Key Strategies for Implementing Evidence

Part 1 ended on a misconception: that a good guideline implements itself. This unit spends its whole length dismantling it, and it opens Part 2 of the course. The claim to carry through everything that follows is precise. The fifteen-year gap between publication and practice does not open at the search, and it does not open at the appraisal. It opens between a good decision and a changed practice — which is a different problem, needing different skills from the ones Part 1 taught. By the end you can say where the gap actually opens; name the three conditions assessed before any plan is written; say why training clinicians without infrastructure wastes the training; say why an implementation needs both a process model and an organizational model; and say which of the three uptake factors your team actually controls.

Eight videos opening Part 2. The claim to hold is that the fifteen-year gap does not open at the search or the appraisal — it opens between a good decision and a changed practice.

Where Part 2 begins.

EBP 1201 Appraisal Is Not Implementation

Appraising evidence and implementing it are separate activities requiring different skills. Part 1 taught the first.

Where the research-practice gap actually opens.

EBP 1202 This Is Where the Gap Opens

The fifteen-year gap does not open at the search or the appraisal. It opens here, between a good decision and a changed practice.

A frame for the whole part.

EBP 1203 Four Domains of the Use of Evidence

Research, evidence-based practice, innovation and process improvement. Four domains that use evidence differently.

The first.

EBP 1204 Domain One — Research

Generating new generalisable knowledge.

The second.

EBP 1205 Domain Two — Evidence-Based Practice

Translating existing evidence into decisions for particular patients.

The third.

EBP 1206 Domain Three — Innovation

Creating what does not yet exist, which unit 13 treats in full.

The fourth.

EBP 1207 Domain Four — Process Improvement

Improving how existing work is carried out, locally.

How they relate.

EBP 1208 The Domains Need Each Other

None is sufficient alone. Research without translation changes nothing, and improvement without evidence rediscovers what is known.

Six videos on three conditions that are assessed separately. An implementation plan that assumes any one of them is a plan that fails.

The three conditions to assess.

EBP 1209 Culture, Readiness, and Infrastructure

Three separate things, assessed separately, and an implementation plan that assumes any of them is a plan that fails.

The first condition.

EBP 1210 EBP Culture

The shared belief that evidence governs practice here.

The second.

EBP 1211 EBP Readiness

Whether this unit can act on evidence now, which is different from whether it believes in it.

The third, and the one most often absent.

EBP 1212 Lack of Infrastructure

Time, access, mentors and a route by which a question reaches someone who can answer it.

The organisation-wide version.

EBP 1213 The Evidence-Based Enterprise

An organisation where evidence use is the operating model rather than a programme inside it.

What replaces what.

EBP 1214 Systematic Problem Solving Replaces Brainstorming

Systematic problem solving replaces the meeting where people suggest ideas from memory.

Seven videos. The second is backed by a study of 207 chief nurse executives, and its finding is not that leaders opposed evidence-based practice — it is that they misread what it was.

Three barriers begin.

EBP 1215 Barrier One — Manager and Leader Resistance

Resistance from the people with the authority to enable it, which is the barrier hardest to route around.

The evidence for that barrier.

EBP 1216 What the Chief Nurse Executives Reported

A 2017 study of 207 chief nurse executives found evidence-based practice ranked a low priority against competing demands.

The specific misreading found.

EBP 1217 EBP Mistaken for an Outcome

The same study found it treated as an outcome to achieve rather than a method for achieving outcomes.

The second.

EBP 1218 Barrier Two — Absence of an EBP Infrastructure

No structures to support the work, which no amount of individual willingness compensates for.

The third.

EBP 1219 Barrier Three — Lack of Clinician Competency

Clinicians who cannot search or appraise, which is the barrier most amenable to training and the one least sufficient alone.

One cause of it.

EBP 1220 Research Taught in Place of EBP

Programmes teaching research methods where evidence-based practice was needed. The two are different subjects.

And why residency does not fix it.

EBP 1221 Residency Programmes Do Not Reliably Close It

Residency programmes do not reliably close the competency gap, so it persists into practice.

Four videos. Seventy-three named strategies exist so that teams select rather than invent — but a list is not a checklist, and attempting all of them is not thoroughness.

The field named.

EBP 1222 Implementation Science

The study of what makes evidence get adopted. Unit 15 is the full treatment.

A named compilation.

EBP 1223 The ERIC Implementation Strategies

A compiled and named set of implementation strategies, so teams can select rather than invent.

How the list is meant to be used.

EBP 1224 The 73 Are a List, Not a Checklist

Seventy-three strategies to choose among by fit. Attempting all of them is not thoroughness.

A naming collision worth knowing.

EBP 1225 Two Different ERICs

The acronym names two unrelated things in this literature, which is a search hazard.

Four videos. A process model describes how evidence moves; an organizational model describes how a system changes. You need both, because the first alone produces a well-sequenced plan nobody adopts.

The instruction of the unit.

EBP 1226 Use a Model

Implementation guided by a model rather than assembled from instinct.

The first kind.

EBP 1227 EBP Process Models

Models describing how evidence moves into practice, step by step.

The second.

EBP 1228 Organizational Models

Models describing how an organisation changes, which is a different question.

And the instruction about them.

EBP 1229 Select Both

A process model with no organizational model gives a well-sequenced plan nobody adopts.

Six videos. Watch the second — laggards have reasons, usually about workload the plan did not account for, and the label is descriptive rather than pejorative.

Who moves first.

EBP 1230 Innovators and Early Adopters

The people who take up a change before it is established, and the ones to work with first.

An important corrective.

EBP 1231 Laggards Have Reasons

Late adopters usually have reasons, often about workload the plan did not account for. The label is descriptive, not pejorative.

The mechanism of the whole part.

EBP 1232 EBP Mentors

People who work alongside clinicians on real questions. Unit 16 is built entirely on this.

How many it takes.

EBP 1233 A Critical Mass

Enough mentors that the practice propagates rather than depending on individuals.

The most quotable line in the unit.

EBP 1234 Competence Without Infrastructure Is Squandered

Training clinicians into a setting with no time, access or mentors wastes the training and the goodwill together.

And the fix.

EBP 1235 Build the Infrastructure Concurrently

Infrastructure is built alongside competence rather than after it.

Four videos on what leaders actually do, beyond approving things.

The leadership section begins.

EBP 1236 Financial Advocacy

Leaders arguing for the resources the work requires.

What leaders have to do themselves.

EBP 1237 Leaders Role Model It

Leaders using the process on their own decisions, visibly.

The consequence of its absence.

EBP 1238 Without Leadership, Stagnation

Without leadership the work stalls regardless of clinician enthusiasm.

What alignment means concretely.

EBP 1239 Align Values, Goals, and Structures

Stated values, operational goals and reporting structures pointing the same way.

Five videos. Of the three factors, only one is under the implementation team's control — which is worth knowing before deciding where to spend effort.

Three factors beyond the plan.

EBP 1240 What Else Shapes Uptake

Uptake is also shaped by the practice, the clinician and the process itself.

The first.

EBP 1241 Characteristics of the Practice

How complex the change is, and how far it sits from what is done now.

The second.

EBP 1242 Characteristics of the Clinician

Beliefs, competence and how much control the clinician has over their own practice.

The third.

EBP 1243 Characteristics of the Process

How the change was introduced, which is the only one of the three the implementation team controls.

Named rather than outlined.

EBP 1244 A Twelve-Step Strategy

The chapter sets out a twelve-step implementation strategy. The steps are named here; the source carries them in full.

Seven videos on sustaining. Sustainability is designed into the plan rather than hoped for afterwards, and a change nobody revisits decays quietly.

The sustaining half begins.

EBP 1245 Sustainability Is Planned, Not Hoped For

Sustainability is designed into the plan rather than hoped for afterwards.

One sustaining mechanism.

EBP 1246 Meaningful Recognition

Recognition that means something to the people receiving it.

Who gets told.

EBP 1247 Dissemination, Bedside to Boardroom

Findings travel to the bedside and to the boardroom, because the two audiences act on different things.

What makes it stick.

EBP 1248 Accountability Measures

Named people accountable for named measures.

The word for making it permanent.

EBP 1249 Action Planning and Hardwiring

Building the change into the systems and routines so that continuing it takes no effort.

Revisiting deliberately.

EBP 1250 Intentional Reassessment

Planned reassessment, because a change that is never revisited decays quietly.

Whose job this is.

EBP 1251 The Role of Every Clinician

Implementation is part of every clinician's role rather than a specialist function.

Three videos, and the first is the one Part 1 ended on. This unit exists to dismantle it.

The first, and Part 1's closing note.

EBP 1252 Misconception: Good Evidence Implements Itself

Quality of evidence and success of implementation are separate questions. Strong evidence changes nothing on its own.

The second.

EBP 1253 Misconception: Training Is Implementation

Education builds competence. Competence without infrastructure, mentors and leadership produces no implementation.

The third, and the comfortable one.

EBP 1254 Misconception: Resistance Is the Problem

Resistance is one factor among the practice, the clinician and the process. It is also the explanation requiring the implementation team to change least.

One procedure carrying a change from readiness assessment to a hardwired practice.

The unit assembled.

EBP 1255 Implementing an Evidence-Based Change

One appraised change carried from readiness assessment through model selection to a hardwired, reassessed practice.

That is the shape of implementation. Against the outcomes. The gap opens between a good decision and a changed practice. Everything in Part 1 was necessary and none of it was sufficient, which is why this part exists. Three conditions, assessed separately: culture is the shared belief that evidence governs practice, readiness is whether this unit can act now, and infrastructure is time, access, mentors and a route by which a question reaches an answer. A plan that assumes any of them fails. Competence without infrastructure is squandered. Sending clinicians on a course and returning them to a setting with no time, no access and no mentor spends the training and the goodwill together — so infrastructure is built alongside competence rather than after it. Both models are needed. A process model describes how evidence moves into practice; an organizational model describes how a system changes. The first alone produces a well-sequenced plan that nobody adopts. And of the three things shaping uptake — the practice, the clinician and the process — only the process is under your control. That is where effort belongs, and it is why blaming resistance is the explanation that requires the implementation team to change least. Unit 10 turns to quality improvement, and to what happens when appraised evidence is put inside an improvement plan rather than beside it.