Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

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

Despite the availability of readily accessible evidence, these behaviors persist, and rampant variation of practices continue unabated. Highly variable care is the opposite of highly reli able care. When leaders allow and tolerate clinician/provider preferences to drive practice, they create a culture that categorically does not support evidence as the driver of practice. These two approaches cannot coexist. Leaders are in the unique position to curtail clini cian/provider preference as the driver of practice and create the expectation of evidence as the driver of practice. Unless leaders insist on evidence-based care, high reliability in healthcare will never be achieved. Another manifestation of a cultural barrier to the integration of EBP into clinicians’ daily work is when outdated, non-evidence-based policies and procedures are the norm. Clinicians are led to believe that the person(s) writing these policies and procedures, updating them, and/or signing them are using a structured, methodologic EBP approach to ensure they are current and evidence-based. However, this is categorically untrue in the vast majority of healthcare organizations as the following is typical in organizations: (1) policies are “reviewed” on an arbitrary time cycle (e.g., every 3 years) rather than being continuously updated as indicated; and (2) a process is used that does not include a comprehensive review of the current best evidence and instead involves the current users agreeing that “yes, that is what we do here; it is current.” This lack of commitment to providing clinicians with current and informed policies (the most basic and essential underpinnings to support practice) is most importantly a disservice to both clinicians and patients. However, it also is a litigation issue waiting to happen, serving as an example of how culturally absent and vastly unprepared most organizations are to consistently implement EBP. Absence of an EBP Infrastructure Another common barrier to implementation of EBP is the lack of infrastructure . An evidence- based enterprise is one where best practices are identi ed and implemented across the orga nization in a timely fashion, all day, every day. It is a place where problem solving based on leader/stakeholder meetings and brainstorming no longer exists. Instead, problem solving is conducted systematically with sound methodology that includes clinical inquiry, PICOT questions, ef cient searching, critical appraisal, and evidence synthesis to render the best answer or solution to the problem. It is a place where that best solution then ows rapidly into and across the enterprise in a consistent manner by means of ef cient and effective infrastructures. Building such a place requires thoughtful planning and leadership com mitment. As with any major change, resistance to the new approach should be expected as many “old ways” will need to end. Emotions may run high as outdated traditions come to an end, previous “experts” suddenly become novices, and long-standing hierarchies and power grids are challenged. Many organizational structures will need to be reviewed, reimagined, and redesigned to support a new way to solve problems and drive decisions using the best evidence to achieve the best outcomes.

Fortunately, there is a growing body of knowledge related to strategies to build EBP infrastructures that are effective. The literature shows EBP councils can be effective in pro viding support for implementation success. These councils can serve as “clearinghouses” or hubs for all EBP work in the organization. They can facilitate deployment of EBP mentors as needed; steer inquiry to the appropriate resources (EBP, research); coordinate the launch of new EBP initiatives with managers at the point of care/location of implementation; and be the locus of tracking EBP outcomes. Another effective approach to implementation infra structure is creating or reengineering a current position to serve as the Director of EBP and Research who forms the link between research, EBP, and evidence-based quality (process) Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.