Article type
Year
Abstract
Introduction/Objective: Since 1994, the Department of Health in England has made improving the clinical effectiveness of health services one of its central policy priorities. Health authorities (purchasers of healthcare) and NHS trusts (healthcare providers) have been exhorted to "secure a knowledge-based health service in which clinical, managerial and policy decisions are based on ... research findings"1. This study set out to establish what progress health authorities and NHS trusts had made in improving clinical effectiveness and fostering evidence-based healthcare, and to identify innovative approaches and techniques from which others might learn and which might represent models of good practice.
Methods: A postal questionnaire survey was undertaken of all health authorities and NHS trusts in England and Wales. Responses were received from 71 (68%) of 105 health authorities and 192 (42%) of 460 NHS trusts surveyed. Site visits were then undertaken to a small sample of health authorities and trusts.
Results: Clinical effectiveness was not high on corporate agendas, with many health authorities and trusts showing limited evidence of senior managerial involvement or support and no formal strategic direction or intent. Most NHS organisations had however taken some actions, such as setting up demonstration projects on specific clinical topics, organising training in accessing and using evidence for clinicians, improving information resources, and revising arrangements for clinical audit. Some existing, widely available sources of information on effectiveness were not being systematically applied and had made a limited impact on actual clinical practice. A number of innovations were identified that other organisations could learn from, though it was too early to recommend them as models of good practice.
Discussion: Developing evidence-based healthcare requires commitment, not just from individual clinicians but also from healthcare organisations and those who lead them. A more substantial corporate response is needed, in which the evidence base for decision making at every level is more rigorously reviewed and applied.
1. NHS Executive. Research and development in the new NHS: functions and responsibilities. Leeds: NHS Executive, 1995.
Methods: A postal questionnaire survey was undertaken of all health authorities and NHS trusts in England and Wales. Responses were received from 71 (68%) of 105 health authorities and 192 (42%) of 460 NHS trusts surveyed. Site visits were then undertaken to a small sample of health authorities and trusts.
Results: Clinical effectiveness was not high on corporate agendas, with many health authorities and trusts showing limited evidence of senior managerial involvement or support and no formal strategic direction or intent. Most NHS organisations had however taken some actions, such as setting up demonstration projects on specific clinical topics, organising training in accessing and using evidence for clinicians, improving information resources, and revising arrangements for clinical audit. Some existing, widely available sources of information on effectiveness were not being systematically applied and had made a limited impact on actual clinical practice. A number of innovations were identified that other organisations could learn from, though it was too early to recommend them as models of good practice.
Discussion: Developing evidence-based healthcare requires commitment, not just from individual clinicians but also from healthcare organisations and those who lead them. A more substantial corporate response is needed, in which the evidence base for decision making at every level is more rigorously reviewed and applied.
1. NHS Executive. Research and development in the new NHS: functions and responsibilities. Leeds: NHS Executive, 1995.