharr/ir/netting.html
and Trawling the Net:
http://www.shef.ac.uk/~scharr/ir/trawling.html
E-mail: [log in to unmask]
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