Amir Rasheed’s eclectic background in clinical practice, government, information technology and quality improvement may seem disparate. But at the heart of all his work experiences is an enthusiastic desire to influence change that helps people. Now, according to him, he has the best job ever.
In this interview, he talks about one of the Institute’s best practice implementation projects in secondary complications -- the Knowledge Mobilization Network -- now being implemented at six sites across Canada.
Where are you from originally? I was born in Pakistan and moved with my family to Edmonton, when I was seven. I later moved to Ontario to attend University of Toronto. When my family moved to Seattle, I moved to Vancouver to be closer to them.
|Amir Rasheed, Rick Hansen Institute's Director of Best Practice Implementation
You trained as an Occupational Therapist. What inspired you to study in that field? My interest was in doing something in the health sector. In the last year of high school, my grandfather had a stroke and went through rehab in a local hospital. I was very close to him, and got to experience all the care he received which gave me a broad exposure to healthcare programs and the impact they could have. The occupational therapist (OT) was most engaging with him and with me. She was a good teacher about her profession, and my grandfather’s needs, and that attracted me to the profession.
How does the work you do now directing best practice implementation (BPI) relate to that time? I learned, through the experience with my grandfather, that an influential person can make things happen in a faster way…that the hands on, human approach works. The research into knowledge transfer (or BPI) suggests the same: nothing beats human interaction. It’s one person teaching another.
"Looking at complex problems and finding creative
So much of healthcare is about the human experience and the touch that people have…that intimate relationship that you develop with people you care for. In OT, you look at the broad spectrum of their lives. When I worked in the brain injury area, I saw that, in the first few weeks following an injury, there can be a tremendous amount of change, and that’s pretty inspiring.
As an administrator, I have to overcome the need to see that change for myself, but I can see how system level changes can be done, how programmatic changes can happen. This work extends the clinician-patient interaction that impacts one individual at a time. Now, we can impact many, and are working to ensure that everyone who is injured now – and in the future – gets exceptional care.
Did you have aspirations to work in policy -- to change and improve systems -- when you first entered the field? No, but it felt like a natural progression. From being an OT, I transitioned into quality improvement and those two experiences ground my work today.
Tell me about Best Practice Implementation. Evidenced-based care has always been a core value, and the concept of translating evidence into practice has been there for years. But, there’s been a clear gap in the healthcare system around how to translate evidence in a way that is sustainable. Applying scientific rigour to the process and practice of implementation is a big change.
Now there is more of a focus -- driven by constraints on funding -- on applying knowledge, and administrators want to make sure that scientists engaged in research are well connected to the users of that knowledge: the clinicians, administrators and consumers.
So how do you make it work properly? A lot of good research information is sitting on bookshelves -- the challenge is not just translating it into practice but making it stick!
We’ve learned that there are key elements to impact the successful absorption -- or ‘stickiness’ -- of a best practice, and are now testing implementation processes with the Knowledge Mobilization Network (the Network). Some of the objectives of a successful implementation are outlined in the Institute of Healthcare Improvement Triple Aim Model:
- Improve the health of the population
- Enhance the patient experience of care (including quality, access, and reliability); and
- Reduce, or at least control, the per capita cost of care.
Why is this important? In some cases, things are done that are not based in evidence but because someone has said it’s a “best practice”. This is not often sustainable, nor does it lead to improve healthcare outcome, and in some cases may actually bring harm.
But knowing the best practice is only half the battle. We also need to contextualize that into various health care systems, and ensure that the practice fits with professional, legal and policy requirements.
Through the Network, we are now working on guidelines for pressure ulcer care -- synthesizing the evidence from the Canadian Clinical Practice Guidelines study* of 41 published recommendations - to change clinical practice. We prioritized two recommendations: a standardized risk assessment and comprehensive education about pressure ulcer management.
"The Institute fits this role well because -- grounded in evidence with sound methodology -- we bridge the two divides."
What’s the Institute’s role in this? While translational research requires a specific methodology and is backed by well-established process, Implementation Science is an emerging discipline…one that isn’t well understood. Best Practice Implementation lives at the intersection of translational research, social science, psychology and marketing.
Very few organizations are leaders in doing this, and there are very few national experts.
Without us helping to bring people together, this wouldn’t happen. We fund and link centres interested in collaboration. We bring researchers and clinicians together around a subject area (in this case, pressure ulcers) to exchange ideas on ways to implement guidelines. We use the (Rick Hansen Spinal Cord Injury) Registry to collect and compare data, and SharePoint to share documents to contextualize the information and collaborate on learning. How would they do that, otherwise?
How would you describe your particular role? I would best describe my job not as an OT with a health administration background, rather as an anthropologist looking at how decisions are made, how people interact with one another and the system, at social norms, the culture and values of health systems. Through that lens, I’ll know that if we want people to provide better pressure ulcer management, for example, we need to do ‘ABC’ over time.
How will the Knowledge Mobilization Network evolve? Our expectation is that once guidelines are established in SCI rehabilitation care, we will scale the efforts upstream into acute care and downstream into the community, across the entire continuum of SCI care. More importantly, we can help support clinical practice outside SCI care. For example, an OT who helps patients prevent a pressure ulcer in SCI rehab can also provide that same expertise in different settings such as long term care.
What are your goals? I envision that, several years from now, every facility in Canada will deliver a standardized level of care using the same set of best practices and specific standards for SCI Care. In the short term, best practice guidelines for ulcer treatment will be fully implemented throughout the six Knowledge Mobilization Network sites in early 2013, and then we prepare for implementation of pain management guidelines. With the systems and relationships we are putting in place, this process can be accelerated as we expand.
It’s the exponential power of collective wisdom, isn’t it? Yes! We fund one person in each place to implement a best practice and it’s a seed that grows. Depending on the issue, the types of people involved in the team change - a clinician, a nurse, an OT, a pharmacist, a surgeon. We share, learn from each other and improve along with way.
Implementation science is a team sport, and a marathon.
How do you feel about the work…are we on the right track? This is the best job I’ve ever had. I’ve done a lot of awesome things but here, we have a great network of dedicated researchers and clinicians wanting to make a positive change…and I know we are.
Check out this video of Amir talking about his role at RHI and the importance of Best Practices.
*Canadian Clinical Practice Guidelines for the treatment of pressure sores in people with SCI Pamela E. Houghton, PT, PhD (Associate Professor, School of Physical Therapy, University of Western Ontario).