Implementing Evidence-Based Practice In Healthcare

Journal Article Evidence-Based Practices in Health Care: Social Work Possibilities Get access Joan Levy Zlotnik, Joan Levy Zlotnik Search for other works by this author on: Oxford Academic PubMed Google Scholar Colleen Galambos Colleen Galambos Search for other works by this author on: Oxford Academic PubMed Google Scholar Health & Social Work, Volume 29, Issue 4, November 2004, Pages 259–261, https://doi.org/10.1093/hsw/29.4.259 Published: 01 November 2004

More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first-line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow-up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge-related preconditions had greatest impact on implementation. The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application.

The Foucauldian concepts of governmentality and pastoral power have been used to explain the way health professionals internalise evidence-based practices in health care generally and clinical networks more specifically. However, we know little about the work, practices and process involved in developing and implementing an ‘evidence-based governmentality’ outside the West, particularly in Low and Middle Income Counties (LMICs), where governmentality often has a different transnational character. We explain the development and implementation of a Western transnational evidence-based governmentality in a clinical network in Kenya, using a decentred analytical approach. We highlight the essential work of medical professional ‘pastors’, with experience of both health care in Kenya and evidence-based medicine in Western High-Income Countries, in transposing this governmentality into health care in a LMIC in a way improving clinical care.

Background: Research competencies across nurses’ career stages have not been adequately explored. Yet, research skills to appraise, synthesize, and implement research findings are required for evidence-based practice. Purpose: To explore the literature on registered nurse research competencies; to identify core competencies (i.e., knowledge, skills, and attitudes), research capacity-building activities, strategies and recommendations to strengthen nurses’ research capacity; and to propose a conceptual developmental framework of nurse research competencies. Methods: As part of a larger project titled “Health Services Researcher Pathway”, with the consultation of a health sciences librarian, we conducted an integrative literature review drawing on relevant publications. The PubMed (Medline), CINAHL, Web of Science and ProQuest Dissertations and Theses databases were searched from 2000 to 2012. From the revealed publications (n=1012), only 22 articles were relevant to nurse research competencies. Findings: The key themes cited in the literature reviewed include models and partnerships for building and developing competencies for research production (rather than utilization), and educational strategies and recommendations for interventions to provide confidence in evidence-based practice including research utilization and in clinical decision-making. According to the five-step evidence-based practice model (i.e., formation of answerable research questions, literature search and retrieval of the best available evidence, critical appraisal of the evidence, application of research findings into practice, and evaluation of performance based on the outcomes), we propose a framework for a nurse researcher pathway that may contribute to two research competency streams: for research users and research producers. The important area of research users is open for further research, since scarce literature exists. Conclusions: The proposed conceptual developmental framework for a nurse researcher pathway includes essential steps toward evidence-based practice in healthcare that have implications at the micro-level (nurse), meso-level (organization), and macro-level (society). Our work continues to pilot and refine a nurse researcher pathway and its associated competencies.

Evidence-based Practice Journal Club: How We Do It

BackgroundMiddle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role.MethodsWe searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge.ResultsOne hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role.ConclusionsOur findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice.

With the focus on evidence-based practice in healthcare, a well-conducted systematic review that includes a meta-analysis where indicated represents a high level of evidence for treatment effectiveness. The purpose of this commentary is to assist clinicians in understanding meta-analysis as a statistical tool using both published articles and explanations of components of the technique. We describe what meta-analysis is, what heterogeneity is, and how it affects meta-analysis, effect size, the modeling techniques of meta-analysis, and strengths and weaknesses of meta-analysis. Common components like forest plot interpretation, software that may be used, special cases for meta-analysis, such as subgroup analysis, individual patient data, and meta-regression, and a discussion of criticisms, are included.

BackgroundClinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program.MethodsThis process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design.ResultsThe CONNECT intervention’s original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context.ConclusionThis approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness.Trial registrationThe study was registered at ClinicalTrials.gov (NCT03300336) on September 28, 2017.

