Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e
348 Unit 3 / Steps 4 and 5: Moving From Evidence to Sustainable Practice Change
recommendation; and (2) implementing and sustaining that best practice. If the rst phase is done without the second, the quadruple aim in healthcare will not be achieved. Both of these phases must take place within an organizational culture that supports EBP or this type of practice will not be sustained and the quadruple aim in healthcare will not be achieved. Organizational culture and readiness must both be assessed and addressed appropriately. They are two different constructs, and they require different work to address them. Many tools are available to assist in this work, but the Organizational Culture and Readiness Scale for System-Wide Implementation of Evidence-Based Practice (OCRSIEP) tool (Fineout-Overholt & Melnyk, 2006) is particularly useful because it addresses both constructs. ORGANIZATIONAL CULTURE: FUNDAMENTAL TO IMPLEMENTING AND SUSTAINING EBP To successfully develop and sustain an EBP culture , organizations must provide the infra structure and resources to implement EBP and EBDM. Research over the past two decades has revealed that instituting EBP as the standard of care requires commitment from both individual clinicians and leaders. Clinicians must achieve EBP competency, participate in EBP problem-solving work, deliver evidence-based care consistently, and sustain the changes to support an EBP culture and environment. Leaders have even more to do in order to build and sustain an EBP culture than do individual clinicians (see Chapter 12). They must become EBP-competent themselves; boldly role model EBDM in their leadership decisions; publicly navigate barriers to EBP; and invest in EBP. Finally, leaders must create environments and cultures in which EBP is universally expected and consistently supported (Gallagher-Ford & Connor, 2020; Shayan et al., 2019). Without a robust effort from leadership, organizations often remain stagnant and immobilized. Leadership support and engagement requires the alignment of organizational values and goals with the constructs of EBDM; infrastructure development that includes organizational adoption of an EBP model; provision of time and resources to support clinicians at the point of care (i.e., to learn the EBP process, to explore clinical inquiries, and become/function as EBP mentors); and public promotion of EBDM. These leadership strategies are aimed at addressing well-known organizational cultural barriers that include: lack of promotion of clinical scholarship; absence of systematic support for evidence-based change implementation; a focus on process improvement rather than practice improvement; little recognition for EBP efforts; and a dearth of organizational incentives to engage in EBP. Leadership engagement and role modeling across all levels (managers and directors to the C-suite) is required for the development and sustainment of internal infrastructures to facilitate the growth of cultures that support EBDM.
ORGANIZATIONAL READINESS A concept analysis of readiness for EBP was conducted by Schaefer and Welton (2018) to provide a clear de nition and provide insight into contributing factors that promote or inhibit EBP. This study described EBP readiness as a complex concept that includes both personal and organizational readiness. Antecedents of EBP readiness were found to be the ability to recognize the need for EBP, the ability to access EBP resources, and a supportive EBP environment. The concept of readiness for EBP included four distinct pillars: (1) a cadre of nurses/clinicians who are empowered to make change happen; (2) nurses/clinicians who are provided with EBP training; (3) nurses/clinicians who are adequately equipped to do Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.
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