1.7.7.1 The Australasian Digital Theses Program

The Australasian Digital Theses (ADT) Program began in 1998 and has been open to all Australian universities since 2000. It consists of a national collaborative of digitised theses produced at Australian universities (PhD and Masters by Research theses only). The program can be accessed free of charge via any internet-connected computer (see www.adt.caul.edu.au).

1.7.7.2 The Conference Papers Index

This database provides over 2.5 million citations to oral papers and poster sessions presented at major scientific conferences internationally from 1982 to the present. Major areas of subject coverage include healthcare, as well as biochemistry, chemistry, biology, biotechnology and many others. The Index is updated bimonthly and is available through subscribing health or academic institutions (see www.csa.com/factsheets/cpi-set-c.php).

1.8.1.1 Why the need for the NICS?

In an editorial in the Medical Journal of Australia (Silagy 2001), the inaugural Chair of the NICS, the late Chris Silagy, observed that the language and concepts of evidence-based healthcare have become institutionalised in most spheres of healthcare, yet there are still significant gaps between evidence and practice.

Silagy noted that since the inception of evidence-based medicine there has been considerable emphasis on what he termed ‘upstream’ strategies to support EBP, an emphasis characterised by huge numbers of systematic reviews, health technology assessments and clinical guidelines being made available to clinicians. This emphasis, however, had come without adequate consideration of the ‘downstream’ strategies necessary to ensure effective uptake and implementation of best evidence by clinicians. The mission of the NICS is to assist clinicians to turn this evidence into action.

1.8.1.2 What is important?

In planning a strategy to address the evidence–practice gaps in Australia, one of the first tasks of the NICS was to work with clinicians in a series of consultation rounds to identify the gaps that are considered widespread, clinically significant and urgent. Professional colleges, societies, special interest groups and policy-making bodies were all invited to make submissions and the views of nurses, who make up over 70% of the Australian healthcare workforce, were particularly sought. The consultation process identified a number of clinical areas, including the care of patients treated in emergency departments and the care of patients with heart failure, as suboptimal when compared to best research evidence.

In 2002, the NICS established a nursing reference group of clinicians and academics to offer high-level advice on important practice gaps, and as a result of their recommendations, the NICS began work to scope opportunities to close the gaps in pain management and pressure-area management. This led to the NICS embarking on a major project to improve pain management in hospitalised patients with cancer, while the latter recommendation led the NICS to scope pressure-area care in Australia (see www.nhmrc.gov.au/nics).

Identification of EBP gaps is an evolutionary process and, in 2003, the NICS published the first in a projected series of reports highlighting important gaps identified by doctors, nurses, allied health clinicians and policy makers in Australia (NICS 2003). In 2005, a review of this report was undertaken (NICS 2005a) to provide a fresh look at what progress had been made in closing the gaps identified in the original report. Additionally, in 2005, a second volume in the series of evidence–practice gap reports was published, highlighting several areas where gaps between evidence and practice remain in day-to-day practice (NICS 2005b). See Appendix 1.1 for further details of clinical topics covered in these reports.

As our understanding of what actually happens in clinical practice improves and we look more deeply through better integration of routine data-collection systems at the surgery and bedside, it is anticipated that many more clinically significant gaps will be identified in the coming years.

1.8.1.3 What do we know about what works?

The second task of the NICS was to bring together the disparate body of work on changing clinician behaviour into a coherent whole. Industries such as mining and aviation have approached behaviour change in a two-pronged way, from both a systemic and an individual perspective. While there is still an emphasis on individual responsibility, there has also been a corresponding reduction in the discretion of individuals to act autonomously, in favour of the introduction of industry-wide systems and protocols. This has resulted in significant improvements in safety. Attempts to change clinical behaviour in the healthcare industry have, to date, focused almost exclusively on the role of the individual clinician in areas such as supporting individual clinical decision making, and there have been very few initiatives that have looked at system-wide approaches to change. One important factor that has inhibited more widespread attempts at system-wide improvement is the lack of a sound scientific evidence base for the many strategies that have been proposed to date.

The NICS also aims to use expertise from areas such as behavioural psychology and marketing to better identify ways of systematically changing clinician behaviour in Australia. In 2003, the NICS convened a national workshop of clinicians and policy makers with an expertise in change management to identify better ways to manage change in Australian healthcare; the results of the workshop were published in 2004 (NICS 2004).