Institutionalization of evidence-informed practices in healthcare settings

Gabriela Novotná,Joanna Henderson,Maureen Dobbins

doi:10.1186/1748-5908-7-112

Abstract

BackgroundThe effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, most KT research has been directed toward implementation strategies that apply cognitive, behavioral, and, to a lesser extent, organizational theories. In this paper, we discuss the potential of institutional theory to inform KT-related research.DiscussionDespite significant research, there is still much to learn about how to achieve KT within healthcare systems and practices. Institutional theory, focusing on the processes by which new ideas and concepts become accepted within their institutional environments, holds promise for advancing KT efforts and research. To propose new directions for future KT research, we present some of the main concepts of institutional theory and discuss their application to KT research by outlining how institutionalization of new practices can lead to their ongoing use in organizations. In addition, we discuss the circumstances under which institutionalized practices dissipate and give way to new insights and ideas that can lead to new, more effective practices.SummaryKT research informed by institutional theory can provide important insights into how knowledge becomes implemented, routinized, and accepted as institutionalized practices. Future KT research should employ both quantitative and qualitative research designs to examine the specifics of sustainability, institutionalization, and deinstitutionalization of practices to enhance our understanding of these complex constructs.

Highlights

The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care
Summary: Knowledge translation (KT) research informed by institutional theory can provide important insights into how knowledge becomes implemented, routinized, and accepted as institutionalized practices
Future KT research should employ both quantitative and qualitative research designs to examine the specifics of sustainability, institutionalization, and deinstitutionalization of practices to enhance our understanding of these complex constructs

Summary

Introduction

The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) is a complex, multifaceted, and interactive process that involves a variety of stakeholders at various levels: policy, organizational, healthcare team, and individual [1]. KT strategies, that we define here as overarching designs that outline carefully planned actions – KT interventions, must take into consideration that healthcare organizations are subjected to multiple demands from funders, clients, and professional bodies regarding the quality of care provided [3]. The complex individual, organizational, and system relations of healthcare organizations may result in significant difficulties in implementing research-informed interventions in real-world settings, despite the apparent ease of implementation in well-controlled research environments [4]. Given that changes in clinical practice are not solely dependent on the actions of clinicians, but rather require organizational and systems support, KT strategies and interventions targeting only individual-level factors are limited in their capacity to bring about and sustain significant change [8,9]

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