Studies of organization-wide implementation of EIDM |
Allen, 2018 (71) | Case report, no comparator | State health department, Georgia, USA, 2013–2016 | Public health | Program staff across organization | Program staff received training for EIDM that included lectures, and small group problem-solving and discussion. | Qualitative: EIDM facilitators and barriers (interviews) | Facilitators for EIDM: -Leadership support -Consistent internal messaging on EIDM -Close partnerships with evaluation teams -Requirement for evidence in proposals Barriers to EIDM: -Competing priorities -Limited budget for staff -Political conflicts in state and local agendas | High (Case report) |
Allen, 2018 (70) | Qualitative | State health departments, USA, 2016 | Public health | Leaders and program managers | State health departments to an intervention group that received EIDM training and support (See Brownson, 2017). | Qualitative: EIDM facilitators and barriers (structured interviews) | Facilitators for EIDM: -Leadership support -Developing structures and culture incorporating evidence based public health -Ongoing training -Building and maintaining partnerships with external partners Barriers to EIDM: -Funding/budget cuts -Lack of time -Lack of political will/support -Staff turnover | Moderate (Qualitative) |
Augustino, 2020 (46) | Case report, no comparator | Military treatment facilities, USA, 2018 | Primary care | Nursing staff at 4 facilities | An evidence-based practice facilitator role supported organization-wide EIDM teams through training, mentoring, and encouraging EIDM. | Findings were described in a narrative case report. | Facilitators for EIDM: -Incorporating the evidence-based practice facilitator into existing practice -Involving evidence-based practice facilitator in nursing meetings and committees -Aligning the evidence-based practice facilitator’s work with organizational priorities Barriers to EIDM: -Staff turnover -Lack of standardized evaluation of EIDM use | High (Case report) |
Awan, 2015 (74) | Case report, no comparator | Centre for Addiction and Mental Health, Toronto, Ontario, Canada, 2013–2014 | Primary care | Service providers, researchers at organization | An integrated care pathway, which relies on EIDM, was implemented for patients with concurrent major depressive disorder and alcohol dependence. Development of the integrated care pathway included evidence reviews, knowledge translation, process reengineering and change management. | Quantitative: -patient symptom assessment and medication titration (Penn Alcohol Craving Scale, Quick Inventory for Depressive Symptoms scores and Beck Depression Inventory) Qualitative: -Facilitators and barriers (focus groups) | Evaluation of patient care found: -Lower program dropout (78–46% p < 0.05) -Reduction in depressive symptom severity (p-value not reported) -Reduction in heavy drinking days (42–23%, p < 0.04) Facilitators for EIDM: -Inclusion and frontline clinicians -Use of tools/templates (e.g., process maps, medication algorithms) -Team meetings Barriers to EIDM: -Lack of knowledge and skill for EIDM -Communication with referring providers | Moderate (Case report) |
Bennett, 2016 (73) | Case report, no comparator | Large urban hospital, Australia, 18 months; dates not specified | Primary care | Occupational therapists in hospital | An EIDM capacity building program was implemented. The program included: -Educational outreach across organization -Teams working on clinical case studies -Allocating time for EIDM -Mentorship -Leadership support -Communication regarding EIDM -Development of EIDM processes and resources -Funding for an EIDM champion one day per week -Setting goals and targets for EIDM -EIDM reporting and evaluation | Qualitative: EIDM use, perceptions of organizational culture toward EIDM, EIDM facilitators and barriers (focus groups with clinicians and observations by the research team) | Facilitators for EIDM: -EIDM integration into roles -Buy-in to EIDM impact -Developing goals for EIDM -Access to mentors -Supportive leadership -Breaking down EIDM into manageable tasks -Journal club to discuss EIDM processes Challenges to EIDM: -Lack of EIDM knowledge and skill -Perceived lack of capability -Perceived lack of time and training -Competing priorities -Challenges with staff rotating between clinical teams | Moderate (Case report) |
Breckenridge-Sproat, 2015 (61) | Single group pre-post study | Military hospitals, Washington, District of Columbia, USA, 18 months; dates not specified | Primary care | Nurses across hospitals | Unit-level mentors facilitated an educational mentoring program for EIDM. The intervention involved an organizational assessment, identification of facilitators and barriers, training EIDM mentors and EIDM implementation. Librarian support, evidence-based practice education material, training modules were provided and supervised study team evidence-based practice projects were completed. | Quantitative: -EIDM beliefs (Evidence-Based Practice Beliefs) -Organizational readiness and barriers to EIDM (Organizational Readiness for System-wide Integration of Evidence-Based Practice) -EIDM implementation (Evidence-Based Practice Implementation Scales) | Following the intervention, -Evidence based practice belief scores increased (p = 0.02) -Organizational readiness for EIDM scores increased (p < 0.01) | Moderate (Quasi-experimental study) |
Brodowski, 2018 (72) | Case report, no comparator | Social service agencies, Kansas and Nebraska, USA, 2005–2011 | Social work | Social service providing organizations | A workgroup of state-led agencies and federal partners developed a framework for infrastructure for EIDM, including federal policy for investing in evidence-based programs and quality improvement. Technical assistance was provided to community-based programs through a third party. | Quantitative: Use of EIDM (annual reported funding for evidence-based programs) Qualitative: EIDM facilitators (interviews) | The percentage of funded programs that were evidence-based increased from 29–63%. Facilitators for EIDM: -Strong infrastructure (outreach, training, fidelity assessment, supervision, management of the program -Availability of Technical Assistance: -Consideration of context when using EIDM to choose programs -Active engagement and collaboration with key stakeholders at all levels | High (Case report) |
Brownson, 2017 (78) | RCT, control group | State health departments, USA, March 2014 and March 2015 | Public health | Program staff across organization | State health departments randomized to: -Intervention group that received EIDM training workshop, and follow-up calls for technical assistance and supplemental activity planning and updates support -Control group that received links to electronic resources. | Quantitative: perceived organizational skills and culture for EIDM (survey) | Following the intervention, -Perceived skills gaps decreased (p = 0.02). -Perceived supervisory expectation for use of EIDM increased (p = 0.006) -Use of evidence increased (p = 0.008). | Moderate (RCT) |
