Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

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

CREATING AN EBP ENTERPRISE Learning from Implementation Science

Implementing evidence-based initiatives is one of the most challenging phases of the EBP process. Reasons for this and how to address and mitigate the barriers have been studied for decades by many scholars, underpinning the eld of science known as implementation science (IS). IS focuses on generating evidence on effective approaches for implementation of evidence in practice settings, identifying facilitators, and addressing barriers. IS began in response to the persistent lags experienced in real-world clinical settings where research evidence existed, but that evidence was not being translated into practice in a timely fashion—if ever. It has been estimated that translation of research ndings into healthcare practice settings can take up to 17 years (Balas & Boren, 2000), though a recent study by Khan et al. (2021) found the research–practice gap to be slightly shorter (i.e., 15 years). Regardless of whether the gap is 17 years or 15 years, that timeline is unacceptable; at that rate, it will take another 150 years to immediately translate evidence into practice (Melnyk, 2021). If knowledge is available that can improve care and outcomes, it is the responsibility of professional clinicians and leaders to advocate for and actively participate in the timely translation of that knowledge into the care setting. These dramatic delays in moving research ndings into practice drive the work of implementation scientists. For decades, many studies have examined speci c implementation strategies to determine their effectiveness in promoting the uptake of evidence within practice settings. A large body of evidence currently exists that can inform the efforts of leaders and clinicians attempting to implement EBP initiatives. Of particular note is the work of the Expert Recommendations for Implementing Change (ERIC) project group (Powell et al., 2015) who developed a classi- cation system that lists 73 implementation strategies that had been widely studied in terms of both effectiveness, clinician adherence, and outcomes that “can be used in isolation or combination” (p. 11). Their work provides a comprehensive list of discrete implementation strategies that are clearly de ned, utilizing consistent nomenclature that are presented with suf cient detail to enable application in real-world clinical settings. The intent of the ERIC work was not to create an implementation checklist because no implementation effort could feasibly use every one of these strategies. Rather, the ERIC compilation provides a list from which to select “discrete strategies that can be used to build a tailored multicomponent strategy for implementation” (p. 7). It is critical that those attempting to implement evidence-based changes stay true to the guiding principle of evidence-based problem solving, which is the intentional use of the robust body of evidence that currently exists to inform change efforts. By doing so, imple mentation of EBP is achieved. Otherwise, those leading EBP work fall back into traditional behaviors of brainstorming and trying their ideas about implementing an EBP project, which is the antithesis of the behavior they should be role modeling in their organization. The eld of IS has provided EBP leaders and mentors with robust resources that can expedite and enhance their implementation efforts. It is the responsibility of EBP leaders and mentors to become familiar with and incorprate evidence-based implementation strategies routinely. For more information about the eld of IS, refer to Chapter 15, which is fully devoted to this topic. The Role of Leaders in Building an EBP Culture and Infrastructure to Support EBP In a recent study, Melnyk et al. (2021) found that EBP culture was the main variable that drove EBP mentorship, EBP beliefs, EBP competency, and EBP implementation, which positively

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