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349 Chapter 9 / Key Strategies for Implementing Evidence in Real-World Clinical Settings

the work; and (4) leadership support of the work. Nurses/clinicians in the concept analysis meant a suf cient collective group with the authority to implement EBP into their practice and who were allocated time away from the bedside to conduct the steps of EBP. Training meant purposeful, applicable, hands-on EBP training (education and skills-building) beyond the training received in school, as many nurses/clinicians report not having any training or experience in EBP and those who have been trained in EBP in their bachelor’s programs often lack con dence and understanding of EBP implementation into practice (Llasus et al., 2014). Equipping nurses/clinicians meant ensuring they had access to computers and databases as well as EBP mentors, all at the point of care. Leading entailed leaders being present and promoting a culture that supported asking questions, allocating protected time to investigate the literature, and fostering an environment that enabled implementation of best practice. This analysis provides a clear description of readiness that, when combined with a culture that supports EBP, create the necessary foundation to build an EBP organization where the best practice can be determined, implemented and sustained. Unfortunately, many organiza tions do not do anything to get ready for EBP, while others make a minimal effort and only a few engage in the thoughtful and concerted effort needed for success. A classic example of not preparing for EBP is when organizations fail to understand and leverage the unique characteristics and synergies of the four unique domains that represent the use of evidence; (1) research (the generation of new evidence); (2) EBP (determination of the current, best evidence to support care); (3) innovation (the ability to imagine novel approaches to care based on the platform of evidence); and (4) process improvement (the best processes to deliver the best evidence-based care). Research is “a systematic process used to generate new knowledge or evidence” (Melnyk & Morrison-Beedy, 2019, p. 4). Most leaders in healthcare organizations have a clear under standing of what research is, who should be conducting it, and where and how research exists in their organization. Process improvement (PI) is a rigorous approach used to streamline operations and production activities, reduce costs, or improve the quality of processes. Three of the most widely utilized PI methodologies employed in healthcare are Plan Do Study Act, Six Sigma, and Lean. The Plan Do Study Act (PDSA) methodology features a cyclical structure for creating and assessing change. Six Sigma methodology involves improving, designing, and monitoring processes to minimize or eliminate waste while optimizing satisfaction and increasing nancial stability. Lean methodology often overlaps with Six Sigma but differs in that it is driven by the identi cation of customer needs and aims to improve processes by removing activities that are non-value-added (i.e., waste). In many organizations, PI is referred to as the “quality department,” but that is a misleading title because for quality to be delivered, the quality department must include more than process improvement alone. EBP is a rigorous methodologic approach to practice improvement that involves a search for best evidence followed by critical appraisal and synthesis of that evidence. All quality improvement (QI) needs to be evidence-based QI. THE FOUR DOMAINS THAT REPRESENT THE USE OF EVIDENCE

Innovation is a process by which a solution is created when one does not exist (emergent) or an existing solution is modi ed to make an improvement (incremental) (Porter-O’Grady & Malloch, 2017). Innovation adds value (Melnyk & Raderstorf, 2019). Three constructs— research, EBP, and innovation—create the “best practice component” and PI creates the “best process component.” Knowing what each of these four domains contributes and how they coexist and synergize with one another is the only path to reaping the bene ts of com prehensive “use of evidence” to improve care and outcomes. The EBP, Research, Innovation Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.