What we need is evidence

Most physios now know that evidencing their practice is important. But what does that mean? In the first of a continuing series, CPD adviser Gwyn Owen sets out the rules of the game.

Since the 1990s, ‘evidence-based practice’ has become a buzzword in healthcare and beyond. But what exactly do we mean by evidence? And how should we be using evidence to support our practice – either as an individual, as a physiotherapy service, or collectively as a profession?

More to the point, does the sort of evidence we use to support our practice need to change depending on the audience we need to convince?

This is the first in a set of five articles in the continuing professional development (CPD) series that will help you think critically about evidence and how you can use it to support the development of your practice.

Perhaps you’re being asked to submit a portfolio of evidence of CPD by the Health Professions Council. Or you may want to convince an employer to give you a new job or an increment. Do you need to convince service planners or service users of why they should continue to support your physiotherapy practice? Or do you, perhaps, want to persuade a grant-awarding body to provide funding to support your research and development idea? In all these scenarios you’ll need the evidence to make your case.

This first article will look briefly at what evidence is, what it allows us to do and the skills needed to use evidence effectively. The second and third articles will explore ways of collecting data from our practice and ways of making judgements about that data. The fourth and fifth articles will look at how to transform data into evidence and ways of presenting evidence – depending on the needs and interests of an audience.

You may want to cut out and keep these articles for future reference. The activities attached to each article are designed to help you illustrate what you have learnt from engaging with the series.

What is evidence?

The dictionary definitions of ‘evidence’ suggest that it is data that can be used for different purposes. It can either prove or disprove something, or demonstrate something. In a legal context, for example, evidence is data presented to a court to help establish the facts or issues. It may include a variety of data – different types (documents or objects, for example) and come from a variety of sources (the police, witnesses, medical advisers and so on).

This last definition of evidence is particularly relevant when we’re thinking about demonstrating our own personal effectiveness – whether to ourselves, our employer (current or future), the organisations that commission our services, the Health Professions Council or other bodies that regulate our practice, or to grant-awarding bodies.

What can evidence achieve?

Evidence can be very powerful. Used effectively it can create a robust argument that convinces somebody of the qualities of our practice, both actual and potential. Used poorly, it can convince someone that we haven’t understood their requirements, or that we don’t have the skills to systematically collect, analyse and evaluate data. Or it could be that our practice is not what they want or need.

That’s why it is so important to understand what evidence is, as well as the expectations of the audience we’re trying to convince. That understanding will enable us to make some informed choices, including what data might be significant to include as part of our evidence and how to use the evidence to construct an argument and communicate it effectively.   

There is a whole variety of evidence that we could use to support our practice. There’s information that draws on theoretical or research literature – like the Physiotherapy Works series produced by the CSP for example. Then there’s empirical evidence – information that’s drawn from actual practice. This information can be qualitative (service users’ feedback on a physio’s performance for example) and quantitative (facts and figures about the outcomes of a physio’s practice or a cost-benefit analysis of the service they provide for example). What you choose to use will depend on the case you need to make.

Evidence therefore depends on what we’re trying to achieve. For example, if I’m invited by the Health Professions Council to submit evidence of my ongoing competence to practise, then my evidence would relate directly to my current and future practice. If I’m applying for a new job, then I would choose to submit evidence that relates directly to the person specification. If I need to convince a service planner of why they should commission my service rather than someone else’s, my evidence would relate to their primary interests – how my service could provide clinical and cost-effective physiotherapy to address local population needs.

But isn’t it an added extra?

The use of evidence is integral to practice. The rules and codes that govern our professional and employment practice all include reference to using evidence to support practice.

One of the domains from the CSP’s physiotherapy framework (www.csp.org.uk/physiotherapyframework) describes the behaviours, knowledge and skills required for using evidence to lead practice. It defines this as the process of analysing, synthesising and evaluating the best available evidence and integrating it with individual expertise and service users’ needs to inform practice.

What that means in reality is that we need the ability to systematically search for evidence. And then, once we’ve found evidence, to be able to make critical judgements about it, and apply it to address a specific issue or need. fl

The next article in the series will explore systematic ways of collecting data as part of our day-to-day practice. That way, evidence becomes an integral part of practice, rather than a bolt-on extra.  

How to use this article towards your CPD

This activity is designed to help you plan your use of the next four articles in the ‘using evidence in practice’ series.

  • Think about your current use of evidence to support your practice - whether that’s your personal practice (such as portfolio of evidence of CPD) or collectively as a department or service.
  • Critically evaluate your skills in using evidence to support your practice – you might find a SWOT (strengths, weaknesses/needs, opportunities and threats) form useful.
  • Use your analysis to create a list of learning needs – behaviours/knowledge/skills you would like to develop in order to improve your ability to use evidence to support your practice.
  • Make a note of how meeting those learning needs would change your performance, and when and where you could put your new learning into practice. Being specific here will help you evaluate the impact of your learning later on.
  • Look at the themes for the remaining four pieces and plan how you could use them to address the needs you have identified.
  • You could even block out a specific time in your diary to work through the articles, or you might choose to work through them with colleagues.
  • Finally, why not cut out this series and use it towards your CPD portfolio?

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