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在组织层面实施循证决策的策略:快速系统评价。

Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review.

机构信息

National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada.

School of Nursing, McMaster University, Health Sciences Centre, 2J20, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.

出版信息

BMC Health Serv Res. 2024 Apr 1;24(1):405. doi: 10.1186/s12913-024-10841-3.

Abstract

BACKGROUND

Achievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health.

METHODS

A systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings.

RESULTS

Thirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management.

CONCLUSION

This review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success.

REVIEW REGISTRATION

PROSPERO CRD42022318994.

摘要

背景

实现循证决策(EIDM)需要通过识别和综合证据,将证据纳入所有实践决策中,然后制定和执行实施和评估实践变更的计划。本快速系统评价综合了组织内实施 EIDM 的策略的证据,该策略是基于行为变化的 COM-B(能力、机会、动机、行为)模型来确定促进因素和障碍。该评价旨在为提供公共卫生服务(健康促进、传染病预防)的组织的领导层提供支持,推动朝着循证公共卫生的方向进行变革。

方法

在多个数据库中进行了系统检索,并通过审查主要作者的出版物进行检索。有资格纳入的文章描述了在团队、部门或组织内推动 EIDM 的干预措施。对每个纳入的文章进行了质量评估,并提取了干预措施、设置、结果、促进因素和障碍的详细信息。采用收敛综合方法分析定量和定性结果。

结果

共纳入 37 篇文章。研究在初级保健、公共卫生、社会服务和职业健康环境中进行。实施 EIDM 的策略包括建立知识经纪人型角色、提高员工的 EIDM 能力,以及建立研究或学术合作伙伴关系。促进因素和障碍与行为变化的 COM-B 模型一致。能力方面的促进因素包括员工知识和技能的发展、建立专门角色以及在整个组织内进行知识共享,但员工流失和随后的知识流失是能力方面的障碍。在机会方面,促进因素包括开发支持新实践的流程或机制、学习和技能发展的论坛,以及有时间保障,障碍包括优先事项竞争。确定的动机促进因素包括支持性组织文化、对新实践的期望、认可和积极强化,以及强有力的领导支持。障碍包括对新实践的负面态度,以及缺乏管理理解和支持。

结论

本评价提供了对公共卫生组织中 EIDM 实施的促进因素和障碍的全面分析,该分析是基于行为变化的 COM-B 模型进行的。现有的支持公共卫生中 EIDM 的策略文献说明了与实现 EIDM 相关的几个促进因素和障碍。了解这些因素将帮助高级领导层制定和实施适合其组织的 EIDM 策略,从而增加实施成功的可能性。

评价注册

PROSPERO CRD42022318994。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0abe/10983660/6685d3fa6c2a/12913_2024_10841_Fig1_HTML.jpg

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