How well have you performed

The last step of EBP is to evaluate your own performance and where you might improve. Depending on the context in which changes are made you are also likely to be interested whether the changes implemented have improved care.

Here you will learn:

  • Self-reflection
  • About evaluation

Getting started

In EBP, self-reflection is part of evaluation. [1] You are asked to reflect on how well you perform steps 1-4 (Ask, Acquire, Appraise, Apply).

In relation to a specific patient and change you might ask yourself: Would it have made a difference if my question were more specific or if I had changed my approach to searching for evidence?

More generally, criteria suggested by Straus [1] provide a detailed self-evaluation framework to assess how well you are doing across the five EBP steps. You could also use the CareSearch self-evaluation form to check your progress with EBP.

Download the form - Evaluation of my use of EBP (169kb pdf)

After implementing practice change you might also want to establish whether the intended effect has been achieved. Generally, this would be compared to no change or usual care (pre-intervention outcomes). It is also important that you identify any information required to sustain changes or to monitor any unintended consequences of the changes. Evaluation of outcomes will help you to do this.

At the practice/health practitioner level EBP evaluation might take the form of a pre- post-study embedded within a PDSA cycle. In this case you could look at outcome measures from the patient, practitioner, or organisational level before and after the changes were implemented. The aim is to ask whether the desired outcome has been achieved.

The measures and approaches that might be employed at each level include: [2]

  • Patient level – measurement of change in actual health status or surrogate markers for health status using medical record audit, and/or patient survey or interview
  • Health practitioner level – measurement of actual change in health practice, or change in health practitioner knowledge and attitudes using medical record audit, health professional survey or interview, computer database e.g. for prescription trends
  • Organisational level – health system changes such as waiting lists, or changes in policy or costs in relation to the intervention.

For complex program and system level changes involving more stakeholders a more structured and detailed format for evaluation is likely to be adopted. This is covered in Evidence Translation.

  1. Straus S, Glasziou P, Richardson WS, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 5th ed. Elsevier; 2018.
  2. Hakkennes S, Green S. Measures for assessing practice change in medical practitioners. Implement Sci. 2006 Dec 6;1:29. doi: 10.1186/1748-5908-1-29.

Page created 28 March 2022