What is Evidence-Based Practice

Information is considered the currency within health systems. Numerous reorganisations and restructuring, coupled with many buzz words (e.g. evidence-based practice) and the various advancements in ICT (information and communication technology) are apparently designed to improve the utilisation of this currency. However, what constitutes information appears to vary between health professionals. For some, only the data derived from RCTs (randomized control trials) is considered evidence, for others it is the conclusions drawn from focus groups, whilst for others, finding information goes well beyond subjectivity and experimental design and comes from understanding human behaviour and other processes.Although advancements in ICT have greatly improved access to information (currency), the data often disguised as information appears only as small change. Restructuring and reorganizing have been used to inflate the value of this currency (information) leading to the replacement of information departments by the Public Health Intelligence Units or Observatories. However, a change in behaviour is difficult to bring about and manage, while it is easier to change the tools with which the tasks are carried out. It is all too easy to fall into the trap of reproducing what has been produced before by information departments only under a different guise, as well as using different configurations, software or updated hardware and ICT (e.g. the Internet). These units hardly concern themselves with exploring the underlying message of the data. A quick trawl of the web pages of these entities can be testimony to this fact. The process so far has been, in effect, one of test-tubing health outcomes and then extracting the data from the test tubes. Although we have been eager to embrace technological advancements and change, we have failed to monitor the impact and consequences of change on our behaviour and thus on health outcomes. This chapter will delve into the current availability of information for public health policy purposes and will argue its ineffectiveness as information/evidence in the context of human behaviour and social processes. Behaviour and processes are by nature dynamic. Specifically, the feedback effect, a feature of dynamic process, can have a profound attenuating effect on data that was once important, thereby affecting not only the shelf life of a policy but also its intended outcomes. Examples from published reports by public health intelligence units/observatories in New Zealand and the UK, plus references to teenage smoking and suicide, will be used to illustrate these concepts and issues. A conceptual but pragmatic model of data collection based on current health care data management systems will be argued as a way forward for translating data into information and tangible evidence with a view to informing the process of public health policy formation. This chapter discusses a holistic approach to identifying data needed as evidence to inform the process of policy formation/decision making as a conceptual model.