A Qualitative Exploration of Adaptation Discussions During EBP Implementation

Abstract

Balancing fidelity and adaptation during implementation of evidence-based practices is a critical issue for healthcare organizations; however, the processes involved in adaptation are not well understood. We build on the EPIS framework and ICT model by providing in depth information about inner and outer contextual factors that drive adaptation, as well as the processes that support discussions of adaptation. We examine 121 meeting and process notes using a grounded theory approach. Five types of adaptation are discussed in these documents. Key inner contextual drivers of adaptation relate to organizational characteristics and user characteristics, while outer contextual drivers involve funding, contracting arrangements, and client characteristics. Four emergent themes describe processes that can encourage adaptation discussions during active implementation: (1) setting boundaries between the practice and adaptation; (2) addressing resistance; (3) normalizing adaptation; and (4) cultivating psychological safety. This study examines naturalistic discussions of adaptation to lay the foundation for a more complex process model of adaptation during EBP implementation.