What Happens After the Evidence?

My last post discussed some of the background principles on evidence-based practice (EBP). Now, that we have some evidence, how do we apply that evidence to our practice – what comes next? I’m glad that you asked!

Unfortunately, it is not as simple as taking that evidence and simply inserting it into your practice or institution. Many make this mistake or even duplicate efforts that were successfully implemented elsewhere only to fail. We cannot simply cookie-cutter successful programs and think that they would automatically work in our organization. We must consider the organizational culture, among other factors, when trying to implement a quality improvement initiative. One aspect of getting a sense of the organization is by performing a organizational assessment. This is a process of examining hierarchy, leadership the mission and values of the organization.

Next, we want to build upon prior success. Performing stakeholder interviews in the Appreciative Inquiry style allows insight into individuals prior successes with the hopes of building upon this success and borrowing techniques that worked. (Check out the Appreciative Inquiry Commons for some wonderful examples of AI.)

Now, we must choose a model to bring this all together. One such model is the Model for Improvement. The Institute for Healthcare (IHI) uses this model as a framework for change (I highly recommend checking out their website as they continuously update it with successful quality improvement information). The model relies on an incremental approach to change – not one of sweeping implications. You may be familiar with or have heard mention of the PDSA cycle. That is, Plan-Do-Study-Act. The PDSA cycle is helpful when implementing a small test of change, such as an evidence-based initiative. The cycle allows for stakeholders to be present at the planning stages right up to the implementation and evaluation stages. This is critical for stakeholder buy-in and to ensure a cohesive approach. The beauty is that multiple PDSA cycles can be performed after each small test and the process can be refined and honed to meet the needs of the patients, providers, and organization.

To review, after you have the research on your evidence-based initiative:

• Perform an organizational assessment
• Conduct an Appreciative Inquiry style of interview
• Implement a small test of change via the PDSA cycle
• Evaluate & re-evaluate the process and consider adding additional improvements/enhancements

Perhaps this is an over-simplified way of looking at this process. But, it is an example of getting just a taste of what that might look like. In fact, there is a whole peer-reviewed and open source journal, Implementation Science, to aide individuals and organization in such processes. It is a whole science unto itself.

Now that we have our evidence and process for practice improvement, we are ready to improve the quality, efficiency, and outcomes for our patients. And if for some reason, that doesn’t work, we can rely on these aforementioned tools to constantly re-evaluate the system to achieve our goal.