Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2007

Open Access 01-12-2007 | Study protocol

Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change

Authors: Cheryl B Stetler, Judith Ritchie, Joanne Rycroft-Malone, Alyce Schultz, Martin Charns

Published in: Implementation Science | Issue 1/2007

Login to get access

Abstract

Background

Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not.

Methods

The core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative.

Discussion

This study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP.
Appendix
Available only for authorised users
Literature
1.
Institute of Medicine (U.S.). Committee on Quality of Health Care in America: Crossing the quality chasm: a new health system for the 21st century. 2001, Washington, DC: National Academy Press
2.
Harvey G: Quality Improvement and Evidence-Based Practice: As One or at Odds in the Effort to Promote Better Health Care?. Worldviews on Evidence-based Nursing. 2005, 2 (2): 52-54. 10.1111/j.1741-6787.2005.05001.x.CrossRefPubMed
3.
Herr K, Titler MG, Schilling ML, Marsh JL, Xie X, Ardery G, Clarke WR, Everett LQ: Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers. Clinical Journal of Pain. 2004, 20 (5): 331-340. 10.1097/00002508-200409000-00008.CrossRefPubMed
4.
Lenfant C: Shattuck lecture – clinical research to clinical practice – lost in translation?. N Engl J Med. 2003, 349 (9): 868-874. 10.1056/NEJMsa035507.CrossRefPubMed
5.
McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA: The quality of health care delivered to adults in the United States. N Engl J Med. 2003, 348 (26): 2635-2645. 10.1056/NEJMsa022615.CrossRefPubMed
6.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F: Implementation Research: A Synthesis of the Literature. 2005, Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network, 1-125.
7.
Grol R, Wensing M, Eccles M, (eds): Improving Patient Care: The Implementation of Change in Clinical Practice. 2005, Edinburgh; New York: Elsevier Butterworth Heinemann
8.
Karkos B, Peters K: A Magnet community hospital: Fewer barriers to nursing research utilization. J Nurs Adm. 2006, 36 (7–8): 377-382.CrossRefPubMed
9.
Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C: Ingredients for change: revisiting a conceptual framework. Qual Saf Health Care. 2002, 11 (2): 174-180. 10.1136/qhc.11.2.174.CrossRefPubMedPubMedCentral
10.
Stetler CB: Role of the organization in translating research into evidence-based practice. Outcomes Manag. 2003, 7 (3): 97-103. quiz 104–105.PubMed
11.
Greenhalgh T, Robert G, Bate P, Kyriakidou O, Macfarlane F, Peacock R: How to Spread Good Ideas: A systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation. 2004, London: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO), 1-424.
12.
Pettigrew A, Ferlie E, McKee L: Shaping Strategic Change – The Case of the NHS in the 1980s. Public Money & Management. 1992, 12 (3): 27-31.CrossRef
13.
Pettigrew AM: The Character and Significance of Strategy Process Research. Strategic Management Journal. 1992, 13 (8): 5-16.CrossRef
14.
Amey A, Corkum S, Lavis J, DesMeules M: Expanding Knowledge Development and Exchange in Chronic Disease in the Public Health Agency of Canada: Results of an Environmental Scan. Knowledge Utilization Conference: Knowledge Utilization and Implementation in Health Services: Theory, Strategies, and Education: July 24 – 26, 2006; Minneapolis, MN. 2006
15.
Yin RK: Case Study Research: Design and Methods. 1994, Thousand Oaks: Sage Publications, 5: 2
16.
McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of 'context'. J Adv Nurs. 2002, 38 (1): 94-104. 10.1046/j.1365-2648.2002.02150.x.CrossRefPubMed
17.
Pettigrew A, Whipp R: Managing change and corporate performance. European industrial restructuring in the 1990s. Edited by: Cool K, Neven DJ, Walter I. 1992, Houndmills, Basingstoke, Hampshire: Macmillan Academic and Professional
18.
Graham ID, Logan J: Innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research. 2004, 36 (2): 89-103.PubMed
19.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment. 2004, 8 (6): iii-iv. 1–72.CrossRefPubMed
20.
Lewis C, Hoffmann ML, Gard A, Coons J, Bichinich P, Euclid J: Development and implementation of an interdisciplinary plan of care. J Healthc Qual. 2005, 27 (1): 15-23.CrossRefPubMed
21.
Horsley JA, Crane J, Crabtree MK, Wood DJ: Using research to improve practice: A guide. 1983, New York: Grune & Stratton
22.
Goode CJ, Lovett MK, Hayes JE, Butcher LA: Use of research based knowledge in clinical practice. Journal of Nursing Administration. 1987, 17 (12): 11-18.PubMed
23.
Stetler CB, Marram G: Evaluating research findings for applicability in practice. Nurs Outlook. 1976, 24 (9): 559-563.PubMed
24.
Goode CJ, Blegen MA: Development and evaluation of a research-based management intervention. A recognition protocol. Journal of Nursing Administration. 1993, 23 (4): 61-66. 10.1097/00005110-199304000-00015.CrossRefPubMed
25.
Titler MG, Kleiber C, Steelman V, Goode C, Rakel B, Barry-Walker J, Small S, Buckwalter K: Infusing research into practice to promote quality care. Nurs Res. 1994, 43 (5): 307-313. 10.1097/00006199-199409000-00009.CrossRefPubMed
26.
Stetler CB, Corrigan B, Sander-Buscemi K, Burns M: Integration of evidence into practice and the change process: fall prevention program as a model. Outcomes Manag Nurs Pract. 1999, 3 (3): 102-111.PubMed
27.
Stetler CB, Brunell M, Giuliano KK, Morsi D, Prince L, Newell-Stokes V: Evidence-based practice and the role of nursing leadership. J Nurs Adm. 1998, 28 (7–8): 45-53.CrossRefPubMed
28.
Goode CJ, Piedalue F: Evidence-based clinical practice. Journal of Nursing Administration. 1999, 29 (6): 15-21. 10.1097/00005110-199906000-00005.CrossRefPubMed
29.
Titler MG, Kleiber C, Steelman VJ, Rakel BA, Budreau G, Everett LQ, Buckwalter KC, Tripp-Reimer T, Goode CJ: The Iowa Model of Evidence-Based Practice to Promote Quality Care. Crit Care Nurs Clin North Am. 2001, 13 (4): 497-509.PubMed
30.
Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM: A qualitative study of increasing beta-blocker use after myocardial infarction: Why do some hospitals succeed?. Jama. 2001, 285 (20): 2604-2611. 10.1001/jama.285.20.2604.CrossRefPubMed
31.
Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK, Barth MC, Lapane KL, Lipson D, Stone R, Koren MJ: Translating research into practice: speeding the adoption of innovative health care programs. Issue Brief (Commonw Fund). 2004, 724: 1-12.
32.
Rubenstein LV, Pugh J: Strategies for promoting organizational and practice change by advancing implementation research. J Gen Intern Med. 2006, 21 (Suppl 2): S58-64. 10.1111/j.1525-1497.2006.00364.x.CrossRefPubMedPubMedCentral
33.
Foxcroft DR, Cole N: Organisational infrastructures to promote evidence based nursing practice. Cochrane Database Syst Rev. 2003, 4:
34.
Funk SG, Champagne MT, Wiese RA, Tornquist EM: BARRIERS: the barriers to research utilization scale. Appl Nurs Res. 1991, 4 (1): 39-45.CrossRefPubMed
35.
Bryar RM, Closs SJ, Baum G, Cooke J, Griffiths J, Hostick T, Kelly S, Knight S, Marshall K, Thompson DR: The Yorkshire BARRIERS project: diagnostic analysis of barriers to research utilisation. Int J Nurs Stud. 2003, 40 (1): 73-84. 10.1016/S0020-7489(02)00039-1.CrossRefPubMed
36.
37.
Estabrooks C, Scott-Findlay S, Rutakumwa W, Duan Q, Rozanova J: The Determinants of Research Utilization in Acute Care: Pain Management in Adult and Paediatric Settings: Technical Report. 2004, Edmonton, Alberta: Knowledge Utilization Studies Program, University of Alberta
38.
Ferlie EB, Shortell SM: Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Quarterly. 2001, 79 (2): 281-315. 10.1111/1468-0009.00206.CrossRefPubMedPubMedCentral
39.
Dopson S, FitzGerald L, Ferlie E, Gabbay J, Locock L: No magic targets! Changing clinical practice to become more evidence based. Health Care Manage Rev. 2002, 27 (3): 35-47.CrossRefPubMed
40.
Stone EG, Morton SC, Hulscher ME, Maglione MA, Roth EA, Grimshaw JM, Mittman BS, Rubenstein LV, Rubenstein LZ, Shekelle PG: Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002, 136 (9): 641-651.CrossRefPubMed
41.
Iles V, Sutherland K: Managing Change in the NHS: Organisational Change: A Review for Health Care Managers, Professionals and Researchers. 2001, London: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D, 1-101.
42.
Dopson S, Locock L, Chambers D, Gabbay J: Implementation of evidence-based medicine: evaluation of the Promoting Action on Clinical Effectiveness programme. J Health Serv Res Policy. 2001, 6 (1): 23-31. 10.1258/1355819011927161.CrossRefPubMed
43.
Solberg LI, Brekke ML, Fazio CJ, Fowles J, Jacobsen DN, Kottke TE, Mosser G, O'Connor PJ, Ohnsorg KA, Rolnick SJ: Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv. 2000, 26 (4): 171-188.PubMed
44.
45.
Charns MP, Schaefer MJ: Health care organizations: a model for management. 1983, Englewood Cliffs, NJ: Prentice-Hall
46.
Cummings G: Investing relational energy: the hallmark of resonant leadership. Can J Nurs Leadersh. 2004, 17 (4): 76-87.CrossRef
47.
