Health Services Department, Boston University School of Public Health, Independent Consultant, 321 Middle St, Amherst, MA 01002, USA.
Implement Sci. 2009 Nov 30;4:78. doi: 10.1186/1748-5908-4-78.
There is a general expectation within healthcare that organizations should use evidence-based practice (EBP) as an approach to improving the quality of care. However, challenges exist regarding how to make EBP a reality, particularly at an organizational level and as a routine, sustained aspect of professional practice.
A mixed method explanatory case study was conducted to study context; i.e., in terms of the presence or absence of multiple, inter-related contextual elements and associated strategic approaches required for integrated, routine use of EBP ('institutionalization'). The Pettigrew et al. Content, Context, and Process model was used as the theoretical framework. Two sites in the US were purposively sampled to provide contrasting cases: i.e., a 'role model' site, widely recognized as demonstrating capacity to successfully implement and sustain EBP to a greater degree than others; and a 'beginner' site, self-perceived as early in the journey towards institutionalization.
The two sites were clearly different in terms of their organizational context, level of EBP activity, and degree of institutionalization. For example, the role model site had a pervasive, integrated presence of EBP versus a sporadic, isolated presence in the beginner site. Within the inner context of the role model site, there was also a combination of the Pettigrew and colleagues' receptive elements that, together, appeared to enhance its ability to effectively implement EBP-related change at multiple levels. In contrast, the beginner site, which had been involved for a few years in EBP-related efforts, had primarily non-receptive conditions in several contextual elements and a fairly low overall level of EBP receptivity. The beginner site thus appeared, at the time of data collection, to lack an integrated context to either support or facilitate the institutionalization of EBP.
Our findings provide evidence of some of the key contextual elements that may require attention if institutionalization of EBP is to be realized. They also suggest the need for an integrated set of receptive contextual elements to achieve EBP institutionalization; and they further support the importance of specific interactions among these elements, including ways in which leadership affects other contextual elements positively or negatively.
医疗保健领域普遍期望组织采用循证实践（EBP）作为提高护理质量的方法。然而，在如何使 EBP 成为现实方面存在挑战，特别是在组织层面以及作为专业实践的常规、持续方面。
采用混合方法解释性案例研究来研究背景；即，研究是否存在多个相互关联的背景要素以及与整合、常规使用 EBP（“制度化”）相关的策略方法。佩蒂格鲁等人的内容、背景和过程模型被用作理论框架。在美国有两个地点被有目的地抽样，以提供对比案例：即，一个“模范”地点，被广泛认为具有成功实施和维持 EBP 的能力，程度超过其他地点；和一个“初学者”地点，自我认为处于制度化的早期阶段。
这两个地点在组织背景、EBP 活动水平和制度化程度方面明显不同。例如，模范地点的 EBP 具有普遍的、综合的存在，而初学者地点的 EBP 则存在零散的、孤立的存在。在模范地点的内部环境中，还有佩蒂格鲁同事的接受性要素的组合，这些要素一起似乎增强了其在多个层面上有效实施与 EBP 相关变革的能力。相比之下，初学者地点在过去几年中参与了与 EBP 相关的努力，但在几个背景要素中存在主要的非接受性条件，整体 EBP 接受度较低。因此，在数据收集时，初学者地点似乎缺乏一个综合的背景来支持或促进 EBP 的制度化。
我们的研究结果提供了一些关键背景要素的证据，如果要实现 EBP 的制度化，这些要素可能需要关注。它们还表明需要一套综合的接受性背景要素来实现 EBP 的制度化；并且它们进一步支持这些要素之间特定相互作用的重要性，包括领导力如何积极或消极地影响其他背景要素。
