Wired, tired or expired? A week of practice change @WeSpeechies

My week as ‘rotation curator’ of the @WeSpeechies handle on Twitter is coming to an end. The tweetchat on our topic ‘Making a change in your practice – what does it take #WeSpeechies?’ generated a particularly wide range of perspectives. This blog post is a chance for me to reflect and offer some references to follow up points raised.

1. How do we find out what supports practice change?

In a systematic review to understand why outcome measurement has failed to be used routinely by allied health professionals, Eddie Duncan and Jennifer Murray find that the barriers and facilitators relate to individual therapists, teams and organisations. Importantly, “many of these factors are bi-directional and can be viewed as either a barrier or facilitator depending on the emphasis given”. Although it is much more common to look for barriers, they suggest that putting the emphasis on facilitators may provide more useful insights.

2. Would research based in natural settings help?

Health services researcher Shaun Treweek is committed to a way of designing trials in which components are assembled to build in the likelihood of speedy and effective implementation. A successful recent example is Football Fans in Training, where professional football clubs provide the setting for weight management groups.

3. What can Journal Clubs contribute?

Lucylynn Lizarondo has had a number of articles on journal clubs for the allied health professions published. What makes this work really interesting is the way she uses the complementary skills of researchers and practitioners, and evaluates the difference the journal clubs have actually made to practice.

4. Do narrative approaches have a role in changing practice?

In a recent BMJ Quality & Safety article, Hilligoss and Moffatt-Bruce explain why narrative or ‘storied’ approaches are safer and more effective for communication-intensive practices such as patient handovers than structured checklists. Another example is Campion-Smith et al.’s use of story sharing as a way of encouraging more interprofessional learning to improve practice in palliative care.

5. What influences implementation?

Finally, if you are interested in all the elements of implementation, Laura Damschroder runs a Wiki of the Consolidated Framework for Implementation Research. Each item in the taxonomy is explained further when you click on it, and this might help you to think through where there are opportunities to encourage change in your own practice environment.

6. Are we wired for implementation?

Samuel Odom characterises implementation as “the tie that binds” evidence-based practices and positive outcomes. Somewhat tongue-in-cheek, he borrows a classification system from Wired© magazine to categorise historically our efforts to make sense of this process: Expired (practices based only on professional opinion; narrative reviews of the literature); Tired (meta-analysis; What Works Clearinghouse; quantitative reviews of studies and aggregation of results) and Wired (practice-based review of evidence; implementation science; enlightened professional development).

At the end of this week I confess to being Tired, but have thankfully not Expired. Meanwhile, @WeSpeechies founders Caroline Bowen and Bronwyn Helmsley remain relentlessly Wired. They lead by example in using social media to encourage international connection and exchange of ideas to benefit people with speech, language and communication needs. If you would like to take a turn as a rotation curator, do get in touch with them.

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