The Belgian Minister of Health, Mrs. dr. De Block, wished to install a standardized shared design methodology for guidelines for Evidence-Based Medicine (EBM) or - Practice (EBP). She wanted to increase the dissemination and rate of implementation of guidelines. Funding was made available to bundle all efforts already performed in this field and make the transition towards a single, coordinated organizational network.
Worldwide, Evidence-Based Practice has become the reference for medical doctors, as well as other professionals in healthcare. The goal of EBP is shifting the basis for decision making by healthcare professionals to firmly grounded scientific research, taking into account the patient's values and expectations. EBP ensures the highest quality healthcare, that is both efficient and effective. Although the quality of the already developed guidelines in Belgium is high, the Minister saw substantial societal value potential in broadening and deepening the scope of application.
Setting up the Evidence-Based Practice Network
Noventus teamed up with Antwerp Management School to assist KCE and facilitate the process of creating the EBP Network, from identifying the main stakeholders, to defining shared goals, co-creating operational structures and processes, designing governance structures and finally recruiting a dedicated network coordinator.
88 independent organisations were identified as stakeholders on evidence-based practice. We grouped them into seven types of stakeholders to kick-off the co-creation process towards a joint network.
The initial focus was on first line healthcare professionals, covering the 10 recognized professions (GP's, pharmacists, nurses, midwives, physiotherapists, ergo-therapists, speech therapists, podiatrists, dentists and dietitians) as well as all the existent organizations working on design and implementation of healthcare guidelines.
The purpose of this phase was for all stakeholders to get a clear and comprehensive view on the participants in the EBP ecosystem and to clarify their roles.
Building the strategic framework
Conventional wisdom suggests: "Good agreements make good friends". Cooperative interactions too have a bigger chance of surviving when all participants are aware of the expectations and the possible consequences of their actions.
Noventus hosted a total of 19 workshops involving all stakeholders, during which the mission, vision and strategic goals of the network were co-created. After 3 months, participants had a clear idea on the involvement and expectations of the different parties. The co-creative effort led to co-ownership of the foundations and shared goals of the network. This provides a solid and necessary base for a sustainable organizational network.
Coordinating processes within the scientific cycle
The life cycle-loop for healthcare guidelines consists of six consecutive steps, i.e. prioritization, development, validation, dissemination, implementation and evaluation, and then back to prioritization. Crucial for achieving and maintaining high standards of evidence-based practice is a well-coordinated scientific process and continuous monitoring.
Therefore, Noventus installed and facilitated a monthly meeting between key stakeholders with focus on knowledge sharing, critical reflection, co-creation and interaction. As each of the steps in the life cycle is executed by an independent organisation, the value of an independent coordination role became apparent. Noventus substantiated this observation with scientific insights on organisation design and outlined alternatives for the path forward.
Designing governance and decision making processes
When starting a new collaborative endeavor, it pays to establish upfront how strongly partners commit to the common goal, how decisions are made and what can be expected in case the collaboration is violated. Leadership in networks needs to be shared to ensure partner commitment and decisions should arise from the team rather than being imposed top-down.
In 4 dedicated workshops, Noventus introduced a consensus based decision making model, assigning specific roles to each of the stakeholders. A Charter of Good Governance was co-created.
This structure ensures that strategic priorities for EBP in Belgium are widely supported by all relevant stakeholders, including the government, which leads to excellence in execution.
Setting up the legal structure and recruitment of network coordinator
Noventus teamed up with Prof. Dr. Marleen Denef at Impact Lawyers to analyse possible legal structures for the EBP Network coordination. We facilitated the entire process from knowledge sessions on alternative legal solutions to drafting and reviewing legal documents, setting up a public utility foundation and finally recruiting and on- boarding the network coordinator.
The stakeholders opted for an independent administrative organization (NAO - Network Administrative Organization) to take up this role. Research suggests this governance model to be the most suitable to keep the balance between efficiency and inclusive decision making.
Trusted Advisory and Coaching
After this intensive design and implementation trajectory, Noventus remained involved in a hands-off advisory and support role for six months, guaranteeing that processes were secured and used in the network. We acted as sparring partner and supplied best practices and scientific insights to enable well-founded decisions.