The NSW Speech Pathology EBP Network

Interested in joining the network?

If you are a speech pathologist working in NSW, Australia, and you are interested in joining the NSW Speech Pathology EBP Network, please read through the information on this website. Learn about the objectives of the network, why it was started, the structure of the network, and how it is fun. Once you have read through the information on this website, complete EBP training  and the training checklist, then contact the clinical group leader of the group you are interested in, to find out when their next meeting is.

Objective of the NSW Speech Pathology EBP Network

The primary objective of the NSW Speech Pathology EBP Network is to facilitate speech pathologist’s conduct of EBP in the context of a shared, collaborative forum.

Why was the NSW Speech Pathology EBP Network started?

The NSW Speech Pathology EBP Network was established in 2002 by senior NSW Department of Health speech pathologists. The idea was discussed during a meeting of the Managers of Sydney Metropolitan Speech Pathology Services in NSW, with the intent of forming a group or network of clinicians to “facilitate opportunities for Speech Pathologists in NSW to learn together, share responsibility in collecting evidence based data and co-operatively evaluate its practical application to clinical practice” (Quinn, Stevens, Bradd 2002). The original steering committee included Trish Bradd, Clare Quinn and Alison Stevens.

By working in a structure that permits task-sharing, joint problem-solving and the production of practical and applicable information, the Network aims to make the task of engaging in evidence-based practice possible.

How does it do this? The Network links practising speech pathologists from across the state of NSW into clinically based groups (e.g., swallowing, paediatric language, Autism), who together review published research evidence, consider whether published evidence should guide changes to current clinical practice, and, guide clinicians in their evaluation of current clinical practice.

Objectives of the NSW Speech Pathology EBP Network

  1. To foster a culture of evidence based practice within the speech pathology profession.
  2. To provide a forum in which speech pathologists can share and support each other in the tasks involved in the conduct of EBP, including the:
    1. the development of pertinent foreground and PICO style clinical questions,
    2. the identification of the best available external evidence (typically high quality, rigorous peer review published research) relevant to clinical questions
    3. the evaluation of the scientific rigor of identified evidence
    4. discussion of the implementation of EBP in everyday clinical practice, which may include:
      • comparing clinical bottom lines, with evidence from current clinical practice (e.g., clinical data, patient outcomes and preferences)
      • reviewing current practice in light of clinical bottom line and considering opportunities for clinical practice change, barriers and enablers, and strategies for facilitating implementation.
      • implementing changes to clinical practice
      • reviewing and monitoring changes to clinical practice, including collection of patient level, clinician level, and organization / practice level outcomes
      • Identifying resources needed to facilitate implementation
  3. To provide speech pathologists and the wider community with public access to summaries of peer reviewed published research including critical appraisals of individual papers (CAPs), and critical appraisals of topics (CATS) relevant to specific clinical questions.

NSW Speech Pathology EBP Network: Organizational structure

Organization

Role of the Steering Committee

The Steering Committee is made up of a number of Speech Pathologists with varying backgrounds in EBP, management, clinical practice and academia. They work in tertiary teaching hospitals, community health and universities in both adult services and paediatrics. They aim to represent the Network in all areas of Speech Pathology. The Steering Committee are responsible for developing training resources for current and new members, assisting clinical leaders, maintaining the website, reviewing CAPS and CATS, and organizing an annual event which showcases the work of clinical groups throughout the year.

Clinical groups that make up the NSW EBP Network

 The NSW EBP Network typically comprises 11 clinical groups, including:  

  1.  Augmentative and Alternative Communication (AAC)
  2.  Adult Language (Sydney)
  3.  Adult Speech (Hunter)
  4.  Head and Neck
  5.  Adult Swallowing
  6.  Adult TBI
  7.  Tracheostomy and Critical Care
  8.  Autism
  9.  Paediatric Feeding
  10.  Paediatric Language
  11.  Paediatric Speech

The availability of clinical groups depends on the availability of clinical group leaders and members. Some groups have formed for a period of time, then dissolved only to re-form at a later date.  The terms of reference (TOR) for each clinical group are available on the Network website. TORs are updated by clinical group leaders. You are encouraged to read the TOR for the clinical group(s) you are interested in joining, as the TOR vary across groups.

Clinical group leaders

  • The role of a clinical leader is to provide support to members of their clinical group. The leaders are expected to have specialty experience in their chosen clinical field. The role is to direct the group through assisting in the development of clinical questions, compiling lists of appropriate articles for critical appraisal, reviewing CAPS and CATS from members, compiling a CAT, preparing a presentation for the annual showcase.
  • Group leaders are responsible for:
    • Organizing clinical group meetings
    • Ensuring that all group members have completed the online training.
    • Attending leaders meetings, and providing feedback from their group to the Steering Committee. (One leader from each clinical group is expected to attend 2x Clinical Leaders Meetings, organized and run by the Steering Committee, each year).
    • Maintaining a central database of members, record of their groups’ activities and any articles used.
    • Reviewing the quality of CAPs, and providing to steering committee group mentor for uploading onto the website.
    • Promptly disseminating any information provided by the steering committee intended for Network members via email.
  • Ideally, groups should have at least 2 leaders to assist with the clinical demands and also the administration that goes along with running a group.
  • All groups are assigned a mentor from the Steering Committee. The steering committee member is available to mentor the leader and help problem solve any issues involved in the running of the leaders’ clinical group.
  • For continuity it is suggested that a leader remain in the position for a minimum of 12 months and that there is a staggered change over when a new leader commences. In the event a leader is not able to continue their role, replacement leaders must be nominated and supported by the group and endorsed by the Steering Committee.
  • Groups are encouraged to have an ‘academic link’ involved with their group. This could take the form of an academic being a member of a group (and therefore regularly involved in meetings), or, an academic who is not a member but willing to consult with member(s) of a clinical group about the latest research associated with a specific clinical question.
  • Being a clinical leader can be a great experience, an opportunity to develop leadership skills and has at times enabled people to develop new interests and skills.

