Models to Guide Implementation and Sustainability

Unit 9 said to use a model and to use two kinds. This unit is the models themselves — and it opens with a finding that makes the whole choice less agonising than it looks. A literature review across implementation models found that they share a skeleton. The same four steps appear in nearly all of them: identify the problem, identify who is affected and who can act, identify a change with evidence behind it, and identify the barriers before you start. Which means choosing among models matters far less than using one at all. By the end you can say what the models share and what follows for choosing; name the four shared steps; say what the Stetler model counts as evidence that a design hierarchy does not; say why ARCC targets beliefs rather than knowledge; and say when experience is evidence and when it is not.

Six videos. The finding that shapes the whole unit is that a literature review across models found them sharing common steps — which means the choice between them matters less than using one.

Why models at all.

EBP 1951 Why Models Exist

A model saves you from designing an implementation from first principles every time.

The finding that shapes the unit.

EBP 1952 The Models Share a Skeleton

A literature review across models found they share common steps, which means the choice between them matters less than using one.

The first shared step.

EBP 1953 Shared Step — Identify the Problem

Every model begins by naming the problem precisely.

The second.

EBP 1954 Shared Step — Identify Stakeholders and Change Agents

Naming who is affected and who can act, which are different lists.

The third.

EBP 1955 Shared Step — Identify an Effective Practice Change

Selecting a change with evidence behind it, rather than the first idea proposed.

The fourth.

EBP 1956 Shared Step — Identify and Address Barriers

Finding the barriers before starting rather than discovering them during.

Six videos on a practitioner-oriented model. Watch the third — reflected experience counts as evidence in this model and unexamined opinion does not, and the whole difference is the reflection.

The first named model.

EBP 1957 The Stetler Model

A practitioner-oriented model, built around how an individual clinician uses evidence.

Its first phase.

EBP 1958 Stetler Phase — Preparation

Defining the purpose and the context before looking at evidence.

The second.

EBP 1959 Stetler Phase — Validation

Appraising the evidence for credibility and fit.

The distinction that gives it teeth.

EBP 1960 Reflected Experience Counts; Opinion Does Not

Experience that has been examined counts as evidence in this model. Unexamined opinion does not, and the difference is the reflection.

Preferences, examined.

EBP 1961 Preferences, Explored for Their Origins

A preference is explored for where it came from rather than accepted or dismissed at face value.

The remaining phases.

EBP 1962 Stetler Phases — Comparative Evaluation, Translation, Evaluation

Comparing across sources, translating into a decision, and evaluating what followed.

Seven videos on an organizational model built on mentors. It rests on cognitive behavioural theory, which is why it targets beliefs rather than knowledge — and that is why teaching alone never moved the needle.

The second named model.

EBP 1963 The ARCC Model

An organizational model built on mentors, and the one this course's own structure most resembles.

Its mechanism.

EBP 1964 Mentors Are the Mechanism

In ARCC the mentor is the mechanism of change rather than a support role beside it.

The dynamic it predicts.

EBP 1965 As Barriers Fall, Competence Rises

The model predicts that removing barriers raises competence, which then removes further barriers.

The theory underneath it.

EBP 1966 Cognitive Behavioural Theory in the Model

ARCC rests on cognitive behavioural theory, which is why it targets beliefs rather than knowledge.

How that works.

EBP 1967 The Thinking-Feeling-Behaving Triangle

Thoughts, feelings and behaviours each affect the others, so changing belief changes practice.

Three levels it acts on.

EBP 1968 Individual, Social, and Environmental Factors

The model acts at individual, social and environmental levels together.

Where it ends.

EBP 1969 Integrate, Maintain, and Disseminate

The model ends in integration, maintenance and dissemination rather than in adoption.

Six videos. Since the models share a skeleton, the choice is about fit with your setting rather than about which model is better.

The others.

EBP 1970 Other Models the Chapter Treats

Further models the chapter treats, each suited to different circumstances.

The question to ask of any model.

EBP 1971 Process Model or Organizational Model?

Ask which kind you are holding, because a process model and an organizational model answer different questions.

How to choose between them.

EBP 1972 Fit Is the Deciding Criterion

Since the models share a skeleton, the choice is about fit with your setting rather than about merit.

Why results vary so widely.

EBP 1973 Why Implementation Varies So Much

Implementation results vary because settings vary, which is what the models are trying to accommodate.

A practical rule.

EBP 1974 Go to Synthesised Evidence First

Start from synthesised evidence rather than primary studies, which is unit 3's ordering restated.

And the ordering within it.

EBP 1975 Hierarchies of Preprocessed Evidence

Preappraised sources have their own hierarchy, by how much work has already been done.

Three videos. The third is answered directly by the Stetler model you met twenty entries ago.

The first error.

EBP 1976 Misconception: The Right Model Matters Most

Choosing among models matters far less than using one at all, because they share their skeleton.

The second.

EBP 1977 Misconception: A Model Is a Checklist

A model names a team invoked and never consulted again has bought the appearance of method.

The third, and the one Stetler answers.

EBP 1978 Misconception: Experience Is Not Evidence

Reflected experience is evidence in these models. What is not evidence is unexamined opinion, and the difference is whether it has been examined.

One procedure selecting both kinds of model by fit, and then consulting them.

The unit assembled.

EBP 1979 Choosing and Using a Model

One implementation with both a process model and an organizational model chosen by fit and then actually used.

That is the models. Against the outcomes. They share a skeleton — identify the problem, the stakeholders and change agents, an effective practice change, and the barriers. Which is why fit with your setting decides between them rather than merit, and why using one at all matters more than which. Stetler counts reflected experience as evidence. Not opinion — experience that has been examined, where the examining is the whole difference. A design hierarchy has no place for that, and this model does. ARCC rests on cognitive behavioural theory, so it targets beliefs rather than knowledge. Thoughts, feelings and behaviours each move the others, which is precisely why decades of teaching people the steps changed so little — the teaching addressed knowledge, and the barrier was belief. So experience is evidence when it has been reflected on, and is not when it has not. The distinction is doing real work: it lets clinician expertise into the decision without letting unexamined habit in alongside it. And a model named in a proposal and never consulted again has bought the appearance of method. The models are used or they are decoration. Unit 15 turns to implementation science itself, and to the frameworks that study why any of this works.