According to the Evidence: Implementing EBPs

by Richard Edwards

Today I sat in on a work session with the NC Practice Improvement Collaborative–a small group dedicated to the implementation and dissemination of evidence-based practices for human services in NC.

The main speaker for the morning was Dr. Dean Fixsen, from The National Implementation Research Network, a renowned speaker on practice implementation in organizations and state systems. He made several interesting points about change leadership and quality improvement, but I was especially interested in his research on the amount of time it takes to implement evidence based practices in an organization.

Two to four years, he said.

Admittedly, two to four years can go by in a flash (where have you gone, 2009?), but in the human service field, when new services go live with perhaps a 90-day hold harmless period, have we ever had two years to get something right? It seems to me that if we’re going to be about bringing science to service, we have to also be about the science of bringing science to service. And how do we fund that in a fee-for-service system?

Dr. Beth Melcher from DHHS was also present and spoke briefly about evidence based practices and their role within the new 1915b/c combo waivers, set to roll out in 2013. Her stance is that–in contrast to the opinion of some that the state is abandoning CABHAs (was she looking at me?)–the waiver environment will actually make EBP implementation easier, because of the flexible funding available through savings generated (if a 1915b/c waiver site or managed care organization saves money, it gets to put that money back into services at its discretion). That’s a fair point–and although I’m not convinced that’s really why NC is going down this road so quickly–it could make that 2 to 4 year start up period for a new EBP more manageable.

My angle is that this kind of flexible funding is essential to an innovative healthcare system that brings evidence-based practices to the people who will benefit most, in the shortest period of time. Otherwise, we run a substantial risk of just being another 2 to 4 years older, and perhaps not a day wiser.

But that’s just my angle. What are your thoughts?

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