Evidence-based Practice: An Elusive Ideal

There is a strong movement toward evidence-based practice and a new buzz-word, evidence-based leadership. is becoming popular. The evidence-based movement involves the complex process of:

1. Figuring out what treatment practices have positive effects on treatment outcomes;

2. Encouraging professionals to use evidence-based principles and practices by encouragingly the use of continuous quality improvement;

3. Promoting a culture of creativity, growth and change within a consistent structure while avoiding cumbersome regulations that fail to add value to the process of patient care.

Evidence-based practice is becoming very complex stuff which, unfortunately, is placing many more levels of complexity between leadership and patient care. The following article reflects, in my opinion, why the evidenced-based movement is struggling.

– The idea of evidence-based practice is becoming way to complex.

– The evidence for what works and what doesn’t work is very weak.

– Different professional cultures fail to effectively communicate and collaborate.

There is the misconception that we know what works and need to force regulations into place that add little or no value to clinical practice.

The comes ideas of evidence-based practice is replacing the idea of simple applied research systems processes once called continuous quality improvement.

It might be helpful to ask both professionals and patients to describe in plain English what they found to be helpful and not helpful in their experience of the treatment process.

For better or worse, here is a description of the complexities of the evidence-based treatment. In my opinion the ideas are far too complex to be practically implemented and the “evidence-based ideal” is placing additional levels of complexity between leadership and patient-care.

The challenge is to simplify the process for real-world application. I still prefer the idea of continuous quality improvement based upon systematic measurement of concrete outcomes close to the the level of patient care that involves patient self-measurement, clinical professional measurement of the same factors, and administrative measurement of treatment plan implementation and incident reporting. The system has been implemented and validated in addiction and mental health programs and requires limited investment.

The USA government has developed and field-tested proven methods for implement CQI in addiction and mental health programs.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483604/pdf/v007p00149.pdf

Cognitive Restructuring for Addiction is an evidence-based practice that can be implemented in the real world and its effectiveness monitored with CQI methods in a cost effective way. Simple measurement of the patients ability to use the five core cognitive restructuring skills (Thought Management, Feeling Management, Urge/Motivational/Craving Management, Behavioral Recovery Skill Acquisition, and Relationship management. It is a skill based model and the ability of recovery people to learn and use the skills can be measured. Knowing how to use the skills, however, is no guarantee they will be used consistently in recovery. These skills also lend themselves to self-monitoring, an evidence-based cognitive-behavioral therapy technique shown to enhance positive change.

References for Continuous Quality Improvement (CQI)

Deming, W. E. (2000). Out of the crisis. Cambridge, MA: MIT Press.

Gustafson, D., & Hundt, A. (1995). Findings of innovation research applied to quality management principles for health care. Health Care Manager Review, 20(2), 16–33.

Langley, G. L., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). San Francisco, CA: Jossey-Bass. NIATx. (2008). CQI model. Retrieved August 26, 2009, from http://www.niatx.net

GORSKI BOOKS: www.relapse.org

Cognitive Restructuring for Addiction

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