I was asked recently whether a clinician would change their behaviour if they read about the latest research in a leading healthcare journal. Sadly, I can not believe this for 2 major reasons. First of all, new research is rarely written in a way that you know exactly what you should do to change your practice in the same article. Research articles focus on telling us what works and by how much – for example, how big is this effect or for how many patients do you need to treat to achieve the desired improvement. While research articles may offer recommendations for change, these will usually require discussion, debate and replication in other studies before the research results are incorporated into clinical guidelines and later into clinical practice.
The second reason is the focus of this post; the process of changing behaviour to improve practice is not a simple linear set of steps that everyone can follow. Many of us have experienced beneficial and not so useful strategies to implement change. Some strategies may seem like common sense. Management consultants and theorists have simplified the complexity of planning and managing change so that people can achieve small gains along the way. However sustained improvement requires more detailed consideration. Managing change for implementation, and later sustainability requires an understanding of how individuals and groups change.
So the challenge for those of us who want to use the evidence to inform our practice is where to start, and with what evidence? Research findings, personal experience and the local context are all important contributors. Because of the huge variability in personal experience and local contexts, we will never be able to generate research to cover all combinations. Therefore, we need to look for research that is transparent about its methodology and participants, so we can understand how, where and when we might be able to apply the results. Further, we need to look for research that incorporates theoretical models to help explain aspects of individual behaviour change and identifies the core components of local barriers and facilitators that impact on future implementation. Sometimes research projects identify and test a model that may be applicable in other situations.
A group of Canadians recently used a systematic review and an expert consensus process to develop a model of key organisational and contextual factors that influenced the success or failure of wait time management strategies. They were able to systematically collect barriers and facilitators, using a theoretical model that identified 4 key factors; governance and leadership, culture, resources and tools. Interestingly, there was consensus between the literature and the expert opinions; however the experts were more aware of the barriers, while the literature was more positively written. This may be a useful methodology to compare expert opinion with the literature in a specific area. Further, the organising theoretical model that was used in this study may be able to be used in other settings, when comparing literature and expert opinion.
Most importantly, we all need to contribute to the growing evidence base in this area.