Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context

Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature.

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Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

Australian Health Review ◽

10.1071/ah020178 ◽

2002 ◽

Vol 25 (4) ◽

pp. 178 ◽

Cited By ~ 1

Author(s):

Stewart L Einfeld ◽

John Beard ◽

Margaret Tobin ◽

Richard Buss ◽

Michael Dudley ◽

...

Keyword(s):

Young People ◽

Service Provision ◽

Policy Development ◽

Best Practice ◽

Service Management ◽

Evidence Based Practice ◽

Successful Implementation ◽

Evidence Based ◽

Self Harm ◽

Attitudinal Changes

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/ attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

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Evidence-Based Practice: The Cochrane Collaboration, and Occupational Therapy

Canadian Journal of Occupational Therapy ◽

10.1177/000841749806500304 ◽

1998 ◽

Vol 65 (3) ◽

pp. 144-151 ◽

Cited By ~ 14

Author(s):

Robyn L. Hayes ◽

John J. McGrath

Keyword(s):

Systematic Reviews ◽

Randomised Controlled Trials ◽

Best Practice ◽

Evidence Based Practice ◽

Occupational Therapists ◽

Cochrane Collaboration ◽

Controlled Trials ◽

Evidence Based ◽

Randomised Controlled ◽

The Cochrane Collaboration

This paper describes how occupational therapists can become involved in the Cochrane Collaboration — a well-developed tool for facilitating the involvement of health professionals and lay people in evidence-based practice. The Cochrane Collaboration is a growing international project intended to systematically locate, conduct systematic reviews (including metaanalyses) of, and disseminate information on all available randomised controlled trials of interventions in any area of health. In particular, occupational therapists can use the Cochrane Collaboration to become better informed about best practice and evaluate research in their areas of interest, and learn skills related to conducting randomised controlled trials, systematic reviews, and meta-analyses.

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Nursing culture

Journal of Child Health Care ◽

10.1177/1367493514530956 ◽

2014 ◽

Vol 19 (4) ◽

pp. 550-557 ◽

Cited By ~ 3

Author(s):

Ellen M Henderson ◽

Margaret Fletcher

Keyword(s):

Health Service ◽

Focus Groups ◽

Evidence Based Practice ◽

Everyday Practice ◽

Time Constraints ◽

Resource Utilisation ◽

Evidence Based ◽

Institutional Level ◽

Nursing Culture ◽

Ready Access

Evidence-based practice (EBP) is challenging for most nurses due to the time constraints of caring for patients and the emerging pressures of a changing health service. To explore these challenges, and thus to establish possible means of overcoming them, three focus groups ( n = 17) with children’s nurses were conducted. Participants were asked how they would define EBP, what the barriers to EBP were, what skills they needed to help access evidence and how they could integrate evidence into everyday practice. Data were analysed thematically and the anticipated themes of definitions of EBP, barriers, education and nursing culture were determined. Important subthemes were personal and employer disengagement, passivity and lack of resource utilisation. Passive use of evidence readily available in patient folders and on the wards was common. It seemed that little consideration was given to how often this evidence was updated. Nurses define their access to evidence as primarily passive in nature. This is reinforced by a lack of ready access to ongoing education and a perceived lack of investment at institutional level in their continued engagement with evidence. Promoting EBP needs to engage more with those ritual and traditional aspects of nursing culture to challenge these perceptions.

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Tele-ICU Partners Enhance Evidence-Based Practice

AACN Advanced Critical Care ◽

10.4037/nci.0b013e31825dfec5 ◽

2012 ◽

Vol 23 (3) ◽

pp. 312-322 ◽

Cited By ~ 3

Author(s):

Carol Olff ◽

Cynthia Clark-Wadkins

Keyword(s):

Health Care ◽

Length Of Stay ◽

Best Practice ◽

Evidence Based Practice ◽

Care Delivery ◽

Health Care Team ◽

Evidence Based ◽

New Members ◽

Management Protocol ◽

Information Research

Evidence-based practice (EBP) has become more than just a trendy buzzword in health care; EBP validates care delivery methods and grants satisfaction to nurses in knowing the care they provide is based on valid, current information. Research-based enhancements are paramount to the advancement of nursing practice and prompt the implementation of creative methods to improve care. The advent of the tele–intensive care unit (ICU) introduces new members of the health care team to assist with implementation of EBP initiatives. This new partnership results in improved length of stay, mortality rates, and ventilator times for critical care patients. Current literature suggests that a clinician-driven, standardized ventilator management protocol is of significant benefit. Tele-ICU clinicians provide an interactive element to coordinate interdisciplinary team efforts. Enhanced communication, data evaluation, and timely intervention expedite the weaning process and reduce ventilator length of stay. Consistent collaboration between tele-ICU and bedside clinicians successfully improves patient outcomes through standardized adherence to best-practice initiatives.

