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Evidence culture

Evidence informed commissioning should fit within an organisation’s wider cultural landscape, to become ‘the way things are done’. The organisation’s ‘culture’ represents beliefs, values, practices and behaviour. It is complex and can influence whether an evidence informed approach to commissioning is adopted; it also shapes the form it takes.

Influencing the culture

A key enabler in the strengthening of an evidence and evaluation culture is good access to relevant evidence; this toolkit can help guide commissioners towards this. Public Health departments within the Local Authority provide expert support in accessing and using evidence and contribute to a growing evidence culture. The Joint Strategic Needs Assessment (JSNA) is a key resource that provides an evidence based overview of the changing health and wellbeing needs in your locality. This can be accessed via your Public Health team – see Contact.

This short video highlights the impact of finding and using evidence, where to look to find it and real world top tips, from commissioners and GP Clinical Evidence Fellows working across the West of England.

Additionally, there are a number of key initiatives in place in the West of England that contribute to getting evidence or knowledge from its source and into practice, known as knowledge mobilisation.

Knowledge mobilisation is defined as ‘making knowledge readily accessible and useful to individuals and groups by developing ways to work collaboratively’ (Health Information Research Unit). Simply, knowledge mobilisation is about sharing knowledge, often between disparate groups. A knowledge mobilisation initiative has been trialling in Bristol for three years, developed jointly between Avon Primary Care Research Collaborative (APCRC), the University of Bristol and the University of the West of England (UWE) – this has taken the form of a Knowledge Mobilisation Team but other roles that also contribute to promoting knowledge mobilisation are now being established:

Knowledge Mobilisation Team

This team foster collaborations between commissioners and researchers to encourage commissioning-informed research and research-informed commissioning. This initiative is led by Professor Nicki Walsh, Professor of Knowledge Mobilisation and Musculoskeletal Health at UWE. Nicki was appointed in July 2016. Her role is to bring together academic, clinical and commissioning colleagues to develop and promote knowledge mobilisation culture across the region.

Researchers in Residence – two researchers from the Centre for Health and Clinical Research (CHCR) at the University of the West of England are attached to the Clinical Commissioning Groups (CCGs), specifically supporting work in the musculoskeletal area.
NHS Management Fellows – APCRC will soon be appointing a commissioning manager attached to the University of the West of England research teams on a part-time basis, to bridge the gap between commissioning and academia.

GP Clinical Evidence Fellows (West of England Academic Health Science Network)

Trained to access and use evidence, these GPs provide two sessions per week per CCG, working to promote an evidence culture, signposting to additional tools and resources. Click here to find out more.

Evidence and Evaluation Assistants (APCRC/local Public Health)

These developmental posts work across CCG and Public Health teams, to provide evidence reviews and advice and guidance on service evaluations to support key commissioning priorities. Part of the role is to increase capacity through training of others. They also undertake small scale evaluations. APCRC support four assistant posts – two are currently filled and the recruitment process for the remaining two is under way.

Graduate Health Economics Assistant (APCRC/local Public Health)

Working on discrete projects, this developmental role supports the CCG and Public Health teams with economic support.

For further information on any of these initiatives, please contact info@nhsevidencetoolkit.net

Embedding evidence culture throughout the commissioning cycle

Use our EvidenceWorks toolkit and this EvaluationWorks toolkit in your:

1 Strategic planning

Service Evaluation

How to apply in practice:

  • For reviewing service provision against commissioning objectives and success criteria for a specific service.
  • Assessing service outcomes to understand patient and system benefits in line with the service specification.
  • Deciding priorities for improvement.

Commissioning Intelligence Model – See: Commissioning Intelligence Model

How to apply in practice:

  • For securing cross section of data types and sources to inform priority setting.
  • Part of any needs assessment to determine health needs of the local population.
  • Identifying gaps or deficits in quality, performance, value or outcomes.
  • Confirming where quality, performance and outcomes are strong.

Review of Evidence: Application

  • Horizon scanning health service research that may influence both national policy and local strategy.
  • Reviewing best practice evidence against commissioned models of care.

2 Procuring services

Evidence appraisal (using PICO to focus your questions for evidence searches)

How to apply in practice:

  • To inform the design/re-design of services including service models and patient pathways.
  • In the consideration of options for change and available evidence to support preferred option.
  • Informs decisions on what to commission at macro, meso and micro levels.

Service Specifications and Contract Formats

How to apply in practice:

  • Place explicit requirements on providers to promote patient participation in research studies, deliver evidence-based clinical care and evaluate their service delivery. See guide.
  • Ensuring that contracts are in place to hold providers to account.

3 Monitoring and evaluation

Service Evaluation- using this Evaluation Toolkit –  Application

  • Evaluating whether changes to the way in which services are commissioned have delivered the expected benefits.

Commissioning Intelligence Model: Application

  • Consideration of a broad range of data types to monitor delivery of commissioning plans.

Evidence is the available body of facts or information indicating whether a belief or proposition is true or valid.

Oxford Dictionaries

Case Study: GP Alcohol Liaison Nurse Pilot Case Study: GP Alcohol Liaison Nurse Pilot This case study is the evaluation of a pilot service for a GP Alcohol Liaison Nurse. The service was evaluated through its second year, and the evaluation findings were used to inform whether the service was to be fully commissioned following completion of the pilot phase.

Evidence based medicine is the integration of best research evidence with clinical expertise and patient values

Sackett D et al
Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1

Research can do more than contribute to better decisions – it can change the way we think about issues or problems and stimulate new and different ideas about services. In short, it’s vital to our capacity for innovation.”

Professor K Walshe
Associate Director of the National Institute of Health Research

Knowledge Mobilisation Knowledge Mobilisation Knowledge Mobilisation - the University of Bristol and APCRC