Clark, 2022 (62) | Mixed methods, no comparator | Public health units, Ontario, Canada, 2015–2018 | Public health | 4–8 Staff members from each of 10 public health units | Senior leadership set organizational goals for EIDM during a facilitated focus group using the Is Research Working for you organizational assessment. Knowledge translation specialist mentors delivered a Knowledge Broker mentoring program, including workshops, webinars, consultations and completion of a rapid review. | Quantitative: -Attainment of organizational goals for EIDM (semi-structured interviews) Qualitative: -EIDM facilitators and barriers (semi-structured interviews) | Facilitators for EIDM: -Integration of EIDM into process through structures, processes, or templates -New or re-defined staff positions for EIDM -Leadership support -Culture of expectations of EIDM -Acceptance of time to learning and do EIDM Barriers to EIDM: -Lack of managers’ EIDM knowledge -Lack of protected time -Lack of staff buy-in -Lack of direction or plan for participants | High (Qualitative) |
Dobbins, 2019 (57) | Single group pre-post study | 3 Public health units, Ontario, Canada, 2010–2012 | Public health | All staff at organization, senior leadership | Knowledge Brokers deployed to public health units supported individual capacity and organizational culture for EIDM. Knowledge brokers held workshops, mentoring, meetings with senior management and developed policies and processes for EIDM. | Quantitative: -Knowledge, skills and behavioral assessment (survey) Qualitative: -EIDM facilitators and barriers (analysis of knowledge brokers journals) | Facilitators for EIDM: -Strong leadership support -Systematic integration of research evidence into decision-making processes -Access to librarian support -Committed financial and human resources -Staff interest and enthusiasm | Moderate (Quasi-experimental study) |
Elliott, 2021 (50) | Case report, no comparator | Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), Canada, dates not specified | Primary care | Clinicians, nurses | An integrated KT network (Can-SOLVE CKD) was established, including: -Central knowledge translation committee available for consultation -Support from external partners -KT planning templates -KT champions -KT virtual community of practice -KT online learning module | Findings were described in a narrative case report. | Facilitators for EIDM: -Diverse knowledge base and members’ commitment to KT -Inclusion of patient’s perspectives Barriers to EIDM: -Generalizability to smaller project teams -Lack of KT skills among research and patient partners | Moderate (Case report) |
Fernández, 2014 (75) | Case report, no comparator | The Cancer Prevention and Control Research Network, USA, dates not specified | Public health | National network | Workgroups across the network facilitated activities, including: -building the capacity of service providers for EIDM -developing technical assistance for KT -developing research partnerships -investigating implementation processes from other studies | Findings were described in a narrative case report. | Successful EIDM activities were described, including the following. Network members translated and adapted the evidence-based Stanford Chronic Disease Self-Management program which was well attended and highly rated by participants. Cancer screening programs were adapted to the local context, increasing uptake among residents. Several partner universities have implemented workplace health promotion interventions. | High (Case report) |
Flaherty, 2021 (77) | Cluster RCT, control group | Outpatient child mental health clinics, New York, USA, dates not specified | Primary care | 52 Child mental health care providers | 4Rs and 2Ss Multiple Family Group intervention: -Providers received training and bimonthly supervision. -Clinic Implementation Teams operated at agencies randomized to the intervention arm. | Quantitative: Frequency of use of new techniques (Training Exposure and Utilization Scale), and organizational climate (Organizational Readiness for Change Scale) | Increased use of evidence-based interventions was associated with providers’ belief that organizational climate supported use of evidence-based interventions (b = − 0.33, SE = 0.11, p < 0.01). | Moderate (RCT) |
Gallagher-Ford, 2014 (48) | Case report, no comparator | Large, complex healthcare system, USA, dates not specified | Primary care | Departments across an organization | A nurse administrator promoted and sustained a culture of evidence-based practice through the following activities: -Organizational assessments -Developing clinical nurse specialists as EIDM champions -Mentoring individuals through the change process | Findings were described in a narrative case report. | Clinical nurse specialists have championed EIDM across the organizations. More than 13 projects for EIDM were initiated by clinical nurse specialists. | Low (Case report) |
Gifford, 2014 (64) | Qualitative | Large community healthcare organization delivering home and community healthcare, Ontario, Canada, 20-weeks; dates not specified | Public health | Management and clinical leaders from 4 units | Strategies to promote EIDM to nurse managers and clinical leaders in home healthcare were implemented, including, -Workshop on EIDM -Mentorship support from experienced “evidence facilitators” -Access to university library services -Information-sharing activities -Encouragement and recognition | Quantitative: EIDM use (Is Research Working for You? A Self-assessment Tool and Discussion Guide for Health Services Management and Policy Organizations) Qualitative: Usefulness of intervention, EIDM barriers and facilitators (semi structured interviews) | Following the intervention, participants reported: -More resources to conduct research -Staff contributions to EIDM discussions -More information about how evidence influenced decisions made in the organization (all p < 0.05) Facilitators for EIDM: -Ongoing education -Linking staff to EIDM experts -Social networking across organization -Recognition for EIDM work -Audit and feedback Barriers to EIDM: -Lack of time -Lack of knowledge, skills, and confidence -Conflicting priorities within the organization -Staff shortages | High (Qualitative) |
Haynes, 2020 (79) | Case report, no comparator | Australian Prevention Partnership Centre, Australia, 5 years; dates not specified | Public health | Organization-wide, in partnership with research institutions | Six components for cross-sector collaborative partnerships for EIDM: 1. Partners involved at all stages 2. Communication efforts, e.g., forums, narrative reports 3. Skill development through workshops, webinars with experts 4. Cross-sector project teams 5. High-quality evidence syntheses 6. Ongoing surveys and opportunities for feedback | Quantitative: -Perceptions of leadership, governance, resource allocation, collaboration and engagement (Partnership survey) Qualitative: -Implementation and impact of projects (project evaluations) -Experiences and perceptions (semi-structured interviews) | Partners reported: -Translation of research into policy was built into processes -Many projects involved partners from different sectors -Communication across sectors and teams was adequate -Capacity building activities were valuable -Synergies were identified across projects | Moderate (Case report) |
Hitch, 2019 (51) | Case report, no comparator | Public mental health service, major city in Australia, 2014–2016 | Occupational therapy | Occupational therapists within the organization | Leadership role in KT established to support EIDM, complete research projects, build research capacity and culture, and create a database of research activity. | Quantitative: -Attitudes towards EIDM (Evidence Based Practice Attitude Scale) -EIDM use (Evidence Based Practice Implementation Scale) -Staff perceptions of the Lead Research Occupational therapist role (survey) | After implementation of the KT role, -number of quality assurance and research activities increased (Cliffs Delta = 0.44; 95% CI = 0.22, 0.62) -no significant change in attitudes towards EIDM -staff viewed KT role positively -staff engaged in KT activities -greater diffusion of evidence across programs | Moderate (Case report) |
Hooge, 2022 (53) | Single group pre-post study | Large academic health system, southeast region, USA, 12-week program; dates not specified | Primary care | 11 Advanced practice registered nurses | Virtual mentoring program delivered via Microsoft Teams platform included synchronous training sessions, podcasts, blog and video tutorials, and additional research articles and educational material. | Quantitative: -Knowledge and skill for EIDM (Evidence-based Practice Beliefs scale, Evidence-based Practice Implementation scale) -Organizational readiness for EIDM (Organizational Culture and Readiness for System-wide Integration of Evidence-based Practice scale) Qualitative -EIDM facilitators and barriers (open-ended survey) | Compared to baseline, evidence-based practice beliefs scores increased (effect size = 0.71, p = 0.018). No significant change in evidence-based practice implementation and organizational culture and readiness for system-wide implementation of evidence-based practice scale scores. Barriers to EIDM: -Competing priorities -Time management | High (Quasi-experimental study) |
Humphries, 2013 (47) | Case report, no comparator | Regina Qu’Appelle Health Region and Northern Health, Alberta and British Columbia, Canada, 2008–2011 | Public health | Management and staff at organizations | The Value Add through Learning and Use of Evidence (VALUE) initiative: -Learning projects (to practice research literacy and skills) -Liaison roles -Research support -Protected time for EIDM activities -Inter-regional collaboration | Findings were described in a narrative case report. | Lessons learned included: -Staff turnover was a challenge -Potential benefit to promoting evidence use in staff orientation -Evidence use implementation needs to be directed at multiple levels within the organization -Strategies with ongoing real-time research expertise and support were valued by participants | High (Case report) |
Irwin, 2013 (49) | Case report, no comparator | Various healthcare settings, USA, 2009–2010 | Primary care | Nursing teams | Institute for Evidence-Based Practice Change program was provided to nurses. This program included a 2.5-day workshop on EIDM, literature searching, and development of an implementation plan, project management, and outcomes measurement. The program also provided an experience mentor for EIDM support for 12-months. | Qualitative: -EIDM facilitators and barriers (log entries from the team champion) | Facilitators for EIDM: -Adequate time -Organizational support -Engagement and teamwork -Communication and planning -Maintaining focus on EIDM goals Barriers to EIDM -Competing priorities -Data collection and measurement challenges -Staff turnover | Low (Case report) |
Kaplan, 2014 (76) | Case report, no comparator | Magnet-designated hospital, USA, November 1, 2012 to May 10, 2013 | Primary healthcare | Nurses across organization | All nurses received an electronic newsletter on EIDM every 2 weeks. A cohort of direct care nurses participated in a series of EIDM workshop to develop, implement, and disseminate an EIDM project. | Quantitative: Organizational readiness for integration of EIDM (The Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Scale), EIDM knowledge and skill (Evidence-Based Practice Beliefs Scale), EIDM implementation (The Evidence-Based Practice implementation Scale) | Following the intervention, perceptions of organizational increased. Confidence in implementing EIDM was not associated with EIDM use. Higher education levels was positively associated with nurses’ EIDM use. | High (Case report) |
Kimber, 2012 (67) | Qualitative | Kinark Child and Family Services, Ontario, Canada, 2006–2010 | Child and youth mental health | Staff across organization | Multiple EIDM interventions were implemented, including: -Leadership support -Appointing working group leaders -Dedicated time for EIDM | Qualitative: -EIDM facilitators and barriers (survey) | Facilitators for EIDM -Staff understanding the clinical transformation project and stages -Effective leadership -Change culture inclusive of staff and management, and various disciplines -Cross-program collaboration -Protected time -Evaluation to demonstrate benefits of change Challenges to EIDM: -Underutilization of internal staff -Lack of preparation for change | Moderate (Qualitative) |
Mackay, 2019 (58) | Single group pre-post study | Haemodialysis unit of a hospital, Queensland, Australia, 2016–2018 | Primary care | All staff at organization | A new nutrition service was established to translate nutrition guidelines into practice to support EIDM through: -Professional development -Evidence-informed recommendations -Multidisciplinary staff involvement -Integrated database prompts | Quantitative: EIDM use, malnutrition prevalence (database audit, Patient-Generated Subjective Global Assessment tool) Qualitative: EIDM facilitators and barriers (clinic observation, team discussion) | There was no significant change in malnutrition categories; most patients (72–80%) began the program well-nourished. Facilitators for EIDM: -Establishing processes for best practices -Buy-in from staff and management-in from staff and management -Regular monitoring and feedback Barriers to EIDM: -Limited prior knowledge -Limited time | Moderate (Quasi-experimental study) |
Martin-Fernandez, 2021 (68) | Case report, no comparator | Regional health agencies, France, 2017–2019 | Public health | Health professionals and decision-makers across regional health agencies | The Transfert de Connaissances en REGion (TC-REG) knowledge translation plan: -Improved access to scientific evidence -EIDM skill development through training, journal clubs and tutoring -Organizational culture development through collaborative workshops, processes, and incentives | Qualitative: -EIDM facilitators and barriers (unstructured interviews) -Use of EIDM (semi-structured interviews) | Facilitators for EIDM: -Understanding of scientific evidence -Confidence in using scientific evidence -Ability to search and find scientific evidence -Motivation to use scientific evidence -Belief that scientific evidence can help to improve practice, develop new frameworks, advocate for their professional activity, and create new partnerships | Moderate (Case report) |
Melnyk, 2017 (60) | Single group pre-post study | Washington Hospital Healthcare System, USA, 12 months; dates not specified | Primary care | Service providers, administrators within organizations | EIDM mentors were developed within the healthcare system, through intensive EIDM workshops. Teams of participants implemented and evaluated an EIDM change project within their hospital. | Quantitative: Knowledge and skill for EIDM (evidence-based practice beliefs scale, evidence-based practice implementation scale), organizational readiness for EIDM (organizational culture and readiness for system-wide implementation of evidence-based practice scale), patient outcomes (aggregate data from the hospital’s medical records) | Following implementation, -Organizational knowledge and skill for EIDM organization increased (effect size = 0.62; p = 0.00) -Organizational implementation of EIDM increased (effect size = 2.3; p = 0.00) -Organizational culture and readiness for EBP increased significantly from baseline (M = 80.9; SD = 90.8) to follow-up (M = 90.8; SD = 14.7; t = 3.9; p = 0.00; effect size = 0.70) The following trends were seen in patient outcomes, -Reduction in ventilator days -Decreased pressure ulcer rate -Reduced hospital readmissions for congestive health failure -Increase in patient reported quality of care -Reduced use of formula as a supplement -Decreased wait time for pain medication and decreased length of stay in emergency room | Moderate (Quasi-experimental study) |
Miro, 2014 (55) | Single group pre-post study | Fraser Health, Island Health and Vancouver Coastal Health, British Columbia, Canada, 2010–2012 | Public health | Organization | Regional health authorities were provided an expert consultant to foster EIDM in land use and transportation plans and policies. The expert worked with staff to develop and facilitate the implementation of the work plans, by conducting a situation assessment, developing and implementing capacity-building plan. | Quantitative: Knowledge and skill for land use and transportation plans/policies (survey) Qualitative: Activities completed at the health units (interviews) | Following the intervention, staff reported: -Increased knowledge and skills -Increased awareness of other organizations Facilitators for EIDM -New relationships with colleagues in other health authorities, governments and sectors -Increased opportunities for collaboration -Collaboration between health authorities and local governments -New insights on partnership work Barriers to EIDM -Lack of time and resources -Roles and partnerships not clearly defined -Lack of leadership support and integration across the organization | High (Quasi-experimental study) |
Parke, 2015 (52) | Case report, no comparator | Island Health and the University of Alberta, British Columbia, Canada, 2012–2014 | Primary care | Whole organization | Scholar-in-residence roles was established to integrate practice, education, and research through collaboration between a health region and a university. Activities included: -Unit-based research teams that conducted literature reviews, literature appraisal -Workshops on writing for publication, research methods skills -Funded research project proposal writing, ethics applications, data collection and analysis -Publications and presentations -Quality improvement through collaboration with community, hospitals and university | Findings were described in a narrative case report. | Barriers to EIDM: -Cultural differences between the healthcare and university system -Establishing protected time for research in the health organization -Building relationship between the scholar and hospital staff | Moderate (Case report) |
Peirson, 2012 (5) | Qualitative | Peel Public Health, Ontario, Canada, September 2008 to February 2010 | Public health | All staff at organization, including leadership | Multiple EIDM interventions were implemented, including: -Hiring new leadership supportive of EIDM -Strategic organizational plan for EIDM -Development of staff knowledge and skills | Qualitative: EIDM facilitators (semi-structured interviews and focus groups, review of documents) | Facilitators for EIDM: -Senior leadership driving EIDM initiatives -Organizational structures (e.g., journal clubs, workshops, library services) -Establishing EIDM specialist roles, training staff in EIDM and encouraging knowledge sharing with co-workers -Supportive organizational culture -Accessible knowledge and sharing knowledge across the organization -Communication around EIDM and its priority to the organization | High (Qualitative) |
Plath, 2013 (66) | Qualitative | Non-governmental social service organization, Australia, dates not specified | Social work | Staff across organization | Strategies to promote EIDM were implemented, including: -Leadership commitment to EIDM -Staff champions for EIDM -Establishment of EIDM “communities of practice” teams | Qualitative: -EIDM facilitators and barriers and facilitators (interviews and focus groups) | Facilitators for EIDM: -Dedicated staff roles for research and KT -Supportive leadership -Sufficient time, training and resources for EIDM -Audit and feedback of practices -Building frontline staff skills in EIDM -EIDM “communities of practice” Challenges to EIDM: -Competing priorities -Lack of knowledge and skills -Culture of responding to crises | Moderate (Qualitative) |
Roberts, 2020 (56) | Single group pre-post study | Tennessee Department of Health, Tennessee, USA, 2012–2018 | Public health | Departments, teams, senior leadership across organization | Volunteers were trained as “Baldrige examiners”, a similar role to knowledge broker. These volunteers supported teams at the local health departments evaluate and improve programming. | Quantitative: -Employee satisfaction (survey) -Adoption of new processes (training records) -Integration of new programs (program process reports) | Authors report diffusion of skills across the local health departments. Department staff reported satisfaction with their jobs at rates higher than national averages. | Moderate (Quasi-experimental study) |
Traynor, 2014 (65) | RCT with control group and case report with no comparator | Public health units, Ontario, Canada, RCT 2003–2007 and case report 2009–2013 | Public health | Organization | Two studies implemented Knowledge Brokers who conducted initial and ongoing needs assessments for EIDM, knowledge management and internal network development. | Quantitative: social network data, EIDM skills, knowledge and behavior (survey) Qualitative: Knowledge, attitudes and behaviours for EIDM (interviews, journal analysis) . | Knowledge brokering intervention was reported to result in increased use of EIDM. Tailoring knowledge broker approaches to the organizational context was most effective. Knowledge brokers were most effective if they were experts in research methodology and public health, as well as being approachable and patient. | High (Qualitative) |
Van der Zwet, 2020 (69) | Case report, no comparator | Social work Organization, Netherlands, 2013–2015 | Social work | Research and development team | Research and development department and long-term collaboration with a university were established to support EIDM. | Qualitative: -EIDM facilitators and barriers (semi-structured interviews) | Facilitators for EIDM: -Leadership commitment to research -Qualified staff in EIDM support roles -Research partnerships -Training in EIDM -Targeted recruitment of staff with diverse educational backgrounds Barriers to EIDM: -Negative attitudes towards EIDM -Preference for experiential vs. research knowledge -Culture of crisis-driven practice -Workload, time management, competing priorities | High (Case report) |
Ward, 2012 (4) | Case report, no comparator | Peel Public Health, Ontario, Canada, 2010-11 (Year 4 of a 10-year initiative) | Public health | All staff at organization, including leadership | Key elements of the EIDM strategic approach included: -Structured process for research review -Library reference service -Staff development in EIDM knowledge and skills -Dedicated staff time for EIDM -Active engagement with the research community -Accountability for EIDM at all levels of the organization | Findings were described in a narrative case report. | After 4 years of implementation, there was systematic and transparent application of research to more than 15 program decisions. EIDM was embedded as a cultural norm within the organization. Key lessons identified included: -Identify a senior, influential leader -Commit to a multiyear strategy -Be realistic about the infrastructure needed -Staff support for skill development -Make senior staff accountable for progress -Partner with leading researchers -Invest resources in change management. -Measure progress to communicate successes to staff | Moderate (Case report) |
Waterman, 2015 (63) | Qualitative | The Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Manchester, United Kingdom; dates not specified | Public health | Organization | KT Associates facilitated the implementation of EIDM. KT Associates joined teams responsible for implementing EIDM along with the clinical lead, academic lead and program manager. | Qualitative: -Evaluation of KT Associates’ role and impact (focus group and interviews) | KT Associates contributed to 4 key stages: -Choosing an evidence-based intervention (collecting information, bringing stakeholders together, identify context, build up network) -Planning the evidence-based intervention (collecting evidence, testing the intervention, sharing info, expanding networks, stakeholder meetings) -Co-ordinating and implementing the evidence-based intervention recruit people and build relationships, individualized support, communication, understanding context) -Evaluating evidence-based intervention (data collection/report, patient and staff experiences, celebratory events, poster/presentations) | High (Case report) |
Williams, 2020 (109) | Single group pre-post study | Outpatient children’s mental health clinics, Philadelphia, USA, 2013–2017 | Primary care | Senior leadership across agencies | Development of organizational leadership and climate for EIDM through training, consultation and technical assistance. | Quantitative: -EIDM use (Cognitive-behavioral therapy subscale of the Therapy Procedures Checklist-Family Revised) -Leadership for EIDM (Implementation Leadership Scale) -Organizations’ climates for EIDM (Implementation Climate Scale) -Perceptions of leader’s transformational leadership (Multifactor Leadership Questionnaire) -Attitudes toward EIDM (Evidence-based Practice Attitudes Scale) | Organizational climates supportive of EIDM were associated with: -Strong leadership for EIDM (d = 0.92, p = 0.017) -Increased use of EIDM (d = 0.55, p = 0.007) There was no association between clinicians’ attitudes towards EIDM and their use of EIDM. | High (Quasi-experimental study) |
Williams, 2019 (59) | Single group pre-post study | Metabolic specialist centres, Australia and New Zealand, 2015–2017 | Primary care | Metabolic dietetic service within organization | The metabolic dietetic service established: -Electronic referral alert -Metabolic sick day nutrition plans available to all clinical staff -Metabolic diet codes and specialised formula recipes | Quantitative: Admissions for patients with inborn errors of metabolism (chart audit) | There was a reduction in total admissions of patients with inborn errors of metabolism (36 vs. 11 across the audit periods; unclear if this was a statistically significant finding.) | Moderate (Quasi-experimental study) |
