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EDITORIAL

It takes three to tango

embracing EBP

Apóstolo, João; Cardoso, Daniela; Rodrigues, Manuel Alves

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JBI Database of Systematic Reviews and Implementation Reports: April 2016 - Volume 14 - Issue 4 - p 1-2
doi: 10.11124/JBISRIR-2016-2889
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Evidence Based Practice (EBP), recently referred to as Evidence Informed Practice,1 promotes high-value health care, improves the patient experience (including quality and reliability of health care) and health outcomes, and reduces health care costs.2 Thus, the adoption, implementation and sustainment of EBP is becoming increasingly important for health and allied healthcare organizations and providers.

However, EBP is currently not incorporated into standard of care worldwide.2 There is a gap between research and practice or policy, and this has been recognized as a problem.3 In the light of this, the adoption, implementation and sustainment of EBP in health and allied healthcare organizations and providers pose a series of challenges.

The use of EBP in clinical practice means that a clinical decision must be substantiated by the best available evidence which considers the context in which the care is delivered, client preferences, and the professional judgment of the health professional.4

There are several identified barriers and facilitators to the implementation of EBP. These barriers are: time limitations, an organizational culture and philosophy of “that is the way we have always done it here”, leader resistance, and inadequate knowledge or training to access or critically appraise evidence.2(p.6,7) The facilitators are: beliefs in the value of EBP and the ability to implement it, EBP mentors working with direct care clinicians to implement best practices, supportive EBP contexts, cultures and infrastructures, and administrative support.2

Strategies focusing on personal characteristics (knowledge/skills, attitudes practice towards EBP), leadership and organizational climate exist to successfully implement and sustain EBP. Examples of these strategies are: (a) development of EBP knowledge and skills of the individual clinician and healthcare leader; (b) promotion of a context and culture that supports EBP, including the availability of resources and EBP mentors; (c) development of healthcare leaders who can spearhead teams to create the vision, mission and strategic goals necessary for system-wide implementation of EBP; (d) sufficient time, resources, mentors and tools for clinicians to engage in EBP; (e) clear expectations of the role of clinicians and advanced practice nurses in implementing and sustaining EBP; (f) defining facilitator characteristics and approaches; and (g) a recognition or reward system for those who are fully engaged in the effort.2

Taking into account the barriers and facilitators to EBP at the organizational level, it is claimed that, besides personal characteristics, leadership and organizational climate are core elements for its implementation and sustainability. The personal characteristics of frontline staff that are crucial to the successful implementation of EBP include age, level of education, training, level of professional experience and knowledge, attitudes and practice towards EBP.5

In this context, EBP knowledge is defined as personal skills and knowledge of research and information technology, and the ability to interpret literature and apply it to individual cases; attitudes toward EBP as the predisposition to EBP and perception of its practical value; and EBP practice as the frequency of use of EBP processes.

Leadership is conceptualized as a multidimensional process of influence to enable health professionals to use research evidence in clinical practice.6 It includes behaviors and activities of managers that exert direct and indirect influence on individuals, their environment and organizational infrastructures. Leadership behaviors of health managers and administrators have been identified as important to support EBP, shaping workers’ perceptions, responses to organizational change, and acceptance of innovations.6,7

Organizational climate is defined as “the shared meaning organizational members attach to the events, policies, practices, and procedures they experience and the behaviors they see being rewarded, supported, and expected”.8(p.115) To create a climate for EBP implementation, organizations should prioritize EBP implementation, provide educational support for the EBPs being implemented, recognize and reward employees for successful implementation and use of EBP, and select employees based on their openness to EBP and/or their previous experience with EBP.9

Therefore, the three core elements for embracing EBP in practice are personal characteristics, leadership and organizational climate. Since these elements largely determine how well EBP is received and implemented in clinical practice, it is crucial for the leadership of health organizations to embrace the concept of EBP and have a grasp of the realities of their environment so as to optimize the likelihood of the successful implementation of EBP.

References

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2. Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs. Worldviews Evid Based Nurs 2014; 11 1:5–15.
3. Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Services Research 2014; 14 1:1–12.
4. Pearson A, Jordan Z, Munn Z. Translational Science and Evidence-Based Healthcare: A Clarification and Reconceptualization of How Knowledge Is Generated and Used in Healthcare. Nurs Res Pract 2012; 2012:792519.
5. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health 2011; 38 1:4–23.
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7. Aarons GA. Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. Psych Serv (Washington, DC) 2006; 57 8:1162–1169.
8. 2014; Ehrhart MG, Schneider B, Macey WH. Organizational Climate and Culture: An Introduction to Theory, Research, and Practice: Taylor & Francis.
9. Ehrhart MG, Aarons GA, Farahnak LR. Assessing the organizational context for EBP implementation: the development and validity testing of the Implementation Climate Scale (ICS). Implement Sci: IS 2014; 9:157.
© 2016 by Lippincott williams & Wilkins, Inc.