The Effectiveness of Different Mechanisms for Spreading Best Practice

A research project report by the Office for Public Management.

Contents

1. Introduction + Methodology

In this section we have identified:

a) reports of initiatives which seek to develop an overarching strategy for the dissemination of best practice, and

b) dissemination and knowledge transfer models based on the authors’ experience of a wide range of dissemination and knowledge transfer practices.

In each case, the authors or practitioners have drawn lessons from the experiences outlined, and made recommendations for further improvements to dissemination strategies.

In general, these ‘holistic’ approaches incorporate a variety of dissemination methods which are used in combinations appropriate to the organisation’s dissemination objectives and the needs of users. Several of the reports contain models and checklists of basic principles to be followed in identifying effective dissemination strategies. Although the literature sources vary widely, consistent themes emerge throughout.

Overall, the reports and models demonstrate the points that have been identified in earlier summaries and conclusions. In order to be effective, dissemination strategies need to match the needs and circumstances of those involved and, wherever possible, to be based on personal interaction and continuing development. The more complex the best practice to be developed and disseminated, the more people-centred and experiential the process should be. People need to be involved in developing, identifying and sharing good practice and/or to trust and value its source. In many cases, good practice guidance materials and databases have their place as part of a wider strategy based on an assessment of what will work best in each particular situation.

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4.1 Overarching Strategies

PACE project, the King’s Fund

The PACE project – Promoting Action on Clinical Effectiveness – was a three-year programme involving 16 projects across England focusing on understanding how to implement change in clinical practice. As part of the findings of this project, the King’s Fund team of researchers, produced Experience, Evidence and Everyday Practice to draw together the main issues which arose during the study (Dunning, Abi-Aad, Gilbert, 1999). The main findings of this report were that implementation:

They also identified 10 tasks which, when used together as components of an overall implementation programme, can lead to success:

Successful implementation requires a sound project management approach. It needs to be clear who will lead the work – preferably a locally respected and knowledgeable senior clinician – and who will undertake day-to-day co-ordination. Effective teamwork is also important, calling for a wide range of skills and contributions.

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The GRiPP (Getting Research into Practice and Purchasing) project

The GRiPP (Getting Research into Practice and Purchasing) project was started in 1993 as a result of a collaboration between Anglia and Oxford Region, Templeton College Oxford and the NHS Executive, to look at the complexity of translating research evidence into practice and purchasing (Dopson and Gabbay, 1995). Drawing on the findings of projects based in four counties, the GRiPP researchers devised a process framework which is intended to help promote ‘an increase in the uptake of evidence-based practice’. There are eight key steps:

The study, which ran between September 1994 and March 1995, identified a number of key recommendations including:

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National League of Cities: US local government and the spreading of best practice

The National League of Cities is the US similar to the Local Government Association and seeks to represent and promote the work of municipal and local government (National League of Cities, 2000). One of its core duties is to ‘build its capacity for sharing best practice information.’ between local government organisations. This has led it to establish one of the most far-reaching systems for gathering, disseminating and sharing best practice. It also seeks to evaluate whether lessons have been learned after the sharing has been completed. The core elements of its strategy are:

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DfEE strategy: Disseminating and sharing good practice in education

In 1997 the DfEE conducted a study into the dissemination of good practice undertaken by the Strategy Development Team working in collaboration with a number of divisions across the DfEE. The study looked at dissemination projects across a range of the department’s work. It drew on the views of DfEE staff, external partners, private sector organisations and a number of people including teachers, college lecturers, librarians, and work place trainers, who are the end users of the good practice the DfEE aims to promote.

When looking at the strengths and weaknesses of current and past mechanisms, the review identified two priorities:

In view of these broad goals, the department decided to focus on the following initiatives:

The department then looked at how good practice could be captured and spread. This focuses on five areas of improvement:

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The Audit Commission

The Audit Commission is planning an evaluation of the impact of Best Value on changing and influencing practice, and the contribution which the Commission’s work has made to this process. The evaluation will address such issues as how people learn and what has helped them to make progress. Overall, their view is that it is important to engage individuals in agreeing what constitutes best practice as part of the learning and dissemination process. In developing effective dissemination strategies, a lot depends on how best practice information is defined and gathered in the first place. The aim should be to achieve a shared sense of ‘ownership’ and agreement as to what constitutes good practice among those working in the field.

Appropriate mechanisms for spreading and promoting best practice will vary according to the commitment of the recipient. Authorities which are already thinking about their performance and how it can be improved will seek out best practice and will therefore be most receptive to ‘passive’ information based dissemination methods. Similarly, the sanctions contained in the inspection process can produce results. The process of reviewing performance and identifying inadequacies can bring change. The aim must be for such change to be long lasting, and for this to happen the means used for spreading best practice needs to be more interactive, with peer group credibility within the process.

There is an increasing readiness among local authority members, for example, to take hard messages if these come with the credibility of having been developed by their peers. The Audit Commission is constantly addressing the question of how best to define criteria for use by inspectors in judging whether practice is good. Generally there will be no blueprint for a service, no standard right or wrong approach. It will be important to take into account local needs. Increasingly, the Commission is working with advisory groups of local authorities and professional groups to get their input and feedback on what should be expected from a particular service.

The inspection process is a good vehicle for spreading and sharing knowledge, and more attention is being given to how this aspect can be developed.

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DfEE Research report: Evaluation of the Investors in People Small Firms Development Project 1999

The Small Firms Development Project was designed to increase the take-up and achievement of the IiP Standard among small firms (DfEE, 1999). The evaluation was based on five in-depth case studies of pilot projects and a focused survey of a further six projects. The overall purpose was to provide a basis for judging the effectiveness of the projects in terms of the accessibility and user friendliness of IiP and the cost effectiveness of delivery.

The study reported the benefits of a tailored approach to marketing and promotion, such as through a combination of mail shots to raise awareness, workshops to gain understanding and interest, and one-to-one contact to secure involvement.

A multidimensional approach to improving accessibility was important, including amending materials and language to be relevant to small firms; delivery through a group approach with an emphasis on mutual support; the use of mentors or ‘buddies’ to offer guidance; and imaginative use of information technology.

The approach which the researchers thought would offer the greatest potential was through a group of companies working together, with workshops, networking and self-help on an ongoing basis. Effective leadership and the use of company role models were also important elements.

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Ways of Disseminating Best Practice

The NHS Central Research and Development Committee (CRDH) set up an advisory group in July 1994, chaired by Professor Andy Haines and lasting six months, to identify means of evaluating methods to promote the implementation of research and development findings in the National Health Service (NHS 2000a).

It was felt at the time that though the transfer of research knowledge into practice is vital if patient care and service delivery are to be improved, there was too little knowledge of evidence-based assessment of research findings. The multidisciplinary group, including health providers, purchasers, consumers, researchers and policy makers, consulted individuals, commissioned expert papers and convened workshops, extending beyond the health sector, to gather information.

Twenty priorities evaluating the uptake of research and development and methods of implementing research findings were identified. These included examining the influences of source and presentation of evidence on its uptake by health care professionals and others; exploring why some clinicians, but not others, change their practice in response to research findings; evaluating the role of the media in promoting uptake of research findings; and the analysis of use of research-based evidence by policy makers.

Subsequently, 35 projects have been commissioned ranging in duration from a few months to four years. Some £4.3 million has been committed, though seven of the priority areas identified have not been funded. In March 2000 the programme transferred to the national programme on Service Delivery and Organisation, based within the London School of Hygiene and Tropical Medicine. Findings from completed projects include: