Culture eats evidence for breakfast: how culture influences implementation of evidence-based practices

Research has produced a substantial and expanding body of evidence-based practices (EBPs), encompassing interventions, programmes, clinical guidelines, protocols, care pathways and models of care supported by the best available evidence. Despite this, healthcare delivery is still frequently characterised as insufficiently evidence-based, reflecting a persistent gap between what is known to be effective and what is routinely implemented in practice. Traditional explanations only partially account for this gap, often overlooking culture as a critical yet under-theorized influence. Culture is a learned phenomenon rooted in social contexts, encompassing shared norms, values, beliefs and assumptions that define a group, whether a team, profession or organization. This paper argues that the uptake and sustainability of EBPs are profoundly shaped by cultural dynamics operating across three key layers: organizational, professional and disciplinary.

Organizational culture shapes openness to change, learning and psychological safety, influencing whether EBPs are seen as improvements or burdens. Professional cultures, rooted in education and identity, affect how physicians, nurses and other professionals apply guidelines and protocols. Disciplinary cultures, tied to clinical environments (e.g. emergency, intensive, mental health, palliative care), also shape how EBPs are received. Enhancing cultural responsiveness requires aligning EBPs with the shared norms, values, beliefs and assumptions of the intended users. Strategies include fostering clinician engagement in the development of EBPs, cultural competence, local adaptation and leveraging cultural champions.

Implementation of EBPs is shaped by culture, not solely by the strength of evidence or implementation strategies. Organizational, professional and disciplinary cultures interact to influence how EBPs are interpreted, accepted, adapted or resisted in practice, helping to explain persistent variation in uptake. Misalignment between EBPs and prevailing norms, values, beliefs and assumptions undermines implementation even when evidence is strong.