An evaluation of a training intervention to support the use of evidence in healthcare commissioning in England.

Abstract

AIM Clinical commissioning groups (CCGs) in England are responsible for the health of their populations through the services they provide, yet we know that the use of evidence to inform commissioning decisions is low. A programme of training in seven CCGs in England was instigated in a joint piece of work by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care and Academic Health Science Network in the West of England, to help build an evidence informed culture in commissioning. METHODS Evidence workshops were delivered in each of the seven CCGs in the West of England by an experienced senior lecturer (the author) and local healthcare librarians. The workshop was developed by the author and an information scientist and included guidance and demonstration of a systematic evidence search covering both traditional and grey literature, and a brief look at quality of evidence including a critical appraisal activity. Participants were asked to evaluate the workshop on the day and to indicate an intended action they would take as a result of the workshop; a short follow-up interview was carried out with a sample of participants between 3 and 6 months later, to identify any longer term impact of the training. RESULTS A total of 63 staff in a variety of commissioning-related roles attended the workshops between March and September 2016. 95% rated the workshop overall as either 'excellent' or 'good'. Of particular value was the involvement of the local healthcare librarian, helping to promote their expertise and services; and the discussion of grey literature as a valuable source of evidence. A variety of intended actions as a result of the training included initiating a thorough search for evidence for new projects, use of bibliographic databases, and making use of local library services for evidence searching. Follow-up interviews with nine staff revealed a positive impact in the longer-term. This ranged from simply triggering an interest in using evidence, boosting motivation and sharing information with colleagues; to changes in processes such as broadening the responsibility for finding and filtering evidence for business cases; to one clear case of financial savings resulting from a search for evidence by a senior commissioning manager. CONCLUSION Offering short, interactive training workshops is valued by healthcare commissioners and can make a difference to their approach to and use of evidence in decision-making. There is a need for a flexible approach to the concept of evidence in healthcare commissioning, which includes the use of grey literature, and training can encourage and support the systematic search for an appraisal of this type of evidence. Tools for improving and sustaining this aspect of evidence use by commissioners are included here.