Abstract
BackgroundEvidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not.MethodsThe core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative.DiscussionThis study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP.
Highlights
Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized
Numerous authors note the gap between current practice and available evidence and/or describe multiple barriers to achieving EBP [1,2,3,4,5,6,7,8]
While findings of the study will have limited generalizability, they will be theoretically transferable and will lead to a number of propositions or hypotheses that can be tested in future research [15]. Data from this comparative, explanatory case study will be analyzed across data sources, across collection methods, across individual units within a case, and across case hospitals
Summary
Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. The Committee on Quality of Health Care in America, in Crossing the Quality Chasm, noted the need to recognize quality as a system property, that is, as a contextual property This need includes systems that "facilitate the application of scientific knowledge to practice, and provide clinicians with the tools and supports necessary to deliver evidencebased care consistently and safely [p. 7–8, [1]]." Such a focus inherently implies the necessity of a broad, strategic view of the practice environment relative to EBP, or, as evolving research suggests, a need to consider methods and strategies for integrating use of evidence into the fabric of the clinical organization [9,10,13,14]. Neither has it appeared to consistently spread related improvements, if they are initially achieved, and the research-practice gap continues to be a challenge
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