BackgroundResearch is crucial for improved healthcare and better patient outcomes, but there is a current shortage of clinician-researchers who can connect research and practice in the health professions field. This study aimed to investigate the effect of career stage, previous training and involvement in research on health professionals' (HPs) motivations to engage in research while in public hospital clinical roles. HPs' perceived motivation concerning the importance, value, and barriers attributed to research during different career stages were examined.MethodsA mixed methods study design was adopted for this research. An online survey developed based on the Expectancy-Value-Cost (EVC) theory was distributed to HPs (doctors, nurses, midwives, and allied health professionals) in three North Queensland Public Hospitals. Data analysis included descriptive and inferential statistics for the quantitative data and content analysis for the qualitative text responses.ResultsThree hundred and fifty-five responses were received. Prior research training and involvement in research influenced respondents' perceptions about the importance, attitude, motivators, and barriers to research. Attainment value was the overarching motivation for involvement in research and research training for all career stages and all professional HP groups. Positive attitude to research was significantly higher (P = 0.003) for the allied health group (27.45 ± 4.05), followed by the medical (26.30 ± 4.12) and then the nursing and midwifery group (25.62 ± 4.21). Perceived importance and attitude attributed to research were significantly higher (P < 0.05) for those who had research training (26.66 ± 3.26 and 28.21 ± 3.73) compared to those who did not have research training (25.77 ± 3.77 and 23.97 ± 3.53). Significantly higher (P < 0.05) perceptions of organisational and individual barriers were reported among early career (50.52 ± 7.30) respondents compared to their mid-career (48.49 ± 8.14) and late career (47.71 ± 8.36) counterparts.ConclusionThe findings from this study provide valuable insights into the factors that influence HPs' motivation for research. The results underscore the importance of professional group, involvement in research, exposure to research training, career stage, gender, and organisational support in shaping HPs' attitudes, values, and perceived barriers to research. Understanding these factors can inform the development of targeted strategies to enhance research engagement among HPs and promote evidence-based practice in healthcare.

BackgroundKnowledge translation (KT) interventions are essential for implementing evidence-based practices in healthcare. However, despite their proven effectiveness in addressing global health challenges, KT strategies in surgery remain challenging to apply. This scoping review examines KT strategies in surgery, their effectiveness, and key barriers and enablers to their implementation.MethodsThis scoping review followed the Arksey and O’Malley and Levac et al. frameworks, integrating the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and the PRISM (Practical Robust Implementation Sustainability Model) models to evaluate the effectiveness of knowledge translation interventions in surgical practice change and associated contextual barriers and facilitators. A systematic search was conducted across MEDLINE (PubMed, OVID), CINAHL (EBSCO), and PsycINFO (ProQuest). Articles were screened using predefined selection criteria, emphasizing experimental and quasi-experimental studies. Data extraction categorized KT interventions: knowledge diffusion, dissemination, and implementation approaches.ResultsA total of 34 studies met the inclusion criteria. Most were hospital-based (88%) and focused on guideline adherence. The review identified three primary KT strategies: (i) educational materials and educational outreach, (ii) reminders and prompts, and (iii) audit and feedback systems. The most effective KT strategies used a combination of these interventions to maximize impact. Barriers included physician resistance, limited leadership support, financial constraints, and workflow disruptions, while enablers included institutional leadership, structured training programs, financial incentives, and interdisciplinary collaboration. A notable finding was the lack of standardized validation processes for adopting changes in the surgical setting, which often burdens individual surgeons and their institutions, thereby constraining both capacity and motivation for practice change.ConclusionsFindings suggest that layered, interdisciplinary KT strategies are the most effective for driving surgical practice change and overcoming institutional barriers. The integrated application of RE-AIM and PRISM frameworks proved valuable in assessing the interventions’ sustainability and real-world effectiveness. This comprehensive analysis contributes to the growing body of knowledge on effective implementation strategies in surgical settings and provides a foundation for future practice improvement initiatives. Future research should focus on refining KT methodologies, expanding implementation frameworks, and addressing barriers to sustainability across diverse surgical settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13369-2.

BackgroundAlthough evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians’ decision making at the point of care.MethodsThree iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.).ResultsOf the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts’ usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or treatment plan. The bottom-line summaries were used more in the office (79.3%), and abstracts were used more at point of care (51.9%).ConclusionsClinicians reported that retrieving relevant health information from biomedical literature using the PubMed4Hh was useful at the point of care and in the office.

According to the 2006 needs assessment conducted by the Hospital Libraries Section (HLS) of the Medical Library Association (MLA), 30.4% of the members responding to the assessment considered evidence-based medicine (EBM) the most important issue they would face in their workplace over the next three years [1]. The responsibilities and support systems of hospital librarians desiring to foster clinicians' practice of evidence-based health care (EBHC) might vary significantly from those of academic librarians. Scherrer et al. reported, “The academic librarian who supports active evidence-based practice curricula in health professions colleges will need teaching approaches that are appropriate for instruction of students in a classroom, while the hospital librarian may be looking for point-of-need instructional techniques that would be effective with residents and clinicians” [2]. While the EBHC support–related needs of individual librarians in either the academic or hospital settings will likely include other approaches as well, the specific needs and attitudes of hospital librarians toward EBHC have not been well explored. This paper reports data collected via a larger survey of hospital librarians regarding hospital librarians' perceptions of the skills required to support EBHC. Results of the survey may be used to inform exploration of the extent to which EBHC has penetrated beyond the academic medical library sphere into the domain of the hospital library and indicate areas for further training for librarians.

