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Implementation is an essential step in the evidence-based practice (EBP) process and warrants dedicated effort within the design and pilot step (Iowa Model Collaborative, 2017). We share an effective, action-oriented approach that applies implementation science and theory for your use. Plan proactively in order to increase your success with adoption (Leppin et al., 2020). In this chapter, you will use local pre-pilot data (see Chapter 8) for a Precision Implementation Approach® by selecting strategies from the Iowa Implementation for Sustainability Framework© to develop a systematic implementation plan that meets local needs (Cullen, Hanrahan, et al., 2019; Cullen, Hanrahan, Steffen, et al., 2022).

You may find it challenging to select and use implementation strategies to improve clinical and operational outcomes (Arsenault Knudsen et al., 2021; Moore & Tierney, 2019). The iterative and nonlinear nature of implementation to promote adoption and sustained use of EBP adds to the complexity (Dryden-Palmer et al., 2020). Implementation science has evolved to answer this pressing need and has resulted in many models, theories, and resources. Yet, many strategies have not been designed to be actionable. Implementation strategies must be actionable, or the gaps between knowledge generation and application in practice will grow. The knowledge-to-practice gap is the time from generating new knowledge to applying it in practice (Borsky et al., 2018; Ukhanova et al., 2020). A secondary gap may be created when the EBP is known but strategies used to implement are not evidence-based (Tucker et al., 2021). Finally, a gap may occur with mis-implementation, when EBP is prematurely abandoned or there is a failure to de-implement despite the lack of benefit that in the end inhibits delivery of EBP (Ornstein et al., 2020; Padek et al., 2018).

Clinicians continue to rely heavily on education and information sharing as primary strategies for implementation, which further impedes EBP (Beard et al., 2019; Cassidy, Harrison, et al., 2021; Häggman-Laitila et al., 2017; Kaiser et al., 2019; McNett et al., 2020; Moreno & Moriana, 2016; Wu et al., 2018). Clarity is still needed to guide when or how to best use strategies (Lewis et al., 2018). The Iowa Model highlights three key points for implementation during the design and pilot step: develop an implementation plan, prepare clinicians and materials, and promote adoption (Iowa Model Collaborative, 2017).


Develop a systematic and phased implementation plan that incorporates effective strategies (see Figure 9.1). Think of implementation as a journey that occurs in phases over time (Aarons et al., 2011; Arsenault Knudsen et al., 2021; Cullen & Adams, 2012; Grol et al., 2013; Kilbourne et al., 2019; Leeman et al., 2017; Prochaska et al., 1992; Rogers, 2003). Create your implementation plan to leverage the benefits of each implementation strategy and promote adoption of an EBP change within the healthcare ...

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