Written by Aditya (Dave) Nidumolu
Dave is a 2016 QE Scholar who, alongside Inna Berditchevskaia, interned at the Caribbean Public Health Agency (CARPHA) headquarters in Port of Spain, Trinidad & Tobago under Dr. Andrea Yearwood. CARPHA, as described in its mandate, aims to build and coordinate public health knowledge in the Caribbean region. Its key activities include 1) Providing laboratory services to support the surveillance, prevention, promotion and control of important public health problems (e.g. infectious disease) 2) Providing public health training and capacity building services to health ministries in the Caribbean 3) Coordinating regional responses to public health crises and 4) Supporting the development, dissemination, and implementation of public health research & policy.
Healthcare organizations across the world are constantly pressed to improve the quality of their patient care, population health, and the cost-effectiveness of their services. To support an evidence-based approach to these goals, there is a growing international interest in evidence portals that collect and categorize health systems interventions such as the McMaster Health Forum’s Health Systems Evidence. Similarly, the Caribbean Public Health Agency (CARPHA) recently launched its own evidence portal that documents research and interventions relevant to Caribbean public health.
While working at the Caribbean Public Health Agency (CARPHA) during the summer of 2016, Inna and I had the opportunity to research how public health interventions can be documented on the CARPHA evidence portal. Within numerous industries, documents that describe how to optimally implement a program or intervention are referred to as ‘best practice documents’. The term “best practice” itself describes a practice producing the most desirable results based on predetermined metrics, such as effectiveness, reach, and feasibility.
Sharing best practice documents is incredibly important as it provides organizations the chance to learn from the experiences of others who have attempted to achieve similar goals in the past. Consequently, a common understanding of how best practices should be documented would be invaluable when CARPHA later develops a systematized way for organizations within the Caribbean to share the success of best practices they have previously used.
Through our research, we found that best practice documents typically share the following elements of information:
- the objectives of the practice;
- the existing gap or problem the practice is addressing (justification of the practice);
- the population and setting where the practice may be used;
- the body of evidence demonstrating the practice’s efficacy. Ideally, this should include information on whether the practice may be feasible or reasonably transferable to other settings;
- the activities, stakeholders, and resources necessary to implement the practice; and,
- the ‘lessons learned’ from the practice. This includes challenges faced in the implementation of the practice as well as any other advice that may be helpful to others interested in implementing the practice.
Moreover, best practice documents are not all equal in their quality. Rather, their quality exists on a sliding scale based upon the degree to which they document each of the following characteristics:
1. Empirical evidence of success
The meaning of success or effectiveness in a best practice document varies greatly depending on its goals. In addition to common health indicators, some of the most common measures of success include cost and the proportion of the target population reached by the practice.
2. Potential for evolution
Studies and documents agreed that best practices are always evolving. Consequently, best practices should discuss how they might be modified to fit different social contexts or implement a quality improvement program.
3. Peer review
Some organizations require a best practice to be reviewed by experts in the field and objectively determined to be superior to other practices according to predetermined metrics.
Practices must demonstrate that their suggested level of effectiveness is replicable in relevant settings. This is especially important for practices which may be scaled up or used widely. Within CARPHA’s context, it will be important for best practice documents to discuss where and why they might work in the Caribbean region.
5. Basis in evidence
Best practice submissions may be required to ground their development in evidence. This can be achieved through innovating an existing practice, presenting research evidence demonstrating gaps in the standard practice, or drawing on expert opinion and experience.
A practice must be sustainable to maintain positive outcomes over time. Thus, it’s essential that best practice documents provide guidance on how to be sustainable.
Altogether, we found that the general themes of the content that a best practice document should contain are consistent in the literature; however, there is no clear understanding of the level of methodological rigor a best practice document – or any other level of practice quality – should possess. As implementation science advances in the coming decades, we’ll undoubtedly see new approaches to disseminating and implementing best practices in public health.
This blogpost was based on the research Inna and I conducted from May to August 2016. Please refer to our white paper – Defining and documenting best practices in public health: a scoping review and its appendix for more information. You can also view our direct contact information on the McMaster Health Forum website (Dave, Inna).
Watch the video from Dave’s QE Scholar Insights webinar: