Foundations of Evidence-Based Practice, Explained

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Foundations of Evidence-Based Practice

Healthcare Organization and Management · Chapter 18: Evidence-Based Practice in HealthcareSection 18.1 · lesson 102 of 10510 min · free with a free account

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In this lesson

Defining evidence-based practice and asking questions evidence can answer.

  • Define evidence-based practice as the integration of evidence, expertise, and the values of those affected
  • Explain unwarranted variation and the research-to-practice gap
  • Apply the five steps of evidence-based practice and write a PICO question
  • Distinguish empirical questions from value choices in management decisions

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Transcript

Everything said in the video, section by section (1,378 words). Read along, or search it.

Opening Case

Bedside or Station Handover

It's shift change on 4 North. Danny Reyes, a new-graduate nurse, was taught to give report at the bedside, with the patient listening and joining in. Ellen Murphy, the charge nurse, shakes her head. Here, report happens at the nurses' station. It's faster, it's private, and it's how it's always been done. Danny wonders if patients would catch mistakes. Ellen wonders who would cover call lights while everyone stands in rooms. Who's right: the unit's habit, or the new graduate's training? And how would anyone actually know?

The Real Question

A Conference Report Sparks Urgency

Then Priya Nair, the chief nursing officer, comes back from a conference. One hospital presented bedside handover, and reported a third fewer falls afterward. She wants it on every unit by the end of the quarter. The energy is real, and so is the problem: handover on 4 North does miss things. But what would it take to know whether bedside handover is better here? That question is what evidence-based practice exists to answer.

Definition

Evidence, Expertise, and Patient Values

Dr. Hannah Weiss, the chief medical officer, gives the definition. In nineteen ninety-six, David Sackett and colleagues defined evidence-based medicine as the conscientious, explicit and judicious use of current best evidence for individual patients. They paired it with clinical expertise, and insisted it was not cookbook medicine. Later definitions made a third part explicit: the patient's values. So today, evidence-based practice integrates three things. The best available evidence, about what tends to happen. Professional expertise, judging whether it applies here, and carrying it out. And the values and circumstances of the people affected: what they want, and what's possible in their lives. A defensible decision sits where all three meet.

Common Misreading

Not Evidence Alone

The most common misreading is that it means evidence alone. That makes it sound like an order to ignore clinical judgment, and experienced staff push back, reasonably. They know the patient in front of them isn't the average patient in a study. The same misreading lets a guideline be applied mechanically to someone it was never meant for. The full definition is more useful to a manager. It shows where a disagreement really sits. People arguing about a change often agree on the evidence, and disagree about whether it applies here, or what matters.

Unwarranted Variation

Two Units, Two Practices

Farah Siddiqui, the quality director, pulls up something telling. On 4 South, report already happens at the bedside. Same hospital, same kinds of patients, two different practices. Some variation is right: patients differ, and care should too. Unwarranted variation, John Wennberg's term, is variation that need and informed preference don't explain. It comes from where someone happens to be treated, local habit, or how a clinician was trained twenty years ago. It matters for equity: some patients get care that others in the same situation don't. And where two practices differ for no reason, at least one is worse. Nobody knows which.

Research-to-Practice Gap

Adoption Is Slow and Uneven

The research-to-practice gap is the time between a finding and its routine use. You'll often hear seventeen years, an average calculated by Balas and Boren in two thousand. But a twenty eleven review by Morris and colleagues found the estimates vary enormously, so seventeen isn't a constant. The pattern is what's reliable: adoption is slow, and uneven. And stopping an outdated practice is slower still. The old practice has defenders, a routine, and often equipment built around it. The gap isn't caused by uninformed staff. It comes from working conditions: time, access, competing priorities, and systems that make the old way easier than the new one.

Evidence-Based Management

Applying the Discipline to Management

Helen Wu, the chief executive, picks up Priya's conference report. It raises a cousin of this discipline: evidence-based management. It asks whether a management practice produces the effect claimed for it. Management decisions are often made on a presentation, a consultant's assertion, or what a neighboring hospital did. And they affect many people at once. Its evidence base is genuinely weaker. Hospitals can't easily be randomized, results depend on context, outcomes are distant, and published stories describe success without a comparison. So apply the discipline with lower confidence. Prefer local evidence about your own operation, treat outside findings as hypotheses to test, and pilot before committing.

Five Steps

Ask, Acquire, Appraise, Apply, Assess

The practice runs in five steps. Ask: turn a problem into an answerable question. Acquire: search for the best available evidence. Appraise: judge what you found for validity and fit. Apply: combine it with expertise, and with the values of the people affected. And assess: evaluate what happened after the decision. That fifth step is skipped more than any other, so organizations often don't know whether their evidence-based decisions worked.