Cummings G, Hayduk L, Estabrooks C: Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership. Nurs Res. 2005, 54 (1): 2-12. 10.1097/00006199-200501000-00002.CrossRefPubMed
48.
Wallin L, Estabrooks CA, Midodzi WK, Cummings GG: Development and validation of a derived measure of research utilization by nurses. Nurs Res. 2006, 55 (3): 149-160. 10.1097/00006199-200605000-00001.CrossRefPubMed
49.
Pepler CJ, Edgar L, Frisch S, Rennick J, Swidzinski M, White C, Brown TG, Gross J: Unit culture and research-based nursing practice in acute care. Can J Nurs Res. 2005, 37 (3): 66-85.PubMed
50.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly. 2004, 82 (4): 581-629. 10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral
51.
Pettigrew A, Ferlie E, McKee L: Shaping Strategic Change: Making Change in Large Organizations: The Case of the National Health Service. 1992, London: Sage Publications
52.
53.
Redfern S, Christian S: Achieving change in health care practice. J Eval Clin Pract. 2003, 9 (2): 225-238. 10.1046/j.1365-2753.2003.00373.x.CrossRefPubMed
54.
Charns MP, Smith Tewksbury L: Collaborative Management in Health Care: Implementing the Integrative Organization. 1993, San Francisco: Jossey-Bass Publishing
55.
Stetler C, Charns MP, (eds): Collaboration in health care: Hartford Hospital's experience in changing management and practice. 1995, Chicago: American Hospital Association Publishing
56.
Rogers EM: Diffusion of innovations. 1995, New York: Free Press, 4
57.
Estabrooks CA: The conceptual structure of research utilization. Res Nurs Health. 1999, 22 (3): 203-216. 10.1002/(SICI)1098-240X(199906)22:3<203::AID-NUR3>3.0.CO;2-9.CrossRefPubMed
58.
Goh S, Richards G: Benchmarking the learning capability of organizations. European Management Journal. 1997, 15 (5): 575-10.1016/S0263-2373(97)00036-4.CrossRef
59.
Avolio JB, Bass BM, Jung DI: Re-examining the components of transformational and transactional leadership using the multifactor leadership questionnaire. Journal of Occupational and Organizational Psychology. 1999, 72: 441-462. 10.1348/096317999166789.CrossRef
60.
Aiken LH, Patrician PA: Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nurs Res. 2000, 49 (3): 146-153. 10.1097/00006199-200005000-00006.CrossRefPubMed
61.
Lake ET, Friese CR: Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res. 2006, 55 (1): 1-9. 10.1097/00006199-200601000-00001.CrossRefPubMed
62.
Leiter MP, Spence Laschinger HK: Relationships of work and practice environment to professional burnout: testing a causal model. Nurs Res. 2006, 55 (2): 137-146. 10.1097/00006199-200603000-00009.CrossRefPubMed
63.
Thomas EJ, Sexton JB, Neilands TB, Frankel A, Helmreich RL: The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units [corrected]. BMC Health Serv Res. 2005, 5 (1): 28-10.1186/1472-6963-5-28.CrossRefPubMedPubMedCentral
64.
Miles MB, Huberman AM: Qualitative data analysis: a sourcebook of new methods. 1984, Beverly Hills, CA: Sage Publications
65.
Lincoln YS, Guba EG: Naturalistic Inquiry. 1985, Newbury Park, CA: Sage Publications, Inc
66.
Rycroft-Malone J: Patient participation in nurse-patient interactions about medication. unpublished PhD thesis. 2002, Southampton, United Kingdom: University of Southampton
67.
Rycroft-Malone J, Stetler CB: Commentary on Evidence, Research, Knowledge: A Call for Conceptual Clarity: Shannon Scott-Findlay & Carolee Pollock. Worldviews on Evidence-Based Nursing. 2004, 1 (2): 98-101. 10.1111/j.1741-6787.2004.04031.x.CrossRef
68.
69.
Stetler CB: Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nurs Outlook. 2001, 49 (6): 272-279. 10.1067/mno.2001.120517.CrossRefPubMed
Metadata
Title
Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change
Authors
Cheryl B Stetler
Judith Ritchie
Joanne Rycroft-Malone
Alyce Schultz
Martin Charns
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2007
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-2-3

Other articles of this Issue 1/2007

Implementation Science 1/2007 Go to the issue

Research article

Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals

Study protocol

Testing a TheoRY-inspired MEssage ('TRY-ME'): a sub-trial within the Ontario Printed Educational Message (OPEM) trial

Research article

Revisiting interaction in knowledge translation

Research article

Assessing organisational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care

Debate

Sticky knowledge: A possible model for investigating implementation in healthcare contexts

Research article

An interdisciplinary guideline development process: the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines