Institutionalizing evidence-based practice: an organizational case study using a model of strategic change

Area of Science:

• Healthcare Management
• Organizational Behavior
• Evidence-Based Practice Implementation

Background:

• Healthcare organizations are expected to adopt evidence-based practice (EBP) to enhance care quality.
• Significant challenges hinder the routine and sustained organizational-level implementation of EBP.

Purpose of the Study:

• To investigate the contextual elements and strategic approaches necessary for the institutionalization of evidence-based practice (EBP).
• To compare EBP implementation in a recognized 'role model' site versus a 'beginner' site.

Main Methods:

• A mixed-method explanatory case study design was employed.
• The Pettigrew et al. Content, Context, and Process model guided the theoretical framework.
• Two contrasting US sites were purposefully selected: one high-performing EBP site and one early-stage EBP site.

Main Results:

• The 'role model' site demonstrated pervasive, integrated EBP, contrasting with the 'beginner' site's sporadic, isolated EBP.
• The 'role model' site possessed receptive inner contextual elements facilitating multi-level EBP change.
• The 'beginner' site exhibited non-receptive conditions and lacked an integrated context for EBP institutionalization.

Conclusions:

• Key contextual elements crucial for EBP institutionalization were identified.
• An integrated set of receptive contextual elements is essential for achieving sustained EBP.
• Interactions among contextual elements, particularly leadership influence, significantly impact EBP institutionalization.