An exploration of the factors that influence the implementation of evidence into practice

Rycroft-Malone, J. and Harvey, G. and Seers, K. and Kitson, A. and McCormack, B. and Titchen, A. (2004) An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13 (8). pp. 913-924. ISSN 0962-1067

Abstract

Background. The challenges of implementing evidence‐based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. Aims and objectives. The aim of the study was to address the following questions: • What factors do practitioners identify as the most important in enabling implementation of evidence into practice? • What are the factors practitioners identify that mediate the implementation of evidence into practice? • Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? Design and methods. The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on‐going or recent implementation projects were studied. Within sites semi‐structured interviews were conducted (n = 17). Results. A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi‐professional relationships and collaboration, role of the project lead and resources. Conclusions. The results are discussed with reference to the wider literature and in relation to the on‐going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence‐based practice, such as skilling‐up practitioners to appraise research evidence, will be ineffective by themselves. Relevance to clinical practice. Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.