From Policy to Practice: How to Achieve Meaningful Changes Using the Best Evidence!

From Policy to Practice: How to Achieve Meaningful Changes Using the Best Evidence!

Although the EBP (Evidence-Based Practice) process is effective for identifying current best evidence, completing the process does not guarantee meaningful changes in clinicians’ behavior, which is essential to achieve desired clinical outcomes. In contrast, evidence strongly suggests that merely introducing a new policy is unlikely to lead to meaningful or sustained changes in practice (Ryan, 2017). Many EBP innovations lead to short-term adoption by only a limited number of clinicians (Stetler, 2003).

To address this issue, healthcare professionals must go beyond policy-making and focus on successfully designing and implementing a structured program for translating best evidence into meaningful and sustained changes in practice. APRNs (Advanced Practice Registered Nurses) play a crucial role in this process by utilizing strategies grounded in theoretical frameworks such as Rogers’ Diffusion of Innovation Theory, which outlines four key stages of adoption: knowledge, persuasion, decision, and implementation (Rogers, 2003).

Practical Strategies for Sustained Practice Change

1. Knowledge Stage
   In the first stage of the adoption process, clinicians become aware of the innovation and its potential impact on practice. This can be achieved through continuing education, professional announcements, or informal communications with colleagues.

2. Persuasion Stage
   In this stage, clinicians evaluate whether the innovation is beneficial based on its perceived effect on patient outcomes and the effort needed to implement it. This is critical when implementing complex interventions, such as those aimed at preventing facility-acquired pressure injuries, which require multiple preventive measures (Bolton, 2007).

Table: Practical Steps for Achieving Meaningful Change Based on Best Evidence

Link to official Rogers’ Diffusion of Innovation Theory

Effective Persuasion: Creating Positive Attitudes toward Innovation

One of the critical steps toward meaningful practice change is persuasion. Persuasion is influenced by two key factors: the perceived benefit of the innovation on patient outcomes and the investment required to alter practice. Clinicians often evaluate whether the anticipated benefits of a new practice outweigh the resources and effort needed to implement it.

For instance, when adopting an innovation to prevent facility-acquired pressure injuries, clinical teams may be persuaded if they believe that using validated tools such as the Braden Scale for Pressure Sore Risk improves patient outcomes and integrates easily into their daily workflow (Bolton, 2007).

Decision Stage: Overcoming Individual Resistance

In the decision stage, clinicians decide whether to adopt or reject the innovation. Historically, decision-making rested with a single leader, but now it involves interdisciplinary care teams, encouraging a more inclusive and transparent decision-making process. This collaborative approach can reduce resistance to change by involving all relevant parties in the decision-making process, which is vital for sustained adoption (Rogers, 2003).

Adoption Stage: Sustaining Meaningful Changes in Practice

Adoption is the final stage in the diffusion of innovation, where clinicians begin integrating the new practice into their daily routines. Ensuring sustained adoption requires not just individual willingness, but also organizational support, leadership backing, and favorable changes in the practice environment.

1. Relative Advantage
   The innovation must clearly demonstrate a significant advantage over existing practices.

2. Compatibility
   The new practice must align well with current workflows and standards.

3. Trialability
   The opportunity to trial an innovation before committing to full-scale implementation increases its acceptance.

4. Observability
   Providing clinicians with observable data on the positive impact of the innovation helps maintain their commitment to the practice.

Key Factors for Successful Practice Innovation Adoption

Several key factors can enhance the likelihood of successfully adopting and sustaining an evidence-based practice innovation:

• Support from Administration
  For practice changes to stick, they need the support of hospital or facility administration. When administrators back the new practice, it demonstrates a commitment to improvement and patient safety.

• Interdisciplinary Collaboration
  Involving an interdisciplinary team fosters a sense of ownership and collective responsibility, ensuring that all perspectives are considered and addressed.

• Adapting the Practice Environment
  Restructuring the environment to support the new practice is vital. This could include integrating new tools into electronic medical records or redesigning workflows to accommodate the innovation.

Feedback and Monitoring: Closing the Loop on Practice Change

Providing feedback to the clinicians implementing the practice change is essential. Involving frontline staff in the feedback loop, rather than restricting this information to administrators, ensures that those directly responsible for patient care remain engaged and invested in the change process.

APRN leaders must ensure that feedback is timely, relevant, and actionable. This can be done by sharing data on patient outcomes, monitoring compliance with the new practice, and recognizing clinicians who contribute to its success.

FAQ: Tips for Achieving Meaningful Changes in Practice Based on Current Best Evidence

Q: What is the most important factor in moving from policy to practice?
A: The most important factor is engaging clinicians early in the process and making them aware of the innovation’s potential impact on patient outcomes.

Q: How can we ensure clinicians adopt new practices?
A: Adoption is encouraged by demonstrating the innovation’s clear advantages, providing opportunities for trial, and offering continuous feedback.

Q: Why is interdisciplinary collaboration important?
A: Collaboration ensures that all relevant stakeholders are involved, which increases the likelihood of sustained practice changes.

Q: How do you handle resistance to change in clinical settings?
A: Resistance can be mitigated by involving clinicians in the decision-making process, providing observable results, and ensuring that the practice aligns with existing workflows.