Within the context of JBI, the metaphor of the "ripple effect" is used as a concept of one idea or piece of knowledge having long lasting effects, as reflected in our logo. It is also based on the understanding that we are all connected and have the capacity to achieve if we have the will, to make a difference if we have the desire and to change the world if we have the courage.
When JBI was launched in December of 1996, it could not have been anticipated how these ripples would reverberate throughout the evidence based healthcare movement. Ultimately the reality is that the ripple effect is immeasurable and it is equally challenging to demonstrate the impact of the Joanna Briggs Institute over the last 20 years. However, with more than 80 collaborating entities across five regions of the world and thousands of subscribers to our content and tools, it is easy to see that the ripples caused by dropping that first "pebble" all those years ago have certainly continued to travel across the globe. These ripples have been international, scientific, technical and pragmatic in nature and I would like to take this opportunity to reflect on those achievements in this editorial.
Theinternationalripple effect[horizontal ellipsis]
Collaboration that crosses international borders can be particularly challenging and is a largely discursive journey. When the Institute was established, we had only five collaborating entities in three countries (Australia, New Zealand and Hong Kong). This grew to 24 entities across 12 countries in 2006 when we celebrated our 10th anniversary. Today we collaborate with over 80 entities (centers and groups) across 30 countries. We have experienced phenomenal growth since our inception and our work continues to garner the attention of academic groups internationally. Not only do these groups work with JBI centrally but they also collaborate regionally on a range of initiatives to promote and support evidence based healthcare, making them a powerful and positive international force. The collaborative model set up by the Institute has ensured that its international collaboration plays a central role in the broader machinery of the Institute itself.1
Thescientificripple effect[horizontal ellipsis]
From the moment JBI started, it was important that the work conducted would be relevant to decision making at the point of care. It was recognized that clinical questions were diverse and related to many different aspects of care provision. This is equally true of policy as it is of practice, and thus the Institute developed the FAME scale which sought to ensure that all aspects of clinical and policy decision making were covered. FAME, of course now familiar to many, was first published by Pearson and colleagues in 2005,2 and stands for the Feasibility, Appropriateness, Meaningfulness and Effectiveness of interventions. In line with this, the Institute recognizes the diverse nature of the evidence required to respond to such questions, and over the course of the last two decades has developed methodologies and methods for the synthesis of a broad range of research including research that utilizes both qualitative and quantitative perspectives and, where no research exists, narrative, opinion and text.
It was equally important that there be equal weight and attention given to the science of the Synthesis, Transfer and Implementation of research evidence. These three strategic focus areas would eventually form the basis of the JBI Model for Evidence Based Healthcare2 and now also align with the three core programs of the Institute in Adelaide. Although the scientific development for transfer and implementation is not yet as far progressed as for synthesis, they are certainly recognized as being of paramount importance to the Institute's ethos in relation to evidence based healthcare.
Thetechnologicalripple effect[horizontal ellipsis]
Information technology continues to change the way we interact, both socially and professionally. We have witnessed significant changes in this field over the course of the last two decades and JBI has always been mindful of the potential role of technology in promoting and supporting best practice - from synthesis to implementation. Although evidence based healthcare is a fast paced and dynamic movement, JBI has done its best to remain competitive in this space.
For evidence appraisal and synthesis, this has involved the development of tools such as the System for the Unified Management of the Assessment and Review of Information (JBI-SUMARI) and the Rapid Appraisal Protocol internet database (JBI-RAPid). Given that it has been suggested that the most significant change required today in the teaching of health professionals is to foster an aptitude for information management (as a major component of evidence based healthcare), tools such as these are becoming increasingly important.3
Equally, however, information technology is increasingly utilized to support evidence implementation and therefore the Institute has developed tools such as the Practical Application of Clinical Evidence System (JBI-PACES) and CAN-Implement. The importance of such systems has been emphasized by authors such as Wells who states that there is an increasing need for healthcare administrators to incorporate them into strategic IT plans so that practitioners can "assess the relevance and validity of available evidence" and incorporate it in their clinical decision making.4 (p7)
Thepoint of careripple effect[horizontal ellipsis]
The first annual report of the Joanna Briggs Institute stated three corporate members. This grew to 330 corporate members and 659 individual members in 45 countries by the end of 2006; in 2016 I am proud to report that our reach now spans well over 1000 subscribing institutions across 54 countries. This level of growth would no doubt have been far more challenging without the assistance of our global publishing partners Wolters Kluwer Health with whom we joined forces in 2012.
With 358 systematic reviews, 2443 evidence summaries and 793 recommended practices available in our database, the Institute continues to publish first class healthcare information to assist clinical decision making at the point of care.5
The impact of JBI at the point of care is further evidenced through participants in the JBI Evidence Based Clinical Fellowship Program. These clinical leaders, now numbering in the hundreds, have identified the JBI approach, and associated resources, as one that provides a meaningful framework within which they can engage with key stakeholders from across disciplines to ensure that practice is informed by the best available evidence. Not only is this true in the developed world but also at the point of care in low income economies like Africa with fellows stating that the JBI process has contributed to a heightened awareness amongst management and staff regarding evidence based practice and to the global effort to reduce mortality rates and improve outcomes.6
As was put so eloquently by Maximus Decimus Meridius (Gladiator), commander of the armies of the North, "what we do in life echoes in eternity". What JBI has achieved over the last 20 years has been nothing short of impressive, and it is with this sentiment that we celebrate our 20th anniversary this year. The people we have influenced as an organization and the impact (however hard to measure) that we have had on improving the quality of care and health outcomes for communities around the globe will be enduring. The ripple effect of JBI will, with any luck, outlast us all.
Executive Director
The Joanna Briggs Institute
References