36th World Hospital CongressParallel Session

Don Juzwishin Ph.D. MHSAReiner Banken M.D. M.Sc.

November 11, 2009Rio de Janeiro, Brazil

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Themes

Describe the importance of scientific evidence on decision making systems in healthcare practice and policy

Describe the impact of scientific evidence on cost reduction and improving the quality of care to the patient

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Improving Health by Improving Decision-Making

High Quality Scientific

Evidence

Appropriate

Intervention

Health Impact

Reduced Cost

Improved QualityDecisions

Governance

Evidence for Informing Decision-Making

IntuitiveDecision-making

Political, Social,

Economic

Conditions

Technological, Ethical,

Legislative

Conditions

Evidence …

The process of evidence

generation and use may be

more important than the

evidence itself.

Layers of Questions & Layers of Evidence

Technical

Performance

Implementation

Reg

ula

tio

n Hig

h Q

uality

Scie

nti

fic E

vid

en

ce

EffectivenessCan it work

here?

Efficacy

Can it work?

AppropriatenessShould we do it

here?

How should we do it

here?

Context is essential for evidence-informed decision making

There are decisions that…

take good

evidence …… and use it well

… and use it poorly poor evidence …

Adapted from Shaxson, L 2004: Evidence-based policy making: if it exists

what makes it robust? Available at http://bit.ly/hIsNC

in context

without context

Canadian Society for International Health Approach to Health System Strengthening

Health Information

SystemsData for Decision-making

Research for Development(Evidence-Based planning and

policy-making)

Evidence-Based Decision-Making

(Clinical and Community-based)

Health Human Resources

Health Financing and Resource Allocation

Service delivery - treatments and programs

Community interventions and health promotion

Stewardship and Leadership

Transparent and Accountable Public/Private Sector

So

cia

l Dete

rm

inan

ts o

f H

ealth

Fram

ew

ork

“ “

Health

in a

ll po

licie

s”

Vision: Equity and Accountability

Strong and vibrant Civil Society

Scientific Evidence for long term Health System Strengthening

Health Information

SystemsData for Decision-

making

Research for Development(Evidence-Based planning and

policy-making)

Evidence-Based Decision-Making

(Clinical and Community-based)

Health Human Resources

Health Financing and Resource Allocation

Service delivery - treatments

and programs

Community interventions

and health promotion

Stewardship and Leadership

Transparent and Accountable Public/Private Sector

So

cia

l Dete

rm

inan

ts o

f H

ealth

Fram

ew

ork

“H

ealth

in a

ll po

licie

s”

Vision: Equity and Accountability

Strong and vibrant Civil Society

Professional Policy-Making for the Twenty-First Century

• Forward looking

• Outward looking

• Innovative and creative

• Using evidence

• Inclusive

• Joined-up

• Evaluates

• Reviews

• Reviews

• Learns lessons • UK Cabinet Office 1999,

Professional Policy-Making for the Twenty-First Century, <http://www.civilservant.org.uk/profpolicymaking.pdf>

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Levels of resource decisions in Health Systems

Patients

Population

Pooling of

resources

Taxes

Health Insurance

Out-of-pocket

payments

Public payers:

National, regional

Private payers

Services

Provider institutionsHealth Professionals

Adapted from Harrison and Moran p 494 in Handbook of Social Studies in Health and Medicine. Sage 1999

How to develop evidence-based decision-making ?

Linked to governance

Linking evidence to decision-

making

Scientific credibility

Social credibility

Appropriate level of decision making to be informed by HTA

Institutional arrangements for guaranteeing scientific independency

Well trained human resources with high analytic capacity

Strong support by senior decision-makers

Processes to include context information from stakeholders

Concluding remarks What foundation

would you like to stand on?

Political expediency

Opinion

Beliefs

Scientific evidence

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References Canadian Society for International Health

www.csih.org

D. Fradon, 1977, New Yorker Magazine

U.K. Cabinet Office http://www.civilservant.org.uk/profpolicymaking.pdf

Contemporary Government Challenges of evidence-based policy-making Australian Public Service Commission

Shaxson, L. 2004, http://bit.ly/hIsNC

Harrison and Moran in Handbook of Social Studies in

Health and Medicine, 1999

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