Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Abstract

BackgroundThere is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice.MethodsA mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization.ResultsThe two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP.ConclusionOur findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively.

Collective action for knowledge mobilisation: a realist evaluation of the Collaborations for Leadership in Applied Health Research and Care

“…44 distributed leadership has been shown to provide a necessary condition and mechanism for collective action around implementation. 16,113 It has been suggested that leadership within collaboration is concerned with making things happen -specifically, the formulation of the collaboration's plan/policy and activity agenda. 76 The importance of leadership for successful change, innovation and implementation is reflected in existing theory and frameworks (e.g.…”

“…Although there are some exceptions to this (e.g. Dopson and Fitzgerald, 111 Crammer et al, 112 Stetler et al 113 ), we know little about how and/or why implementation might take place within more sustained interactions such as organisational partnerships and collaborations like CLAHRCs. While reinforcing some aspects of the existing evidence base, such as that implementation is multifaceted and context is important, our findings also provide a more detailed narrative about the nature and pattern of interactions.…”

Leadership in evidence-based practice: a systematic review

“…Nine of the 17 studies provided information that allowed assessment of how leadership was operationalized (Aarons, 2006, Boström et al, 2007, Brown and McCormack, 2011, Cummings et al, 2010, Estabrooks et al, 2007, Forsman et al, 2012, Hagedorn and Heideman, 2010, Schultz and Kitson, 2010, Stetler et al, 2009). The studies varied greatly with respect to how leadership was measured and how instruments were used.…”

Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study

“…[89][90][91] Our findings help to explain that context does not simply act as a backdrop to action (i.e. as a set of obstacles or facilitators), but that is where implementation takes place.…”