Incorporating evidence-based healthcare practice would improve patients' response and safety and make patients partners in current healthcare practice. This partnership is certain to offer patients the opportunity to guide safety initiatives through data access by clinicians and encourage evidence-based healthcare while alleviating potential medical errors. In this paper, we promote a collaborative model that integrates interrelated concepts for responsive healthcare services that target patient-centred healthcare--with healthcare providers and relevant stakeholders in the loop. The implementation strategies for fulfilling the desired healthcare outcomes as well as design implications are also provided. The model is expected to offer transformative impact that would drive our weak healthcare system for improved healthcare and complement the huge dearth in healthcare services. The outcome is shared prosperity and health, and a mainstream of the people into healthcare decision making for informed policy planning and implementation.

Action potential is a key process by which signals are transmitted from one nerve cell (neuron) to another, and as this editorial suggests, the structure and functions of neurons share some analogies with implementation science. Neurons are the critical subunit of the nervous system that mediate receipt and transmission of essential chemical and electrical signals that enable us to survive and thrive. In neurons, messages (action potentials) are driven by transfer of positive and negatively charged ions back and forth across the cell membrane causing an electrical charge to be transmitted in about 7 ms – much quicker and more reliable than a lightning strike. To allow rapid conduction of electrical signals and make them more energy efficient, certain neuronal axons are covered by a myelin sheath.1 Myelination is essential to nerve health, as well as speed and directness of impulse transmission.2 Similarly, the role of JBI Evidence Implementation is essential to ensure the prompt dissemination of implementation case studies and other related publications. Getting the signal through with the desired speed and adequate signal ratio in evidence-based health care (EBHC) is often described as dissemination or knowledge transfer; effective dissemination is as complex as neural transfer. The purpose of JBI Evidence Implementation is to facilitate – analogous to an action potential, while the speed and directness that an implementation focused journal will contribute to expanding the toolbox of JBI methods and methodology in implementation is analogous to reinforcing the myelin sheath. The process is informed by the JBI model for EBHC, our framework for a global mission to see evidence used to inform decision-making at the point of care.3 The JBIC (JBI Collaboration) is a global collaboration, an interconnected network of practising health professionals, academics, researchers and policy makers and funders with a shared mission of identifying, disseminating, implementing and evaluating best practice.3 The JBIC has expertise in the pedagogy of implementation science and methods to diverse professional groups, as well as significant accumulated experience in mentoring and facilitating implementation studies across diverse geographic and sociocultural groups and a wide range of clinical specialties. JBI's programmatic approach to implementation has enabled standardisation in line with the JBI model.4 The launch of JBI Evidence Implementation is more than a rebadge and relaunch. It will enable dissemination of methods, programmes and projects for implementation of best practice by increasing the focus, directness and accessibility of content aligned with the JBI model to members of the JBIC and subscribers more widely. It is a behavioural nudge for JBI to amplify internationally the work we do at the point of care for implementation of evidence. The launch of JBI Evidence Implementation fills an opportunity gap for the JBIC that encompasses evidence implementation, including investigations of feasibility, applicability, meaningfulness and effectiveness in healthcare delivery and practice, including emerging programmatic and pragmatic innovations such as JBI Endorsement (https://wiki.jbi.global/display/JEP). The journal accepts and will feature analytic and evaluation studies using standardised data sets of comparable implementation reports conceptually aligned with the JBI model.4 In parallel with JBI Evidence Synthesis (Editor in Chief: Associate Professor Aromataris), we recognise the strategic value of a journal for disseminating pragmatic implementation studies as well as the contribution to scholarship that makes visible the local implementation activities of the JBIC, that highlights and actively disseminates shared learnings and draws upon an expert editorial board, and the JBI Implementation Methods group. Increasing visibility and exposure to critique are important for further development of the scholarship implicit in JBI implementation studies. There is much methodological work to be done in these areas for which a publication pathway is an essential component of scholarship and contribution to implementation science. Studies of fidelity, and scalability, rapid cycle change projects that investigate improvement or implementation related to the JBI model for EBHC and the subcomponents of implementation including context, facilitation or evaluation are critical to our understanding of implementation across diverse clinical and cultural contexts. Similarly, theoretical and methodological work that evaluates, compares or contrasts approaches or world views are important ongoing contributions to knowledge. As such JBI Evidence Implementation aspires to provide the network support that speeds and strengthens the transfer of implementation science knowledge.5 As Editors in Chief, we are delighted to present JBI Evidence Implementation as an opportunity. Our vision as editors is to renew the JBIC focus on methodology, pedagogy and pragmatic implementation. We will achieve this by a focus on dissemination of rigorous, high-quality scholarship, research, synthesis and implementation case studies that inform and further the science and practice of EBHC within the context of implementation and improvement science. We have added new sections in the new journal including commentary/debates, educational articles in addition to other solicited articles to highlight JBI evidence implementation research to further the science of implementation and knowledge translation. We hope you enjoy reading and interacting with the newly available content each quarter and look forward to working with the implementation science community and across the JBIC. Acknowledgements Conflicts of interest The authors report no conflicts of interest.