Improving the Quality of Care through Routine, Successful Implementation of Evidence-Based Practice

Thursday, 10 July 2008: 3:15 PM
Jo Rycroft-Malone, PhD, MSc, BSc, RN , Centre for Health Related Research, School of Healthcare Sciences, University of Wales, Bangor, Bangor, United Kingdom
Cheryl Stetler, PhD, RN , Boston University, Amherst, MA
Judith Ritchie, RN, PhD , Nursing, McGill University Health Centre, Montreal, QC, Canada
Alyce A. Schultz, PhD, RN, FAAN , College of Nursing and Healthcare Innovation, Arizona State University, Phoenix, AZ
Martin Charns, MBA, DBA , School of Public Health, Boston University, Boston, MA

Learning Objective 1: The learner should have a better understanding about the organisational factors that influence the implementation of evidence-based practice.

Learning Objective 2: The leaner will learn how models of strategic change and evidence-based practice can be used to theoretically inform the conduct of research.


It is now an expectation that health care organisations use evidence-based practice (EBP) as an approach to improving the quality of patient care and service delivery. However challenges exist about how to make evidence-based practice a reality, particularly at an organisational level and on a sustained basis.


The overall purpose of this research study was to explore nursing organizations that seem able to find and use evidence at multiple levels in an on-going, integrated fashion in contrast to those that do not.

Theoretical framework

The study was theoretically underpinned by Pettigrew and Whipp's Content, Context, and Process model of Strategic Change and Pettigrew et al's signs and symptoms of contextual receptivity to change.


A multiple method case study was conducted following the approach of Yin (1993 & 1994). Two sites were purposively sampled to provide contrasting cases; a ‘role model' site for the normalization of evidence-based practice, and a matched ‘beginning' case that self-identified as early in the journey to EBP normalization. Data collection methods in both sites included: a multi-tool survey; key informant interviews; focus groups; focused observations, and document review.


Findings show a difference between the ‘role' and ‘beginner' sites in the extent and pervasiveness of EBP. The role site demonstrated integrated and widespread EBP activity driven by hospital, external priorities and local nursing practice problems. In contrast, the beginner site was mainly engaged in individual projects primarily motivated by external, hospital, regulatory and physician-driven priorities.

Key contextual elements that facilitated the use of EBP included; key people leading change at multiple levels of the organisation, development of a supportive organisational context and culture that embedded EBP into the organisation's day-to-day processes and infrastructures, and co-operative inter-organisational relations.


These, and other findings will be considered in the context of their implications for normalising EBP within healthcare organisations.