The theory and practice of evidence implementation

I am a health services researcher based at the International Centre for Allied Health Evidence, University of South Australia. For the last two years, I have been undertaking research to ‘demystify’ the theory and practice of implementing evidence into clinical practice. This research, sponsored through a National Health and Medical Research Council (NHMRC) National Institute of Clinical Studies (NICS) Fellowship, and co-funded by the Motor Accident Commission (MAC), evaluated a targeted approach to implementing the MAC clinical guideline for Whiplash Associated Disorders (WAD) by physiotherapists and chiropractors.

Despite strong and robust evidence, many evidence-practice gaps persist. For example, evidence indicates that wearing a soft collar is harmful and staying active promotes recovery in WAD, yet clinicians’ practice and behaviour does not match this. This is not a new problem however - the acceptance of the practice of consuming citrus fruits to treat scurvy took more than two centuries.

There are several reasons for this. Increasing research on the science of evidence implementation recognises that practice and behaviour change can be influenced by a range of factors, influencing at varying levels. These include:

• individual professional (cognitive, educational, attitudinal, motivational)
• social (social learning, social networks and influence, patient influence, leadership)
• organisation and economic context (innovativeness of the organisation, quality management, complexity, organisational learning and economic).

While we understand the complexities underpinning evidence implementation, we are still unclear as to which factors need to be targeted - which strategies to undertake, aimed at whom and in which settings - in order to achieve practice and behaviour change.

My research with physiotherapists and chiropractors has indicated that while there are barriers to implementing evidence into clinical practice it is education, support and mentoring that can facilitate evidence implementation. The assumption that clinicians can, and do, have the knowledge, skills and resources to successfully implement and sustain such initiatives is wrong. As part of addressing this, I have developed a freely available web resource, dedicated to evidence implementation. The Implementation Central website currently hosts a range of tools and resources for those who are interested in the theory and practice of evidence implementation. Check it out, I would love to hear from you!

For further information contact:
<www.implementationcentral.com>
P: 08 83022085
E: Saravana.kumar@unisa.edu.au

Reference
Grol R, Wensing M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust, 180(6 Suppl), S57-S60