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Identifying Best Practice for Communication of Evidence‐Based Practice Changes to Frontline Nurses at a Large Complex Health Organization

Worldviews on Evidence-Based Nursing ◽

10.1111/wvn.12421 ◽

2020 ◽

Vol 17 (3) ◽

pp. 246-248

Author(s):

Ashley Hole ◽

Natalie Bell ◽

Kathleen Burt ◽

Abigail Cohen ◽

Megan Dunne

Keyword(s):

Best Practice ◽

Evidence Based Practice ◽

Evidence Based ◽

Large Complex ◽

Health Organization

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THE ROAD TO ACCEPTANCE OF DRIVER RETIREMENT FOR PATIENTS WITH DEMENTIA: PHYSICIANS’ AND PATIENTS’ PERSPECTIVES

Innovation in Aging ◽

10.1093/geroni/igz038.430 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S117-S117

Author(s):

Theresa L Scott ◽

Jacki Liddle ◽

Nancy A Pachana ◽

Elizabeth Beattie ◽

Geoffrey Mitchell

Keyword(s):

Focus Groups ◽

Best Practice ◽

Current System ◽

Driving Safety ◽

Evidence Based ◽

Driving Cessation ◽

Safe Driving ◽

The Road ◽

Assessment Measures ◽

Evidence Based Guidelines

Abstract People living with Alzheimer’s disease and related dementias (ADRD) must eventually stop driving. While some will voluntarily retire, many others will continue to drive until a crisis. In Australia, like many other countries, general physicians/practitioners (“GPs”) play a key role in monitoring driving safety and driver retirement with their patients with ADRD. Advising patients about driving cessation is one of the most challenging aspects of clinical dementia care, complicated by limited time in consultations, lack of patient awareness and insight, and objective screening and assessment measures. We examined how to support best practice in relation to management of driving cessation with patients with ADRD through focus groups with 29 GPs and contrasted their perspectives with those of 11 retired drivers with ADRD. Focus groups and interviews were transcribed and thematically analysed. Themes discovered highlighted the importance of providing education about the effects of dementia on safe driving and incorporating regular assessment of driving safety into the care continuum. Key strategies that GPs successfully employed included acknowledging loss and encouraging continued community engagement, providing referral pathways, and deferring to other GPs within the practice in challenging circumstances. In conclusion, there is demand for an overhaul of the current system of management and a need to establish nationally aligned, standardized and evidence-based guidelines, in particular relating to assessment of safe driving. In the meantime, we can learn from these GPs who have implemented particular strategies that mitigate some of the challenges and complex driving related issues that present in primary care.

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The barriers perceived to prevent the successful implementation of evidence‐based practice by speech and language therapists

International Journal of Language & Communication Disorders ◽

10.1080/13682820802585967 ◽

2009 ◽

Vol 44 (6) ◽

pp. 1018-1035 ◽

Cited By ~ 11

Author(s):

Siobhan O'Connor ◽

Catharine M. Pettigrew

Keyword(s):

Evidence Based Practice ◽

Successful Implementation ◽

Evidence Based ◽

Speech And Language

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Use of Evidence-Based Practice Among Athletic Training Educators, Clinicians, and Students, Part 2: Attitudes, Beliefs, Accessibility, and Barriers

Journal of Athletic Training ◽

10.4085/1062-6050-48.2.19 ◽

2013 ◽

Vol 48 (3) ◽

pp. 405-415 ◽

Cited By ~ 21

Author(s):

Cailee W. McCarty ◽

Dorice A. Hankemeier ◽

Jessica M. Walter ◽

Eric J. Newton ◽

Bonnie L. Van Lunen

Keyword(s):

Clinical Practice ◽

Athletic Training ◽

Evidence Based Practice ◽

Athletic Trainers ◽

Perceived Barriers ◽

Successful Implementation ◽

Evidence Based ◽

Attitudes And Beliefs ◽

Athletic Training Educators ◽

Personal Skills

Context: Successful implementation of evidence-based practice (EBP) within athletic training is contingent upon understanding the attitudes and beliefs and perceived barriers toward EBP as well as the accessibility to EBP resources of athletic training educators, clinicians, and students. Objective: To assess the attitudes, beliefs, and perceived barriers toward EBP and accessibility to EBP resources among athletic training educators, clinicians, and students. Design: Cross-sectional study. Setting: Online survey instrument. Patients or Other Participants: A total of 1209 athletic trainers participated: professional athletic training education program directors (n = 132), clinical preceptors (n = 266), clinicians (n = 716), postprofessional athletic training educators (n = 24) and postprofessional students (n = 71). Main Outcome Measure(s): Likert-scale items (1 = strongly disagree, 4 = strongly agree) assessed attitudes and beliefs and perceived barriers, whereas multipart questions assessed accessibility to resources. Kruskal-Wallis H tests (P ≤ .05) and Mann-Whitney U tests with a Bonferroni adjustment (P ≤ .01) were used to determine differences among groups. Results: Athletic trainers agreed (3.27 ± 0.39 out of 4.0) that EBP has various benefits to clinical practice and disagreed (2.23 ± 0.42 out of 4.0) that negative perceptions are associated with EBP. Benefits to practice scores (P = .002) and negative perception scores (P < .001) differed among groups. With respect to perceived barriers, athletic trainers disagreed that personal skills and attributes (2.29 ± 0.52 out of 4.0) as well as support and accessibility to resources (2.40 ± 0.40 out of 4.0) were barriers to EBP implementation. Differences were found among groups for personal skills and attributes scores (P < .001) and support and accessibility to resources scores (P < .001). Time (76.6%) and availability of EBP mentors (69.6%) were the 2 most prevalent barriers reported. Of the resources assessed, participants were most unfamiliar with clinical prediction rules (37.6%) and Cochrane databases (52.5%); direct access to these 2 resources varied among participants. Conclusions: Athletic trainers had positive attitudes toward the implementation of EBP within didactic education and clinical practice. However, accessibility and resource use remained low for some EBP-related resources. Although the perceived barriers to implementation are minimal, effective integration of EBP within athletic training will present challenges until these barriers dissolve.

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