Williams, 2017 (54) | Single group pre-post study | Children’s mental health agencies, large midwestern urban area, USA, 2010–2013 | Primary care | CEOs and administrators, and front-line clinical teams at organizations | External facilitators supported leadership, staff and an internal liaison. Principles of EIDM were integrated into the organizations’ operating procedures. Organizational infrastructure and tools to enable EIDM were developed. Staff and leadership mental models to support EIDM were enabled. | Quantitative: Intentions to adopt EIDM, barriers to EIDM (surveys), Unit-level enactment of Availability, Responsiveness, and Continuity principles and completion of planned activities (ARC principles questionnaire), Organizational proficiency culture for EIDM (Organizational Social Context measure) | Following implementation, clinicians exhibited: -Higher odds of adopting EIDM (OR = 3.19, p = 0.003) -Greater use of EIDM with clients (p = 0.003) -Fewer EIDM barriers (p = 0.026) Intention to use EIDM was the only predictor of EIDM adoption (p = 0.032) and EIDM use (p = 0.002). | High (Quasi-experimental study) |
Studies of implementation of EIPs |
Connell, 2019 (110) | Case report, no comparator | Department of Children and Families, Connecticut, USA, 2011–2016 | Social work | All staff at organization | Implementation of trauma-informed care, through workforce development, trauma screening procedures, policy changes, improved access to evidence-based trauma-focused treatments, and focused evaluation of changes. | Quantitative: -Staff perceptions of individual and organizational use of trauma-informed practices (Trauma System Readiness Tool) -Staff perception of contributions of each intervention component to success of program (survey) | Staff and organizational use of trauma-informed practices increased. Staff rated the availability of trauma-focused treatments in the community, integration of trauma-informed care into practice guides as the strongest contributors to organizational change. | High (Case report) |
Damschroder, 2013 (111) | Case report, no comparator | Five Veteran Affairs facilities, USA, July and October 2007 | Public health | Organization | Implementation of the MOVE! weight management program, a multi-tiered set of tools and treatment options based on published guidelines for obesity management. | Qualitative: -Facilitators for implementation (semi-structured interviews with 24 key stakeholders) | Facilitators for implementation, according to the Consolidated Framework for Implementation Research: 1. Inner setting: -Strong working relationships -Tension for change (seeking and welcoming new programming and improvements) -Priority of the change or program -Goals and feedback ( -Learning climate -Leadership engagement to support the program 2. Process: -Planning a formal implementation plan 3. External change agents: -Audit and feedback 4. Intervention characteristics: -Relative advantage over alternatives 5. Outer setting: -Staff who are aware of patient needs | High (Case report) |
Darling, 2021 (112) | Case report, no comparator | Alongside Midwifery Unit, Markham Stouffville Hospital, Markham, Ontario, Canada. November 2018-May 2020 | Primary care | Unit within a large community hospital | Implementation of the first Alongside Midwifery Unit in Canada: -Frequent and open communication -Dedicated project management -Leadership engagement -Ongoing evaluation and adaptation. | Qualitative -Facilitators (document analysis and key informant interviews) | Facilitators for implementation: -sociopolitical climate, desire for change, effective project support, dedicated time and resources, ongoing program evaluation and feedback, communication with leadership, involving all staff in planning and decision making. | Moderate (Case report) |
Fabbruzzo-Cota, 2016 (113) | Single group pre-post study | Mount Sinai Hospital, Toronto, Ontario, Canada, 2012–2014 | Primary care | Organization | An advanced practice nurse-led interprofessional initiative to reduce hospital-acquired pressure ulcers using evidence-based practice: -Clinical experience integrated with theory, research and expert opinion -Synthesizing, critiquing and applying research - Involvement of interprofessional teams and senior leadership -Funding -Education | Quantitative: -Incidence of pressure ulcers (Quarterly pressure ulcer prevalence and incidence audits) -Uptake of change in clinical practice (audits) | Findings included: -80% decrease in hospital acquired pressure ulcers since the implementation. -63% of at-risk patients had a turning click posted at the bedside. -All units had the Positioning Decision Tree for Patients at Risk available -28 Skin and wound nurse champions -2 Nurses joined Skin and Wound Care Steering Committee | Moderate (Quasi-experimental) |
Fearing, 2014 (114) | Case report, no comparator | Kinark Child and Family Services Ontario, Canada 2006–2009 | Social work | Organization | This report explores the process of an evidence-based practice implementation effort in all clinical services. Implementation was driven by multidisciplinary implementation teams. | Qualitative: -Managers perceptions (audio recording of management meetings) | Facilitators for implementation: -Clearer understanding of the organization’s clinical supervision model -Development of sustainability plans -Practice Lead and Peer Coach -Organizational culture change Barriers to implementation: -Staff workload -Limited resources | High (Case report) |
Hurlburt, 2014 (115) | Case report, no comparator | Large children’s service system, California, USA, 2008–2009 | Social work | 27 Stakeholders (community, directors, supervisors, trainers, coaches, front line providers) | The Interagency Collaborative Team (ICT) model was used to implement an evidence-based child neglect intervention (SafeCare): -Stakeholder education and alignment -Practice fit assessment -Resource support -Skill development -Monitoring and feedback. -Distributed local leadership -Program adaptation. | Qualitative: personal-, organizational- and system-level factors affecting implementation (semi-structured interviews) | Facilitators for implementation: -Initial commitment and collaboration among stakeholders -Cross-level leadership -Practice fit to the local context -Ongoing negotiation of rights, roles, responsibilities, and interests among stakeholder organizations -Early successes Barriers to implementation: -Insufficient communication | High (Case report) |
Kane, 2017 (116) | Case report, no comparator | Public health departments, USA, 2010–2012 | Public health | Organization | The Communities Putting Prevention to Work (CPPW) Initiatives program was implemented to increase high-impact, evidence-based, population-wide environmental improvement strategies. The program implemented strategies through partnerships with local, community and state organizations. | Quantitative: Completion of work plan objectives, leadership support, collaboration, staff turnover (site visits and interviews) | The following conditions were found to lead to successful completion of objectives 88.2% of the time: -Having public health improvement and topical experience and having a history of collaboration with partners 2)Not having public health improvement and topical experience and having leadership support | Moderate (Case report) |
Kegeles, 2015 (117) | Single group pre-post study | Community-based organizations, USA, 2-year data collection period; dates not specified | Public health | 2–4 Individuals (coordinators, leadership, volunteers) from 72 community- based organizations | The Mpowerment Project, a multi-level HIV prevention intervention, was implemented. Implementation included education for providers, resources for providers, e.g., manuals and videos. The community-based organizations implementing the program were involved in planning the implementation. | Qualitative: barriers and facilitators to implementation (semi-structured interviews, notes and commentaries from technical assistance providers) | Facilitators for implementation: -Buy-in from service providers -Planning prior to implementation -Evaluation of intervention -Organizational stability Barriers to implementation: -Program complexity -Program adaptability | Moderate (Quasi-experimental) |
McAllen, 2018 (118) | Single group pre-post study | 532-bed, acute care tertiary teaching hospital, midwestern USA, dates not specified | Primary care | 3 Units within the hospital | A bedside report was implemented in standard nursing care. Staff were involved in implementation planning and provided education. | Quantitative: -Compliance (audits) -Number of patient falls (hospital incident reporting system) -Patient satisfaction (a combination of questions from the Press Ganey® and Hospital Consumer Assessment of Healthcare Providers and Systems surveys) -Nurse satisfaction (survey) | Findings included: -Program compliance rate of 94% -Patient falls decreased by 24% in the four months after implementation -One unit had improvement in patient satisfaction (p = 0.03) -Significant reduction in the proportion of nurses who reported having enough time for report (80–59.6%, p = 0.008) | Moderate (Quasi-experimental) |
McCarthy, 2021 (119) | Case report, no comparator | Child welfare system, Victoria, Australia, dates not specified | Social work | Organization | This case report explores the adoption and implementation of evidence-based practice within the child welfare system. Implementation was initiated by new leadership. A new role dedicated to implementation was established. Staff recruitment focused on hiring individuals with experience implementing evidence-based practices. | Qualitative: -Facilitators for implementation (interviews) | Facilitators for implementation: -Consistent communication and messaging -Adaptive management -Building a shared understanding of evidence -Development of a learning culture -Investment in staff skilled in evidence-based practice -Building relationships -Transformational leadership approach | Moderate (Case report) |
McConnell, 2015 (120) | Case report, no comparator | Health and social care trust, Northern Ireland, 2011–2012 | Palliative care | Two policymakers from the Department of Health, Social Services and Public Safety, and 22 participants from two service groups (Cancer and Specialist Services, and Acute Services) | The Liverpool Care Pathway was implemented to improve best practice in end-of-life care. Implementation involved a dedicated program facilitator, education for staff, regular evaluation and feedback. | Qualitative: facilitators and barriers for implementation (realist evaluation, semi-structured interviews) | Facilitators for implementation: -Visibility and availability of program facilitator as a reminder to use pathway and support staff -Sharing positive feedback -Supportive senior management Barriers to implementation: -Lack of resources -Differing needs and expectations -Ambivalence toward pathway approach from medical providers -Lack of ongoing senior management support and withdrawal of program facilitators -Social barriers (i.e., negative public perceptions in response to negative media) | Moderate (Case report) |
Nelson, 2016 (121) | Case report, no comparator | Alberta Health Services, Alberta, Canada, February 2013-December 2014 | Primary care | Within a single health care system for colorectal surgery | A guideline for enhanced recovery after colorectal surgery was implemented. Implementation included an multidisciplinary implementation team and ongoing audit and feedback. | Quantitative: -Length of stay, complications, and 30-day post-discharge 30-day post-discharge readmissions (Interactive Audit System) -Guideline compliance (interview audit) | Findings at 15 months of implementation: -Median length of stay reduced from 6 days to 4.5 days (p < 0.0001) -Reduction in the risk of readmission (adjusted RR = 1.73; 95% CI = 1.09, 2.73) -Reduction patients who develop a complication (-11.7%, 95% CI = 2.5%, 21%) -Net cost savings between $2806 and $5898 USD/patient -Median overall guideline compliance increased from 39–60% | High (Case report) |
Poehler, 2020 (122) | Case report, no comparator | Local health departments, Missouri, USA, January-April 2017 | Public health | Organization | Twenty diabetes-related evidence-based programs and policies were implemented in local health departments. Staff capacity to implement these programs was developed through training and provision of resources. | Qualitative: -Facilitators, barriers and capacities to use evidence-based programs and policies (interviews with directors and diabetes/chronic disease practitioners) | Facilitators for implementation: -Knowledge of evidence-based programs and policies -Leadership support -Targeted messaging -Staff capacity building for EIDM evidence-based decision making -Access to professional development/training -Regular staff communications/ meetings -Meetings with internal and community decision makers -Community-relevant evidence Barriers to implementation: -Community perception/buy-in -Limited resources (funding and staff) | Moderate (Case report) |
Pullyblank, 2022 (123) | Single group pre-post study | Clinical health departments and community-based organizations, rural New York state, USA, March 2017- Nov 2019 | Primary care | Organization | Multi-sector collaboration between a rural health care system and a network of community-based organizations, and establishment of a central recruitment, referral and coordinating office for the region. | Quantitative: Number of referrals (electronic health records), implementation, training, workshop schedules, quality assurance (Living Well internal documents), Workshop attendance and completion (program records) | The number of program workshops offered increased from 4–6/year to 23 by 2019. The number of community-based organizations grew from 4 to 6 counties. The number of non-referring clinics fell from 27 to 9. Health care providers and community-based organizations integrated the Living Well program into their culture of care. Multi-sector approach using a central hub supported implementation of evidence-based programs in rural locations. | High (Quasi-experimental) |
Rodriguez-Quintana, 2022 (124) | Single group pre-post study | Wolverine Human Services juvenile residential facilities, Michigan, USA, 2013–2018 | Social work | Organization | A cognitive behavioural therapy program was implemented. The program was adapted fit the needs of the population and the multidisciplinary health team. Strategies used to support the programs integrated all team members. | Qualitative: -Implementation facilitators (site visits by the cognitive behavioral therapy intermediary and implementation research team for an intensive immersion) | Facilitators for EIDM: -Dedicated implementation teams -Progress monitoring -Adapting the program to meet organization’s needs -Training/supervision -Consultation calls to support implementation -Train-the-trainers approach | Moderate (Quasi-experimental) |
Schreiber, 2015 (125) | Case report, no comparator | Pediatric outpatient facility with one primary and three satellite clinics, USA, 6-month duration; dates not specified | Primary care | 17 physical therapists | A multicomponent KT program was implemented to increase the use of standardized outcome measures and address inconsistency of frequency and duration of physical therapist services. The KT program included: barrier identification, use of a knowledge broker, workshops / practice sessions, online and hard-copy resources, and an ongoing program evaluation with communication of results. | Quantitative: knowledge assessment (baseline, 8-month follow-up), self-report surveys, chart review data on use of outcome measures | Knowledge assessment scores increased from 54.1 to 81.8 (p < 0.001). Self-reported knowledge improved for test selection (p = 0.003), administration (p = 0.001), interpretation (p = 0.001), and sharing of results (p = 0.022). Self-reported performance of testing and measurement improved for test selection (p = 0.001), administration (p < 0.001), and interpretation (p = 0.006). Frequency of administration increased for all outcome measures for 8-month program duration. | High (Case report) |
Scott, 2022 (126) | Case report, no comparator | Wolverine Human Services juvenile residential facilities, Michigan, USA, 2013–2018 | Social work | Organization | Cognitive behavioral therapy was implemented across facilities. Adaptation involved an implementation team, needs assessment, development of an implementation template, site training and ongoing reassessment. | Quantitative: -EIDM needs assessment (Evidence-Based Practice Attitude Scale, Attitudes Toward Standardized Assessment Scale, Organizational Culture Survey, Survey of Organizational Functioning and Infrastructure Survey and Sociometric Opinion Leader Survey) Qualitative: -Perceived effectiveness of implementation strategies, organizational culture and readiness for change, and impact of infrastructure (Focus group interviews with clinicians and operations staff) | The needs assessment identified 76 barriers; 23 were prioritized and addressed. On reassessment, 24 of the barriers showed statistically significant improvement. Barriers to implementation: -Lack of training in evidence-based practice -Poor communication -Low morale among staff -Lack of teamwork -Lack of incentive -High staff turnover | Moderate (Quasi-experimental) |
Stevans, 2015 (127) | Case report, no comparator | The University of Pittsburgh Medical Center, Centers for Rehab Services, Pennsylvania, USA, 2005 | Primary care | Organization | The Low Back Pain Quality Improvement Initiative project was implemented. A local consensus process engaged providers in planning. Implementation champions supported the program. Providers were provided with education for the project. Implementation was evaluated regularly, and feedback applied to adjust strategies. | Qualitative: Facilitators for implementation (interviews) | Facilitators for implementation: -Understanding the complex nature of the clinical setting from a systems perspective to identify implementation barriers. -Multicomponent intervention strategy -Vision, leadership, and commitment from all the members of the organization -Iterative measurement, reassessment, and refinement of strategies. | High (Case report) |
Wilkinson, 2019 (128) | Qualitative | Two regional sites, Queensland, Australia, dates not specified | Primary care | Team | A medical nutrition therapy model of care for gestational diabetes mellitus was implemented at local regional sites. The implementation strategy included developing local consensus processes, self-monitoring clinician behaviour, prompts and cues, adjusting and reorganising clinic environment. | Qualitative: stakeholder experiences and learnings (semi-structured interviews) | Facilitators for implementation: -Engagement with an external project team -Robust project methodology and guided process to overcome local barriers -Wide, ongoing site stakeholder engagement and local networking -Multi-disciplinary higher-level management support and engagement -Positive attitude -Building confidence and capacity of local implementers through regular contact | High (Qualitative) |
Wilkinson, 2018 (129) | Single group pre-post study | South-East Queensland Hospital, Queensland, Australia, 2016–2017 | Primary care | Organization | A medical nutrition therapy model of care for gestational diabetes mellitus was adapted at local regional sites. The adaptation strategy included a needs assessment, barrier analysis and adaptation to local context. | Quantitative: service attendance metrics, anthropometry, diet quality, interventions delivered (hospital records) | Guideline adherence increased over time (4.4% − 50%, p < 0.001). | High (Qualitative) |
Williams, 2018 (130) | Case report, no comparator | Department of Behavioral Health and Intellectual DisAbility Services, Philadelphia, Pennsylvania, USA, 2 years; dates not specified | Primary care | Network of clinics | Policy initiative for 4 psychotherapy protocols was initiated. A dedicated role for implementation was established. Clinicians were trained in the new psychotherapy protocols. | Quantitative: impact of work environment on personal well-being and strategic implementation climate, perceptions of organizational for EIDM (survey) | In organizations with more supportive work environments, organizational support for EIDM predicted implementation. In organizations with less positive work environments, there was no association between implementation and organizational support. | High (Case report) |