Chapter 8: Implementation

INTRODUCTION

Implementation can be a challenging step in the evidence-based practice (EBP) process (Saunders & Vehviläinen-Julkunen, 2016). The Iowa Model highlights broad considerations for implementation during the pilot. These considerations need to be expanded into a full implementation plan. A phased approach to implementation may facilitate adoption (Rogers, 2003). Four broad phases are adapted from Rogers’ (2003) Diffusion of Innovation Theory for use in healthcare (see Figure 8.1). This chapter is organized using the Implementation Strategies for EBP as a guide. An overview of the process is described, and tools and examples follow. The last part of the chapter includes a description of 63 of the most complex implementation strategies (see Figure 8.2). Each strategy has a definition, identified benefit(s), a procedure for how to operationalize the strategy, an example, and select citations. Strategies are arranged by phases. Select from among the strategies to create a comprehensive implementation plan (see Tool 8.1). Strategies are organized to enhance movement through four phases of implementation: Create awareness and interest, build knowledge and commitment, promote action and adoption, and pursue integration and sustainability. Using a phased approach can help team leaders organize their implementation plans. Complete Phases 1 and 2 before the actual “go live” begins to prepare clinicians for the scheduled EBP change. In Phase 3, active adoption of the practice change begins with the pilot “go live.” Each phase is essential to achieve a sustained improvement.

IMPLEMENTATION STRATEGIES FOR EBP

The Implementation Strategies for EBP (Figure 8.2) was designed to help EBP team leaders select effective strategies to use (Cullen & Adams, 2012). The columns in the implementation guide (see Figure 8.2) represent implementation phases progressing from awareness through sustained change. Each column includes strategies addressing the goal for that phase. Implementation strategies targeting two distinct groups are arranged in rows. The first row specifically targets the clinicians and organizational leaders, including key stakeholders. The second row of strategies builds support for the practice change within the organizational system or context. Project leaders select implementation strategies that are appropriate for the topic, their particular unit/clinic, and organization as the EBP initiative progresses. This implementation planning is an important step during the pilot step of the Iowa Model.

SELECT IMPLEMENTATION STRATEGIES

Selecting strategies and knowing how to use them and how to package them together is complex (Proctor, Powell, & McMillen, 2013). Collect and use pre-data from the pilot evaluation (see Chapter 9) to guide ...