Bringing knowledge to action in the context of a major organizational transition

In the context of organizational transitions in health care institutions, the decisions taken by leaders and clinicians are informed by multiple sources and by a multitude of actors at all levels of the organization. A study was conducted in the context of a major organizational transition at the McGill University Health Centre in Montreal, Quebec, Canada. The purpose was to examine the body of literature around the notions of "evidence" in decision-making processes in health care. Key informants who had a strategic decision-making role linked to the transition activities were interviewed to explore their perceptions of the types of evidence used to support changes in the organization. Results revealed that managers and clinicians relied on multiple sources of evidence and shared similar concerns about reliability and validity of scant evidence.

How clinical decisions are made

There is much variation in the implementation of the best available evidence into clinical practice. These gaps between evidence and practice are often a result of multiple individual decisions. When making a decision, there is so much potentially relevant information available, it is impossible to know or process it all (so called 'bounded rationality'). Usually, a limited amount of information is selected to reach a sufficiently satisfactory decision, a process known as satisficing. There are two key processes used in decision making: System 1 and System 2. System 1 involves fast, intuitive decisions; System 2 is a deliberate analytical approach, used to locate information which is not instantly recalled. Human beings unconsciously use System 1 processing whenever possible because it is quicker and requires less effort than System 2. In clinical practice, gaps between evidence and practice can occur when a clinician develops a pattern of knowledge, which is then relied on for decisions using System 1 processing, without the activation of a System 2 check against the best available evidence from high quality research. The processing of information and decision making may be influenced by a number of cognitive biases, of which the decision maker may be unaware. Interventions to encourage appropriate use of System 1 and System 2 processing have been shown to improve clinical decision making. Increased understanding of decision making processes and common sources of error should help clinical decision makers to minimize avoidable mistakes and increase the proportion of decisions that are better.

Pharmacists' online information literacy: an assessment of their use of Internet-based medicines information

INTRODUCTION

Pharmacists need effective skills in accessing and using Internet-based medicines information (IBMI) for themselves and their consumers. However, there is limited information regarding how pharmacists use the Internet.

OBJECTIVES

To develop and use a research instrument to measure pharmacists' Internet knowledge, search skills, evaluation of and opinions about using IBMI.

METHODS

A structured questionnaire examining general Internet knowledge, ability to search for and select pertinent IBMI, evaluation of IBMI, opinions about using IBMI and current Internet use was developed. Exploratory factor analysis was performed to analyse IBMI evaluation.

RESULTS

208 pharmacists responded (response rate 20.6%). There was a large variation in pharmacists' scores. Mean scores were low for General Internet Knowledge (mean 7.91 +/- 3.62; scale 0-16), Search and Selection of IBMI (4.98 +/- 2.91; 0-10) and Opinions on IBMI (44.51 +/- 9.61; 0-80). Four factors [Professionalism of website (4 items; factor loading 0.62-0.87; Cronbach's alpha 0.84), Disclosure (5; 0.37-0.79; 0.73), Appropriateness of content (5; 0.32-0.50; 0.65), Standard of information (6; 0.31-0.48; 0.58)] were extracted from the evaluation scale, explaining 36.89% of the total variance.

CONCLUSIONS

A tool was developed to evaluate pharmacists' skills and opinions in using IBMI. A wide range of skills and opinions highlighted the need for training in online information literacy.