Clinical group members

Clinical group members must be fully qualified Speech Pathologists, working in the state of NSW,  Australia, who have
(i) completed the following training steps, and
(ii) completed the training checklist

Clinical group members are expected to actively participate in the activities coordinated by the group leader. This involves brainstorming a clinical question, reading and evaluating articles and electronically completing CAP and CAT forms. It is assumed that group members will attend the meetings prepared and ready to engage in the EBP discussion process. There are usually varying degrees of experience and expertise within the group.

E3BP: Dollaghan’s (2007) conceptual framework guiding the NSW Speech Pathology EBP Network:

Dollahgan’s (2007) conceptual framework of E3BP guides discussions during our meetings, and our thoughts about how findings from empirical research might be adopted into our various work places, in light of our own internal evidence and the patients/families we work with.

What is the difference between EBP and E3BP? Evidence-based practice (EBP) was defined by David Sackett and colleagues as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richarson, 1996, p. 71).  While this definition has been instrumental in developing a global culture of EBP among health workers, it assumes that the application of research evidence is straight forward. In practice, it is not. The application of research to practice and the process of making clinical decisions in unique workplace settings with unique workplace constraints, with individual clients on a case-by-case basis can be complicated.  Clinical settings are different, and clinicians have different types of expertise and experience. Clinical settings also have different types of resources and policies and procedures regarding how they are to be used.

In an effort to bring some balance between empirical research evidence, what is possible in everyday clinical practice, and, individual client characteristics, values and preferences,  Chris Dollaghan proposed a modified definition of EBP, known as E3BP. Dollahgan (2007, p. 2) defines  E3BP as “the conscientious, explicit, and judicious integration of 1) best available external evidence from systematic research, 2) best available evidence internal to clinical practice, and 3) best available evidence concerning the preferences of a fully informed patient.”

This means that:

EXTERNAL EVIDENCE = the peer reviewed published research literature or empirical evidence

INTERNAL CLINICAL EVIDENCE = evidence from clinical practice (i.e., practice-based evidence). It may include outcome measures for an individual patient and/or patient satisfaction ratings associated with a particular clinical decision for a patient/s.  Internal clinical evidence could comprise evidence from an individual speech pathologist working with a specific client group, and/or evidence from a workplace for all patients with a particular type of communication or swallowing difficulty, managed by a team of speech pathologists.

INTERNAL PATIENT EVIDENCE = the characteristics of clients, their values, beliefs, and preferences.

Clinical expertise integrates all three sources of evidence (published literature, clinical evidence, client evidence) in the provision of optimal clinical care (Dollaghan, 2007). Dollaghan (2007) considers clinical expertise to be “the glue by which the best available evidence of all three kinds is integrated in providing optimal clinical case (p. 3).

Dollaghan, C. A. (2007). The Handbook for Evidence-Based Practice in Communication Disorders. Baltimore: Paul H.  Brookes Publishing Co.
Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence Based Medicine: What It Is And What It Isn’t: It’s About Integrating Individual Clinical Expertise And The Best External Evidence. BMJ: British Medical Journal, 312(7023), 71-72.  Retrieved from http://www.jstor.org.ezproxy1.library.usyd.edu.au/stable/29730277

5 steps of E3BP 

There are five steps involved in the conduct of E3BP. They including:

  1. Formulating a clinical question. This could begin with a background question or topic area, then transformed into a specific clinical question, that adheres to the PICO elements – patient, intervention, comparison, and outcome.
  2. Searching for evidence: Helpful sites particularly relevant to speech pathology practice include:
    http://speechbite.com/
    http://www.asha.org/Evidence-Maps/
    http://www.thecochranelibrary.com/
    http://www.campbellcollaboration.org/library.php
    http://www.psycbite.com/
    http://www.tandfonline.com/toc/tebc20/current
  3. Critical appraisal of the evidence: Evidence includes external published evidence, and relevant internal evidence from your own clinical practice. There are helpful checklists to guide your critical of external evidence http://www.casp-uk.net/casp-tools-checklists
  4. Implementation: This involves the implementation of a clinical bottom line (or a modified version of a clinical bottom line after problem-solving barriers and enablers to clinical practice). It can also involve the adoption of strategies for facilitating the application of  evidence into practice, such as focused meetings about the change to practice, audit and feedback on clinical practice, the creation and use of printed materials about the change, e-reminders)(Grumshaw, Eccles, Lavis, Hill, & Squires, 2012). Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science, 7(1), 50. doi:10.1186/1748-5908-7-50
  5. Evaluation: It is important to evaluate the impact of a change to clinical practice and/or how the application of a modified form of a clinical bottom line has changed (or not changed) clinical practice. There are multiple ways to measure impact. The most common would be to collect data using a reliable and valid outcome measure

How can I join the network?

If you’re interested in joining the network,  see the training page for the steps to joining the network

Criteria to join

  • Qualified speech pathologists working in NSW in any clinical setting (i.e., public or private practice) are welcome to join the Network.

 

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