Implementing Evidence-Based Practice for Patient Outcomes

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Implementing Evidence-Based Practice for Patient Outcomes

Healthcare Organization and Management · Chapter 18: Evidence-Based Practice in HealthcareSection 18.2 · lesson 103 of 10510 min · free with a free account

← Foundations of Evidence-Based PracticeNext lesson: Evidence-Based Practice: Advantages, Disadvantages, Models →

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In this lesson

Turning evidence into everyday practice by diagnosing and removing barriers.

  • Distinguish the evidence question from the implementation question
  • Identify barriers at the individual, team, organizational, and external levels
  • Match implementation strategies, from passive dissemination to structural change, to diagnosed barriers
  • Explain fidelity versus adaptation and why implementation is measured separately from outcomes

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Transcript

Everything said in the video, section by section (1,286 words). Read along, or search it.

Opening Case

A Well-Explained Change That Didn't Happen

Two months into the 4 North bedside handover pilot, Ellen Murphy had done the usual things. She emailed the new procedure, explained it at a staff meeting, and posted it in the break room. Then Farah's audit came back. Report was happening at the bedside in only about a third of shift changes. Ellen's first thought was that people hadn't read the email. So why didn't a well-explained change happen? And what would make it happen?

Two Problems

Knowing Versus Doing

Priya Nair, the chief nursing officer, has seen this before. Knowing what works and getting it done are different problems, and treating them as one is the field's most consistent mistake. Appraisal answers the evidence question. Implementation answers the other one: how a practice supported by evidence becomes the practice that actually happens. That means understanding a particular workplace, and changing the conditions people work in. A hospital can be completely right about the evidence and change nothing at all.

Barriers

Four Levels of Barriers

Barriers sit at four levels. Individual: time, access to evidence, skill in judging it, and belief that it applies to these patients. Team: the established norm, what's done here, reinforced by colleagues and professional culture. Organizational: competing priorities, missing resources, and often no route at all for changing a standard and getting the change into practice. External: regulation, reimbursement, supply and professional standards, which a local team can't change. A barrier at one level is rarely fixed by a strategy aimed at another.

Objections as Information

Shared Rooms and Private-Room Evidence

Belief deserves its own moment. Grace Okafor, an ICU nurse who picks up shifts on 4 North, tells Ellen why she still gives report at the station. The studies she's read come from private rooms. Half of 4 North's rooms are shared. At the bedside, a roommate hears everything. That isn't resistance. It's an appraisal argument: is the evidence from patients like ours? And she may be right. Treat it as an attitude problem, and you lose the information in it. The objection comes back later, as quiet non-adoption.

Passive Dissemination

Emails and Posters Rarely Change Practice

Ellen's email, meeting and poster are passive dissemination. On its own, it almost never changes practice. That's one of the better-supported findings in implementation research. It's still the most popular strategy, because it's cheap, fast, and leaves a record that something was done. It works only when the sole barrier is that people don't know. And when practice doesn't change, people usually blame the staff, not the strategy. Ellen tests her theory anyway. She asks six nurses to describe the new procedure. Five describe it accurately. Awareness was never the barrier.

Implementation Strategies

From Weak to Strong Strategies

Strategies range from weak to strong. Passive dissemination is weakest. Education helps when there's a genuine skill gap, especially when it's interactive. Opinion leaders, respected colleagues, can change team norms, because the message comes from inside the group. Audit and feedback shows people how current practice actually measures up. A Cochrane review by Ivers and colleagues in twenty twelve found its effect modest on average, and stronger when feedback is repeated, comes from a respected source, and carries targets and an action plan. Reminders and decision support act at the moment of action. And structural change is strongest, because it changes the default instead of asking people to fight it. Strength and cost rise together. Budgets pull plans toward the cheap end, and then the failure gets blamed on staff.

Diagnosis

Watching Three Shift Changes

The step most failed implementations skip is diagnosis: finding out what's actually in the way before choosing a fix. Ask the people who'd have to change. And watch the work. So Ellen watches three shift changes. The handover sheet prints at the station, so that's where report starts. Shifts overlap for only fifteen minutes. During bedside report, nobody covers call lights. And Grace's shared-room concern is real. Each barrier gets its own fix. The sheet prints to the unit's tablets. A buddy covers call lights. Sensitive details are shared quietly at the station, after the bedside part. The fifteen-minute overlap is a scheduling rule, beyond Ellen's authority, so she escalates it, with the audit attached.

Quick Check

A Checklist Stuck in a Binder

Quick check. On 4 South, nurses keep skipping a new fall-risk checklist. Asked, they can all describe it. But the only copy is on paper, in a binder at the station. Which strategy fits? Pause, and decide. Build it into the charting screen. The barrier is structural: the system makes skipping easier than doing. Change the default, and the problem goes away. More training is tempting, because training is what most plans reach for. But the nurses already know the checklist. Training can't move a binder.

Fidelity vs. Adaptation

Hold the Essentials, Adapt the Rest

Ellen's fixes raise a real tension. Fidelity is how closely a practice matches the version that was studied. Adaptation is changing it to fit the local setting. High fidelity keeps whatever produced the effect, but may not fit the workflow, so staff work around it. High adaptation fits, but can remove the active ingredient without anyone noticing. The way through: decide which elements are essential to the effect, hold those constant, and adapt the rest freely. For bedside report, Priya and Ellen judge the essentials to be the patient taking part, and both nurses checking safety items together. The exact script is incidental. Where nobody can tell what's essential, fidelity is the safer default. And every adaptation gets written down, so a disappointing result can be interpreted later.

Frontline Manager

Four Things the Manager Must Own

The frontline manager is where implementation succeeds or doesn't. Four things are hers, and nobody else does them well. Protect time, or the change competes with patient care and loses. Make it visible: raise it at the huddle, ask about it when discussing a patient. Remove local obstacles, which are usually mundane: a form in the wrong place, a supply not stocked, a password nobody has. And model it. A manager who endorses a change but still accepts the old way has told everyone the real standard.

Quick Check

Was the Teaching Ever Delivered

Quick check. Ridgeway Memorial started new discharge teaching for heart-failure patients. Six months later, readmissions haven't fallen. Its leaders want to drop the program. What should they check first? Pause, and decide. Whether the teaching was actually delivered. If most eligible patients never received it, the program hasn't failed. It was never really tried. Staff opinion is tempting to check, because it's easy to collect. But it can't tell you whether patients got the teaching.

Measurement

Implementation Measures Versus Outcome Measures

That's why implementation is measured separately from outcome. Implementation measures ask whether the practice happens: the share of eligible handovers done at the bedside, completeness, timeliness. Outcome measures ask whether the result followed: fewer missed items, and fewer falls in the hour after shift change. Without the first, a disappointing outcome can't be interpreted. Does the practice not work, or was it never delivered? Those lead in opposite directions. And a change achieved isn't a change held. Results rise during the effort, then decay when attention moves on. So build standard work, a named owner and continuing measurement now, not afterward.

Resolution

The Email Couldn't Move a Printer

Back to 4 North. With the tablets, the call-light buddy and the shared-room rule in place, bedside report rose from about a third of shift changes to most of them. The overlap change is still in the scheduling queue. Ellen says plainly that results will stay partial until it lands, rather than calling a partial gain success. And Farah keeps tracking both numbers: how often report happens at the bedside, and how many essential items still get missed. Nobody on 4 North had ignored the email. The email just couldn't move a printer.

Key Takeaways

Diagnose, Match, Measure, Sustain

To recap. Knowing what works and getting it done are separate problems. Diagnose barriers at four levels, by asking and watching. Match the strategy to the barrier. Passive dissemination rarely works alone. Hold the essential elements, and adapt the rest. Measure delivery and outcome separately, and build sustainment in from the start.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

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Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Implementing Evidence-Based Practice for Patient Outcomes

What are the barriers to implementing evidence-based practice?
Barriers occur at four levels. Individual barriers include time, access to evidence, appraisal skill, and doubt that the evidence applies to local patients. Team barriers are established norms. Organizational barriers include competing priorities, missing resources, and no route for changing a standard. External barriers include regulation, reimbursement, supply, and professional standards. A barrier at one level is rarely fixed by a strategy aimed at another.
Why don't emails and staff meetings change clinical practice?
Emails, meetings, and posters are passive dissemination, and implementation research consistently finds that passive dissemination alone rarely changes practice. It only fixes a lack of awareness, yet staff often already know the new procedure; what blocks them is workflow, resources, or team norms. Stronger strategies include opinion leaders, audit and feedback, reminders at the point of action, and structural changes that make the new practice the default.
What is the difference between fidelity and adaptation in implementation?
Fidelity is how closely a practice matches the version that was studied, while adaptation changes it to fit the local setting. Too much fidelity can clash with workflow and invite workarounds; too much adaptation can remove the active ingredient without anyone noticing. The usual approach is to identify the essential elements, hold those constant, adapt the rest, and document every adaptation.
Why measure implementation separately from patient outcomes?
Implementation measures show whether a practice is actually happening, such as the share of eligible handovers done at the bedside, while outcome measures show whether results followed. If outcomes do not improve, only implementation data can show whether the practice failed or was never delivered. For example, a discharge teaching program cannot be judged ineffective if most eligible patients never received the teaching.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

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105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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