As THIS Institute works to build an evidence base to support healthcare improvement, they sat down for a Q&A with one of the world leaders in improvement research: Dr Sanjay Saint, George Dock Professor of Medicine at the University of Michigan, Chief of Medicine at VA Ann Arbor Healthcare System and chair of the Scientific Advisory Board.
Q. As improvement researchers, we all want our work to translate into practice change. How can we approach improvement studies to help achieve that goal?
I think fundamentally it comes down to the following things. The first is trying to identify what are the best practices that seem to work, that improve patient outcomes, and that improve their satisfaction. Are those studies based on rigorous designs? Second, once we figure out what works, we look to see: are we doing those things, and are we doing them across the health system? Or are there some gaps? The third step is identifying where those gaps are and trying to understand: why aren’t we actually doing what we should be doing? And then finally, we try to overcome some of those obstacles.
Q. In your experience, why does some evidence not find its way through to practice?
There are a number of obstacles, including challenges with staff engagement, insufficient resources and lack of leadership. Improvement initiatives can go wrong if data isn’t collected effectively, if the reporting infrastructure isn’t appropriate or if there’s confusion about what the data suggest. There is also a hefty amount of tribalism in healthcare which can lead to a silo-based mindset. For example, in far too many hospitals, surgeons only listen to surgeons, nurses only listen to nurses, and so on. As researchers, we must come up with approaches to overcome some of these obstacles.
Q. So it isn’t enough just to generate evidence about best practices?
The evidence alone is insufficient – it’s not self-implementing. We also have to address socio-adaptive aspects like the culture of the health system, or the microculture of a hospital or even an individual unit. Does this best practice fit in to that culture? Then, there is the issue of prioritisation. We ask healthcare professionals to do so many different things. How can they prioritise the practice your research suggests ahead of the dozens of other practices they’ve been told to prioritise? It ultimately comes down to the people involved. Are they committed to the new evidence-based approach, or are they too overworked and overstressed to do the right thing each time? These problems are pervasive, so the solution must be holistic.
Q. Many healthcare professionals say they’ve heard all this talk about research before. How do you overcome this scepticism?
Unfortunately, those of us in healthcare sometimes get jaded. We’re told over and over that this initiative is going to be different. This time it’s going to make a sustained improvement. Getting past this scepticism requires participation from people who are making these decisions – doctors, nurses, pharmacists, and others – and who are involved with clinical care. They give the research credibility with the frontline staff and – perhaps even more importantly – they will understand what the real issues are. Follow the link below to read the transcript from the entire session.