Fostering a culture that supports evidence-based practice
Evidence-based medicine is generally regarded as the “gold standard” of clinical practice. As I travel across the country helping hospitals add evidence-based content to their EHRs, I often encounter organizations that are not culturally prepared to embrace practices based on the best and most current clinical evidence.
Hospitals seeking to fully embrace evidence-based medicine may want to first assess their organization’s culture. The successful adoption of evidence-based practices requires a culture that supports clinical decision making based on an examination of the latest research, rather than an over-reliance on intuition, outdated regimens or a “that’s-the-way-we’ve-always-done-it” approach.
Between my current role as a clinical informaticist and my years as an RN in community hospitals, I have identified several key organizational practices that provide excellent insight into a hospital’s culture and serve as good predictors of a hospital’s readiness to embrace evidence-based medicine. If your organization seeks to foster a culture that is supportive of evidence-based medicine, these best practices are a great place to start.
Open visitation policy
An open visitation policy–rather than restrictive visiting hours–enable families and friends to visit patients 24/7. Open visitation policies allow and encourage loved ones to become patient advocates who retain critical information, ask clinicians important questions and give voice to patients who are heavily medicated or feeling unwell. This creates a safer care environment and reduces the possibility of avoidable adverse events.
With open visitation, patients feel supported and safe, families are more satisfied with care and less anxious, and providers have increased opportunities for communication and teaching. Despite the proven benefits, some facilities resist open visitation, often because clinicians perceive that the ongoing presence of family and friends limits staff control of the care delivery process.
However, hospitals with open visitation policies are generally more ready and willing to adopt evidence-based practices rather than adhere to entrenched protocols that may contradict the latest evidence.
Interdisciplinary bedside rounding
Interdisciplinary bedside rounding involves care team members along with physicians. This method supports open communication between care team members and with the patient, and it creates a more collaborative approach to care. Rather than relying solely on the judgment or preferences of the physician, an interdisciplinary approach fosters patient engagement and encourages care team members to practice at the top of their license, and to consider the latest clinical evidence. Patient benefits include increased safety, decreased need for invasive procedures, and reduced lengths of stay.
Hospitals that support interdisciplinary rounding are more likely to rely on evidence-based practices and discourage a hierarchical culture. Clinicians are encouraged to work at the top of their license, instead of allowing physicians to dictate how care should be delivered.
The use of open visit notes also indicates that a hospital may be culturally ready to embrace evidence-based practices. OpenNotes is an international movement that supports making healthcare more transparent and encourages clinicians to invite patients to read notes. Studies have shown that by providing ready access to notes, patients and their caregivers feel more in control of healthcare decisions and are better able to identify incorrect information, which in turn improves the quality and safety of care.
By encouraging the open sharing of visit notes, hospital leaders can foster a culture that prioritizes strong patient-clinician communication, trusting relationships, and enhanced patient safety. Such an environment provides a strong foundation for the adoption of evidence-based medicine.
Patient safety initiatives
Organizations such as the Agency for Healthcare Research and Quality (AHRQ) recommend that hospitals adopt evidence-based safety practices to prevent adverse events. Meanwhile, the Institute for Health suggests that hospitals accelerate patient safety efforts by partnering with patients and families to develop strong programs, such as patient and family advisory committees, that promote the exchange of ideas and otherwise engage patients and families in safety initiatives. Engaging patients and their families not only improves safety, but also enhances clinical outcomes.
Hospitals that promote a safety culture based on evidence and recommendations of strategic organizations typically employ physicians and staff who are open to following evidence-based practices.
Organizational culture affects a hospital’s ability to implement evidence-based practices. By fostering an environment that promotes evidence over the status quo, every segment of the organization can contribute to the delivery of cost-effective and efficient care that creates superior patient outcomes.