Practitioners’ conceptualisations of ‘evidence-based practice’ as a barrier to changing practice

Abstract

The promotion of evidence-based, healthcare practice is a key concern for healthcare professionals both in the UK and internationally. However, what healthcare professionals understand by the term ‘evidence-based practice’ varies, and this can have implications for changing practice. This discussion piece describes a doctoral research project exploring the implementation of a new Enhanced Recovery Pathway (ERP) in three NHS hospitals. ERPs are evidence-based approaches to streamlining surgery and research demonstrates the positive impacts that their introduction has had for patient hospital stay, morbidity and mortality, post-surgical complications and quality of life. The ERP discussed in this article was designed to address the specific, complex needs of patients with cognitive impairment who fracture their hip. These patients are currently underrepresented in published literature regarding ERP effectiveness. As such, the evidence informing the ERP’s design consolidated current best practice guidelines, expert consultation and guidance from public and patient involvement groups. Staff members who were tasked with coordinating the implementation interpreted this to mean that the ERP was not sufficiently ‘evidence-based’. This presented an unexpected barrier to changing staff behaviour and successful ERP implementation. To promote successful intervention implementation, policy makers need to carefully consider how staff conceptualise ‘evidence-based practice’ and their attitudes towards newly introduced practices.