PICO Questions

Never Leave Out the Comparison

Everything depends on the first step. A vague question can't be searched, and an unfocused search returns nothing, or everything. So Danny rewrites his idea using a structure called PICO, from Richardson and colleagues in nineteen ninety-five. Population: patients on a medical unit at shift change. Intervention: report at the bedside, with the patient. Comparison: report at the nurses' station. Outcome: essential items missed, and how involved patients feel. The comparison is the part most often left out, and adding it improves the question most. Does it work is unanswerable. Does it work better than what we do now is answerable.

Quick Check

A Question Missing Its Outcome

Quick check. 4 South's manager writes a question: do text-message reminders, compared with phone calls, help patients discharged from 4 South? Which part of a well-built question is missing? Pause, and decide. Measured how? The question names the patients, the reminder and the phone-call comparison. But help how? Fewer missed visits, or more satisfied patients? Evidence can only answer a question with a defined outcome. Compared with what might seem missing, but the phone call is the comparison. It's already there.

Evidence or Values

Separating Empirical Questions From Value Choices

Before searching, a manager checks one more thing: can evidence answer this at all? Whether bedside report cuts missed items is an empirical question. Whether 4 North should accept a slower handover for more patient involvement is a value choice. Evidence can show what each option costs and produces. It can't settle the choice. Dressing a value choice up as an evidence question hides the decision inside a technical debate. The reverse error is just as common: treating an empirical question as opinion, and settling it by seniority. A manager's first contribution is often just to separate the two, and say which is which.

Quick Check

Ward Pharmacists or a New Scanner

Quick check. Two questions reach Larkfield's board. Question A: does adding a pharmacist to ward rounds reduce medication errors? Question B: should next year's money go to ward pharmacists, or to a new MRI scanner? Which can evidence settle on its own? Pause, and decide. Only A. Whether pharmacists on rounds reduce errors is empirical, and studies can address it. Question B needs that evidence, and the evidence on the scanner, but choosing between them weighs different goods against each other. That's a value choice the board has to own.

The Manager's Role

Asking the Uncomfortable Question

So what's the manager's job? Usually not appraising research. It's insisting that the question is stated before the answer is chosen, and separating evidence from values. It's asking what a proposal rests on, and accepting an honest answer, even if it's weak evidence. It's protecting the time the work takes. It's making sure decisions and their reasoning are recorded, so they can be reviewed. And it's requiring the fifth step: assess. None of that needs methodological expertise. It needs the willingness to ask an uncomfortable question in a room where enthusiasm has already gathered.

Resolution

From Hospital-Wide Rollout to Measured Pilot

Back to Priya's plan. She doesn't argue against bedside handover, and she has no reason to. Instead she writes down Danny's question, comparison included. Farah measures 4 North's current handover first: how many essential items get missed today. Nobody had ever counted. A librarian searches for comparative studies. That evidence still has to be appraised, and its patients may not resemble Larkfield's. So the rollout to every unit becomes a pilot on 4 North, with the assess step planned from day one. Who was right, Danny or Ellen? Nobody knows yet. But now there's a question evidence can answer.

Key Takeaways

Foundations of Evidence-Based Decisions

To recap. Evidence-based practice integrates evidence, expertise, and the values of the people affected. Unwarranted variation means at least one practice is worse, and nobody knows which. The research-to-practice gap is slow and uneven, and stopping old practices is slower. Ask with PICO, and never leave out the comparison. Separate evidence questions from value choices, and require the assess step.

About Healthcare Organization and Management at UPI Study

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Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

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FAQ

Questions students ask us

About Foundations of Evidence-Based Practice

What is the definition of evidence-based practice?
Evidence-based practice integrates three components: the best available research evidence, professional expertise, and the values and circumstances of the people affected. It builds on David Sackett and colleagues' 1996 definition of evidence-based medicine as the conscientious, explicit, and judicious use of current best evidence in the care of individual patients. A common misreading treats it as evidence alone, but it was never meant as cookbook medicine.
What does PICO stand for in evidence-based practice?
PICO stands for population, intervention, comparison, and outcome, a structure for turning a problem into an answerable question, described by Richardson and colleagues in 1995. For example: for medical unit patients at shift change, does bedside report, compared with report at the nurses' station, reduce missed essential items? The comparison is the element most often left out, and adding it improves the question most.
What are the five steps of evidence-based practice?
The five steps are ask, acquire, appraise, apply, and assess. Ask turns a problem into an answerable question, acquire searches for the best available evidence, appraise judges it for validity and fit, apply combines it with expertise and the values of those affected, and assess evaluates what happened. Assess is the step most often skipped, leaving organizations unsure whether their decisions worked.
What is the research-to-practice gap?
The research-to-practice gap is the time between a research finding and its routine use in care. An often-quoted average is 17 years, from Balas and Boren in 2000, but a 2011 review by Morris and colleagues found that estimates vary widely. The reliable pattern is that adoption is slow and uneven, stopping outdated practices is slower, and the gap stems mainly from working conditions rather than uninformed staff.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
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