A Framework for Integrating Evidence and Practice

Why do we need to consider evidence-based methodologies for our practices, because as Jeffrey Pfeffer recently stated, belief often trumps evidence and bias and false beliefs abound.  But implementing these methods is often not linear, rational or easy.  Joanne Rycroft-Malone, et. al. (working in the medical field) have developed a model suitable to this level of complexity.

The model is divided between evidence concerns (sub-divided into research, clinical and patient [or customer] concerns) and contextual concerns (subdivided into context, culture, leadership and evaluation concerns).  See Figure 1

Some of the lessons learned include:

    • Getting evidence into practice is not . . . a linear and logical process.
    • (This) framework attempts to represent the complexity of the processes involved in implementation . . ..
    • The nature of the evidence, the quality of the context, and the type of facilitation all impact simultaneously on whether implementation is successful.
    • Implementation is more likely to be successful when:
    • Evidence (research, clinical experience, and patient experience) is well conceived, designed, and executed and there is consensus about it.
    • The context in which the evidence is being implemented is characterised by clarity of roles, decentralised decision making, transformational leadership, and a reliance on multiple sources of information on performance.
    • Facilitation mechanisms appropriate to the needs of the situation have been instigated.

The intended purpose of this framework is to provide practitioners with a tool to plan, implement, and track their own strategies for change.  The article also notes that research methods must match the research question considered.  RCT methods are not always the best way to frame research.