Factors for Sustainability of Evidence-Based Practice Innovations: Part I

Abstract

The translation of research-based evidence into nursing practice has increased significantly over the past decade and has fostered the delivery of high-quality care, improved patient outcomes, decreased practice variability in care, and reduced health care costs (Stevens, 2013). Despite the palpable benefits of evidence-based practice, nurse leaders and other health care professionals often encounter challenges while implementing innovative practices. Unless these challenges are used as a learning experience and used as information to refine implementation processes, any immediate gains will not be sustained (Doyle et al., 2013). This column will define sustainability and address four important factors, which are key in facilitating sustainability of improvement projects.According to the National Health Service Modernisation Agency (2002), sustainability is defined as the standardization of ways of and the maintenance of improved outcomes over time. Not only have the processes and outcomes changed, but thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed in support (p. 12). Therefore, implementing projects based on trial-and-error thinking without attention to using supportive evidence and/or perfecting implementation processes does not foster sustainability. According to Wallin, Bostrom, Wikblad, and Ewald (2003), sustainability of effective and valuable evidence-based practices are deemed a more vital component of quality improvement efforts than repetitive introduction of new strategies, which are not based on the highest level and quality of evidence. In addition to the need to base improvements on the best available evidence, a primary and very important step toward ensuring sustainability is to make an investment in engaging stakeholders in the development and implementation of any improvement project from Day 1 (Burke & Levin, 2010).Few studies have described factors that promote sustainability of evidence-based quality improvement initiatives. The extant literature (Clarke & Marks-Maran, 2014; Johnston, Hays, Center, & Daley, 2004; Mancini & Marek, 2004; Scheirer, 2005; Shediac-Rizkallah & Bone, 1998) that has addressed sustainability of practice innovations has identified the following common factors:1. Strong leadership2. Support of stakeholders3. Nurse champions4. Modifiable projects that are in alignment with the organization's vision, mission, and goalsSTRONG LEADERSHIPHealth care organizations that sustain quality improvement efforts often demonstrate evidence-based leadership that promotes an operational framework to reduce costs, improve quality of care, and enhance patient satisfaction (Studer, 2014). To effectively implement and sustain new evidence-based quality improvement projects, it is imperative for all levels of interprofessional leaders in a health care organization to join forces and collaborate on a shared mission. Morrow, Robert, and Maben (2014) explored the nature and impact of four levels of leadership relative to the implementation of evidence-based quality improvement projects (Figure 1). The first leadership level consists of executive and senior leaders, who are primarily responsible for strategically aligning quality improvement projects with organizational vision, mission, and goals, incorporating quality improvement staff in project development and implementation and acquiring and allocating funds for such improvements. The second leadership level involves project leaders, who plan the process of implementation with executive and senior leaders working collaboratively, with internal quality improvement teams and external networks. These teams facilitate education of staff and monitor project processes and outcomes. The third leadership role is middle managers; these individuals inform unit staff of new impending quality improvement projects, encourage staff to participate on projects, connect staff with quality improvement team members, and facilitate meetings and shared learning experiences. …