Table 1 Included studies of organization-wide implementation of EIDM

Studies of organization-wide implementation of EIDM

 Allen, 2018 [39]

Case report, no comparator

State health department, Georgia, USA, 2013–2016

Public health

Program staff across organization

Program staff received training for EIDM that included lectures, and small group problem-solving and discussion

Qualitative: EIDM facilitators and barriers (interviews)

Facilitators for EIDM:

-Leadership support

-Consistent internal messaging on EIDM

-Close partnerships with evaluation teams

-Requirement for evidence in proposals

Barriers to EIDM:

-Competing priorities

-Limited budget for staff

-Political conflicts in state and local agendas

High (Case report)

 Allen, 2018 [40]

Qualitative

State health departments, USA, 2016

Public health

Leaders and program managers

State health departments to an intervention group that received EIDM training and support (See Brownson, 2017)

Qualitative: EIDM facilitators and barriers (structured interviews)

Facilitators for EIDM:

-Leadership support

-Developing structures and culture incorporating evidence based public health

-Ongoing training

-Building and maintaining partnerships with external partners

Barriers to EIDM:

-Funding/budget cuts

-Lack of time

-Lack of political will/support

-Staff turnover

Moderate (Qualitative)

 Augustino, 2020 [41]

Case report, no comparator

Military treatment facilities, USA, 2018

Primary care

Nursing staff at 4 facilities

An evidence-based practice facilitator role supported organization-wide EIDM teams through training, mentoring, and encouraging EIDM

Findings were described in a narrative case report

Facilitators for EIDM:

-Incorporating the evidence-based practice facilitator into existing practice

-Involving evidence-based practice facilitator in nursing meetings and committees

-Aligning the evidence-based practice facilitator’s work with organizational priorities

Barriers to EIDM:

-Staff turnover

-Lack of standardized evaluation of EIDM use

High (Case report)

 Awan, 2015 [42]

Case report, no comparator

Centre for Addiction and Mental Health, Toronto, Ontario, Canada, 2013–2014

Primary care

Service providers, researchers at organization

An integrated care pathway, which relies on EIDM, was implemented for patients with concurrent major depressive disorder and alcohol dependence. Development of the integrated care pathway included evidence reviews, knowledge translation, process reengineering and change management

Quantitative:

-patient symptom assessment and medication titration (Penn Alcohol Craving Scale, Quick Inventory for Depressive Symptoms scores and Beck Depression Inventory)

Qualitative:

-Facilitators and barriers (focus groups)

Evaluation of patient care found:

-Lower program dropout (78% to 46% p < 0.05)

-Reduction in depressive symptom severity (p-value not reported)

-Reduction in heavy drinking days (42% to 23%, p < 0.04)

Facilitators for EIDM:

-Inclusion and frontline clinicians

-Use of tools/templates (e.g., process maps, medication algorithms)

-Team meetings

Barriers to EIDM:

-Lack of knowledge and skill for EIDM

-Communication with referring providers

Moderate (Case report)

 Bennett, 2016 [43]

Case report, no comparator

Large urban hospital, Australia, 18 months; dates not specified

Primary care

Occupational therapists in hospital

An EIDM capacity building program was implemented. The program included:

-Educational outreach across organization

-Teams working on clinical case studies

-Allocating time for EIDM

-Mentorship

-Leadership support

-Communication regarding EIDM

-Development of EIDM processes and resources

-Funding for an EIDM champion one day per week

-Setting goals and targets for EIDM

-EIDM reporting and evaluation

Qualitative: EIDM use, perceptions of organizational culture toward EIDM, EIDM facilitators and barriers (focus groups with clinicians and observations by the research team)

Facilitators for EIDM:

-EIDM integration into roles

-Buy-in to EIDM impact

-Developing goals for EIDM

-Access to mentors

-Supportive leadership

-Breaking down EIDM into manageable tasks

-Journal club to discuss EIDM processes

Challenges to EIDM:

-Lack of EIDM knowledge and skill

-Perceived lack of capability

-Perceived lack of time and training

-Competing priorities

-Challenges with staff rotating between clinical teams

Moderate (Case report)

 Breckenridge-Sproat, 2015 [44]

Single group pre-post study

Military hospitals, Washington, District of Columbia, USA, 18 months; dates not specified

Primary care

Nurses across hospitals

Unit-level mentors facilitated an educational mentoring program for EIDM. The intervention involved an organizational assessment, identification of facilitators and barriers, training EIDM mentors and EIDM implementation

Librarian support, evidence-based practice education material, training modules were provided and supervised study team evidence-based practice projects were completed

Quantitative:

-EIDM beliefs (Evidence-Based Practice Beliefs)

-Organizational readiness and barriers to EIDM (Organizational Readiness for System-wide Integration of Evidence-Based Practice)

-EIDM implementation (Evidence-Based Practice Implementation Scales)

Following the intervention,

-Evidence based practice belief scores increased (p = 0.02)

-Organizational readiness for EIDM scores increased

(p < 0.01)

Moderate (Quasi-experimental study)

 Brodowski, 2018 [45]

Case report, no comparator

Social service agencies, Kansas and Nebraska, USA, 2005–2011

Social work

Social service providing organizations

A workgroup of state-led agencies and federal partners developed a framework for infrastructure for EIDM, including federal policy for investing in evidence-based programs and quality improvement. Technical assistance was provided to community-based programs through a third party

Quantitative: Use of EIDM (annual reported funding for evidence-based programs)

Qualitative: EIDM facilitators (interviews)

The percentage of funded programs that were evidence-based increased from 29 to 63%

Facilitators for EIDM:

-Strong infrastructure (outreach, training, fidelity assessment, supervision, management of the program

-Availability of Technical Assistance:

-Consideration of context when using EIDM to choose programs

-Active engagement and collaboration with key stakeholders at all levels

High (Case report)

 Brownson, 2017 [46]

RCT, control group

State health departments, USA,

March 2014 and March 2015

Public health

Program staff across organization

State health departments randomized to:

-Intervention group that received EIDM training workshop, and follow-up calls for technical assistance and supplemental activity planning and updates support

-Control group that received links to electronic resources

Quantitative: perceived organizational skills and culture for EIDM (survey)

Following the intervention,

-Perceived skills gaps decreased (p = 0.02)

-Perceived supervisory expectation for use of EIDM increased (p = 0.006)

-Use of evidence increased (p = 0.008)

Moderate (RCT)

 Clark, 2022 [20]

Mixed methods, no comparator

Public health units, Ontario, Canada, 2015–2018

Public health

4–8 Staff members from each of 10 public health units

Senior leadership set organizational goals for EIDM during a facilitated focus group using the Is Research Working for you organizational assessment

Knowledge translation specialist mentors delivered a Knowledge Broker mentoring program, including workshops, webinars, consultations and completion of a rapid review

Quantitative:

-Attainment of organizational goals for EIDM (semi-structured interviews)

Qualitative:

-EIDM facilitators and barriers (semi-structured interviews)

Facilitators for EIDM:

-Integration of EIDM into process through structures, processes, or templates

-New or re-defined staff positions for EIDM

-Leadership support

-Culture of expectations of EIDM

-Acceptance of time to learning and do EIDM

Barriers to EIDM:

-Lack of managers’ EIDM knowledge

-Lack of protected time

-Lack of staff buy-in

-Lack of direction or plan for participants

High (Qualitative)

 Dobbins, 2019 [47]

Single group pre-post study

3 Public health units, Ontario, Canada, 2010–2012

Public health

All staff at organization, senior leadership

Knowledge Brokers deployed to public health units supported individual capacity and organizational culture for EIDM. Knowledge brokers held workshops, mentoring, meetings with senior management and developed policies and processes for EIDM

Quantitative:

-Knowledge, skills and behavioral assessment (survey)

Qualitative:

-EIDM facilitators and barriers (analysis of knowledge brokers journals)

Facilitators for EIDM:

-Strong leadership support

-Systematic integration of research evidence into decision-making processes

-Access to librarian support

-Committed financial and human resources

-Staff interest and enthusiasm

Moderate (Quasi-experimental study)

 Elliott, 2021 [48]

Case report, no comparator

Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), Canada, dates not specified

Primary care

Clinicians, nurses

An integrated KT network (Can-SOLVE CKD) was established, including:

-Central knowledge translation committee available for consultation

-Support from external partners

-KT planning templates

-KT champions

-KT virtual community of practice

-KT online learning module

Findings were described in a narrative case report

Facilitators for EIDM:

-Diverse knowledge base and members’ commitment to KT

-Inclusion of patient’s perspectives

Barriers to EIDM:

-Generalizability to smaller project teams

-Lack of KT skills among research and patient partners

Moderate (Case report)

 Fernández, 2014 [49]

Case report, no comparator

The Cancer Prevention and Control Research Network, USA, dates not specified

Public health

National network

Workgroups across the network facilitated activities, including:

-building the capacity of service providers for EIDM

-developing technical assistance for KT

-developing research partnerships

-investigating implementation processes from other studies

Findings were described in a narrative case report

Successful EIDM activities were described, including the following. Network members translated and adapted the evidence-based Stanford Chronic Disease Self-Management program which was well attended and highly rated by participants. Cancer screening programs were adapted to the local context, increasing uptake among residents. Several partner universities have implemented workplace health promotion interventions

High (Case report)

 Flaherty, 2021 [50]

Cluster RCT, control group

Outpatient child mental health clinics, New York, USA, dates not specified

Primary care

52 Child mental health care providers

4Rs and 2Ss Multiple Family Group intervention:

-Providers received training and bimonthly supervision

-Clinic Implementation Teams operated at agencies randomized to the intervention arm

Quantitative: Frequency of use of new techniques (Training Exposure and Utilization Scale), and organizational climate (Organizational Readiness for Change Scale)

Increased use of evidence-based interventions was associated with providers’ belief that organizational climate supported use of evidence-based interventions

(b =  − 0.33, SE = 0.11, p < 0.01)

Moderate (RCT)

 Gallagher-Ford, 2014 [51]

Case report, no comparator

Large, complex healthcare system, USA, dates not specified

Primary care

Departments across an organization

A nurse administrator promoted and sustained a culture of evidence-based practice through the following activities:

-Organizational assessments

-Developing clinical nurse specialists as EIDM champions

-Mentoring individuals through the change process

Findings were described in a narrative case report

Clinical nurse specialists have championed EIDM across the organizations. More than 13 projects for EIDM were initiated by clinical nurse specialists

Low (Case report)

 Gifford, 2014 [52]

Qualitative

Large community healthcare organization delivering home and community healthcare, Ontario, Canada, 20-weeks; dates not specified

Public health

Management and clinical leaders from 4 units

Strategies to promote EIDM to nurse managers and clinical leaders in home healthcare were implemented, including,

-Workshop on EIDM

-Mentorship support from experienced “evidence facilitators”

-Access to university library services

-Information-sharing activities

-Encouragement and recognition

Quantitative: EIDM use (Is Research Working for You? A Self-assessment Tool and Discussion Guide for Health Services Management and Policy Organizations)

Qualitative: Usefulness of intervention, EIDM barriers and facilitators (semi structured interviews)

Following the intervention, participants reported:

-More resources to conduct research

-Staff contributions to EIDM discussions

-More information about how evidence influenced decisions made in the organization (all p < 0.05)

Facilitators for EIDM:

-Ongoing education

-Linking staff to EIDM experts

-Social networking across organization

-Recognition for EIDM work

-Audit and feedback

Barriers to EIDM:

-Lack of time

-Lack of knowledge, skills, and confidence

-Conflicting priorities within the organization

-Staff shortages

High (Qualitative)

 Haynes, 2020 [53]

Case report, no comparator

Australian Prevention Partnership Centre, Australia, 5 years; dates not specified

Public health

Organization-wide, in partnership with research institutions

Six components for cross-sector collaborative partnerships for EIDM:

1. Partners involved at all stages

2. Communication efforts, e.g., forums, narrative reports

3. Skill development through workshops, webinars with experts

4. Cross-sector project teams

5. High-quality evidence syntheses

6. Ongoing surveys and opportunities for feedback

Quantitative:

-Perceptions of leadership,

governance, resource

allocation, collaboration and

engagement (Partnership survey)

Qualitative:

-Implementation and impact of projects (project evaluations)

-Experiences and perceptions (semi-structured interviews)

Partners reported:

-Translation of research into policy was built into processes

-Many projects involved partners from different sectors

-Communication across sectors and teams was adequate

-Capacity building activities were valuable

-Synergies were identified across projects

Moderate (Case report)

 Hitch, 2019 [54]

Case report, no comparator

Public mental health service, major city in Australia, 2014–2016

Occupational therapy

Occupational therapists within the organization

Leadership role in KT established to support EIDM, complete research projects, build research capacity and culture, and create a database of research activity

Quantitative:

-Attitudes towards EIDM (Evidence Based Practice Attitude Scale)

-EIDM use (Evidence Based Practice Implementation

Scale)

-Staff perceptions of the Lead Research Occupational therapist role (survey)

After implementation of the KT role,

-number of quality assurance and research activities increased (Cliffs Delta = 0.44; 95% CI = 0.22, 0.62)

-no significant change in attitudes towards EIDM

-staff viewed KT role positively

-staff engaged in KT activities

-greater diffusion of evidence across programs

Moderate (Case report)

 Hooge, 2022 [55]

Single group pre-post study

Large academic health system, southeast region, USA, 12-week program; dates not specified

Primary care

11 Advanced practice registered nurses

Virtual mentoring program delivered via Microsoft Teams platform included synchronous training sessions, podcasts, blog and video tutorials, and additional research articles and educational material

Quantitative:

-Knowledge and skill for EIDM (Evidence-based Practice Beliefs scale, Evidence-based Practice Implementation scale)

-Organizational readiness for EIDM (Organizational Culture and Readiness for System-wide Integration of Evidence-based Practice scale)

Qualitative

-EIDM facilitators and barriers (open-ended survey)

Compared to baseline, evidence-based practice beliefs scores increased (effect size = 0.71, p = 0.018). No significant change in evidence-based practice implementation and organizational culture and readiness for system-wide implementation of evidence-based practice scale scores

Barriers to EIDM:

-Competing priorities

-Time management

High (Quasi-experimental study)

 Humphries, 2013 [56]

Case report, no comparator

Regina Qu’Appelle Health Region and Northern Health, Alberta and British Columbia, Canada,

2008–2011

Public health

Management and staff at organizations

The Value Add through Learning and Use of Evidence (VALUE) initiative:

-Learning projects (to practice research literacy and skills)

-Liaison roles

-Research support

-Protected time for EIDM activities

-Inter-regional collaboration

Findings were described in a narrative case report

Lessons learned included:

-Staff turnover was a challenge

-Potential benefit to promoting evidence use in staff orientation

-Evidence use implementation needs to be directed at multiple levels within the organization

-Strategies with ongoing real-time research expertise and support were valued by participants

High (Case report)

 Irwin, 2013 [57]

Case report, no comparator

Various healthcare settings, USA, 2009–2010

Primary care

Nursing teams

Institute for Evidence-Based Practice Change program was provided to nurses. This program included a 2.5-day workshop on EIDM, literature searching, and development of an implementation plan, project management, and outcomes measurement. The program also provided an experience mentor for EIDM support for 12-months

Qualitative:

-EIDM facilitators and barriers (log entries from the team champion)

Facilitators for EIDM:

-Adequate time

-Organizational support

-Engagement and teamwork

-Communication and planning

-Maintaining focus on EIDM goals

Barriers to EIDM

-Competing priorities

-Data collection and measurement challenges

-Staff turnover

Low (Case report)

 Kaplan, 2014 [58]

Case report, no comparator

Magnet-designated hospital, USA, November 1, 2012 to May 10, 2013

Primary healthcare

Nurses across organization

All nurses received an electronic newsletter on EIDM every 2 weeks. A cohort of direct care nurses participated in a series of EIDM workshop to develop, implement, and disseminate an EIDM project

Quantitative: Organizational readiness for integration of EIDM (The Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Scale), EIDM knowledge and skill (Evidence-Based Practice Beliefs Scale), EIDM implementation (The Evidence-Based Practice implementation Scale)

Following the intervention, perceptions of organizational increased. Confidence in implementing EIDM was not associated with EIDM use. Higher education levels was positively associated with nurses’ EIDM use

High (Case report)

 Kimber, 2012 [59]

Qualitative

Kinark Child and Family Services, Ontario, Canada, 2006–2010

Child and youth mental health

Staff across organization

Multiple EIDM interventions were implemented, including:

-Leadership support

-Appointing working group leaders

-Dedicated time for EIDM

Qualitative:

-EIDM facilitators and barriers (survey)

Facilitators for EIDM

-Staff understanding the clinical transformation project and stages

-Effective leadership

-Change culture inclusive of staff and management, and various disciplines

-Cross-program collaboration

-Protected time

-Evaluation to demonstrate benefits of change

Challenges to EIDM:

-Underutilization of internal staff

-Lack of preparation for change

Moderate (Qualitative)

 Mackay, 2019 [60]

Single group pre-post study

Haemodialysis unit of a hospital, Queensland, Australia, 2016–2018

Primary care

All staff at organization

A new nutrition service was established to translate nutrition guidelines into practice to support EIDM through:

-Professional development

-Evidence-informed recommendations

-Multidisciplinary staff involvement

-Integrated database prompts

Quantitative: EIDM use, malnutrition prevalence (database audit, Patient-Generated Subjective Global Assessment tool)

Qualitative: EIDM facilitators and barriers (clinic observation, team discussion)

There was no significant change in malnutrition categories; most patients (72–80%) began the program well-nourished

Facilitators for EIDM:

-Establishing processes for best practices

-Buy-in from staff and management-in from staff and management

-Regular monitoring and feedback

Barriers to EIDM:

-Limited prior knowledge

-Limited time

Moderate (Quasi-experimental study)

 Martin-Fernandez, 2021 [61]

Case report, no comparator

Regional health agencies, France, 2017–2019

Public health

Health professionals and decision-makers across regional health agencies

The Transfert de Connaissances en REGion (TC-REG) knowledge translation plan:

-Improved access to scientific evidence

-EIDM skill development through training, journal clubs and tutoring

-Organizational culture development through collaborative workshops, processes, and incentives

Qualitative:

-EIDM facilitators and barriers (unstructured interviews)

-Use of EIDM (semi-structured interviews)

Facilitators for EIDM:

-Understanding of scientific evidence

-Confidence in using scientific evidence

-Ability to search and find scientific evidence

-Motivation to use scientific evidence

-Belief that scientific evidence can help to improve practice, develop new frameworks, advocate for their professional activity, and create new partnerships

Moderate (Case report)

 Melnyk, 2017 [62]

Single group pre-post study

Washington Hospital Healthcare System, USA, 12 months; dates not specified

Primary care

Service providers, administrators within organizations

EIDM mentors were developed within the healthcare system, through intensive EIDM workshops. Teams of participants implemented and evaluated an EIDM change project within their hospital

Quantitative: Knowledge and skill for EIDM (evidence-based practice beliefs scale, evidence-based practice implementation scale), organizational readiness for EIDM (organizational culture and readiness for system-wide implementation of evidence-based practice scale), patient outcomes (aggregate data from the hospital’s medical records)

Following implementation,

-Organizational knowledge and skill for EIDM organization increased (effect size = 0.62;

p = 0.00)

-Organizational implementation of EIDM

increased (effect size = 2.3; p = 0.00)

-Organizational culture and readiness for EBP increased significantly

from baseline (M = 80.9; SD = 90.8) to follow-up (M = 90.8; SD = 14.7; t = 3.9; p = 0.00; effect size = 0.70)

The following trends were seen in patient outcomes,

-Reduction in ventilator days

-Decreased pressure ulcer rate

-Reduced hospital readmissions for congestive health failure

-Increase in patient reported quality of care

-Reduced use of formula as a supplement

-Decreased wait time for pain medication and decreased length of stay in emergency room

Moderate (Quasi-experimental study)

 Miro, 2014 [63]

Single group pre-post study

Fraser Health, Island Health and Vancouver Coastal Health, British Columbia, Canada, 2010—2012

Public health

Organization

Regional health authorities were provided an expert consultant to foster EIDM in land use and transportation plans and policies. The expert worked with staff to develop and facilitate the implementation of the work plans, by conducting a situation assessment, developing and implementing capacity-building plan

Quantitative: Knowledge and skill for land use and transportation plans/policies (survey)

Qualitative: Activities completed at the health units (interviews)

Following the intervention, staff reported:

-Increased knowledge and skills

-Increased awareness of other organizations

Facilitators for EIDM

-New relationships with colleagues in other health authorities, governments and sectors

-Increased opportunities for collaboration

-Collaboration between health authorities and local governments

-New insights on partnership work

Barriers to EIDM

-Lack of time and resources

-Roles and partnerships not clearly defined

-Lack of leadership support and integration across the organization

High (Quasi-experimental study)

 Parke, 2015 [64]

Case report, no comparator

Island Health and the University of Alberta, British Columbia, Canada,

2012–2014

Primary care

Whole organization

Scholar-in-residence roles was established to integrate practice, education, and research through collaboration between a health region and a university. Activities included:

-Unit-based research teams that conducted literature reviews, literature appraisal

-Workshops on writing for publication, research methods skills

-Funded research project proposal writing, ethics applications, data collection and analysis

-Publications and presentations

-Quality improvement through collaboration with community, hospitals and university

Findings were described in a narrative case report

Barriers to EIDM:

-Cultural differences between the healthcare and university system

-Establishing protected time for research in the health organization

-Building relationship between the scholar and hospital staff

Moderate (Case report)

 Peirson, 2012 [14]

Qualitative

Peel Public Health, Ontario, Canada, September 2008 to February 2010

Public health

All staff at organization, including leadership

Multiple EIDM interventions were implemented, including:

-Hiring new leadership supportive of EIDM

-Strategic organizational plan for EIDM

-Development of staff knowledge and skills

Qualitative: EIDM facilitators (semi-structured interviews and focus groups, review of documents)

Facilitators for EIDM:

-Senior leadership driving EIDM initiatives

-Organizational structures (e.g., journal clubs, workshops, library services)

-Establishing EIDM specialist roles, training staff in EIDM and encouraging knowledge sharing with co-workers

-Supportive organizational culture

-Accessible knowledge and sharing knowledge across the organization

-Communication around EIDM and its priority to the organization

High (Qualitative)

 Plath, 2013 [65]

Qualitative

Non-governmental social service organization, Australia, dates not specified

Social work

Staff across organization

Strategies to promote EIDM were implemented, including:

-Leadership commitment to EIDM

-Staff champions for EIDM

-Establishment of EIDM “communities of practice” teams

Qualitative:

-EIDM facilitators and barriers and facilitators (interviews and focus groups)

Facilitators for EIDM:

-Dedicated staff roles for research and KT

-Supportive leadership

-Sufficient time, training and resources for EIDM

-Audit and feedback of practices

-Building frontline staff skills in EIDM

-EIDM “communities of practice”

Challenges to EIDM:

-Competing priorities

-Lack of knowledge and skills

-Culture of responding to crises

Moderate (Qualitative)

 Roberts, 2020 [66]

Single group pre-post study

Tennessee Department of Health, Tennessee, USA, 2012–2018

Public health

Departments, teams, senior leadership across organization

Volunteers were trained as “Baldrige examiners”, a similar role to knowledge broker. These volunteers supported teams at the local health departments evaluate and improve programming

Quantitative:

-Employee satisfaction (survey)

-Adoption of new processes (training records)

-Integration of new programs (program process reports)

Authors report diffusion of skills across the local health departments. Department staff reported satisfaction with their jobs at rates higher than national averages

Moderate (Quasi-experimental study)

 Traynor, 2014 [67]

RCT with control group and case report with no comparator

Public health units, Ontario, Canada, RCT 2003–2007 and case report 2009–2013

Public health

Organization

Two studies implemented Knowledge Brokers who conducted initial and ongoing needs assessments for EIDM, knowledge management and internal network development

Quantitative: social network data, EIDM skills, knowledge and behavior (survey)

Qualitative: Knowledge, attitudes and behaviours for EIDM (interviews, journal analysis)

Knowledge brokering intervention was reported to result in increased use of EIDM. Tailoring knowledge broker approaches to the organizational context was most effective. Knowledge brokers were most effective if they were experts in research methodology and public health, as well as

being approachable and patient

High (Qualitative)

 Van der Zwet, 2020 [68]

Case report, no comparator

Social work Organization, Netherlands, 2013–2015

Social work

Research and development team

Research and development department and long-term collaboration with a university were established to support EIDM

Qualitative:

-EIDM facilitators and barriers

(semi-structured interviews)

Facilitators for EIDM:

-Leadership commitment to research

-Qualified staff in EIDM support roles

-Research partnerships

-Training in EIDM

-Targeted recruitment of staff with diverse educational backgrounds

Barriers to EIDM:

-Negative attitudes towards EIDM

-Preference for experiential vs. research knowledge

-Culture of crisis-driven practice

-Workload, time management, competing priorities

High (Case report)

 Ward, 2012 [13]

Case report, no comparator

Peel Public Health, Ontario, Canada, 2010–11 (Year 4 of a 10-year initiative)

Public health

All staff at organization, including leadership

Key elements of the EIDM strategic approach included:

-Structured process for research review

-Library reference service

-Staff development in EIDM knowledge and skills

-Dedicated staff time for EIDM

-Active engagement with the research community

-Accountability for EIDM at all levels of the organization

Findings were described in a narrative case report

After 4 years of implementation, there was systematic and transparent application of research to more than 15 program decisions. EIDM was embedded as a cultural norm within the organization

Key lessons identified included:

-Identify a senior, influential leader

-Commit to a multiyear strategy

-Be realistic about the infrastructure needed

-Staff support for skill development

-Make senior staff accountable for progress

-Partner with leading researchers

-Invest resources in change management

-Measure progress to communicate successes to staff

Moderate (Case report)

 Waterman, 2015 [69]

Qualitative

The Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Manchester, United Kingdom; dates not specified

Public health

Organization

KT Associates facilitated the implementation of EIDM. KT Associates joined teams responsible for implementing EIDM along with the clinical lead, academic lead and program manager

Qualitative:

-Evaluation of KT Associates’ role and impact (focus group and interviews)

KT Associates contributed to 4 key stages:

-Choosing an evidence-based intervention (collecting information, bringing stakeholders together, identify context, build up network)

-Planning the evidence-based intervention (collecting evidence, testing the intervention, sharing info, expanding networks, stakeholder meetings)

-Co-ordinating and implementing the evidence-based intervention recruit people and build relationships, individualized support, communication, understanding context)

-Evaluating evidence-based intervention (data collection/report, patient and staff experiences, celebratory events, poster/presentations)

High (Case report)

 Williams, 2020 [70]

Single group pre-post study

Outpatient children’s mental health clinics, Philadelphia, USA, 2013–2017

Primary care

Senior leadership across agencies

Development of organizational leadership and climate for EIDM through training, consultation and technical assistance

Quantitative:

-EIDM use (Cognitive-behavioral therapy subscale

of the Therapy Procedures Checklist-Family Revised)

-Leadership for EIDM (Implementation Leadership Scale)

-Organizations’ climates for EIDM (Implementation Climate Scale)

-Perceptions of leader’s transformational leadership (Multifactor Leadership Questionnaire)

-Attitudes toward EIDM (Evidence-based Practice Attitudes Scale)

Organizational climates supportive of EIDM were associated with:

-Strong leadership for EIDM (d = 0.92, p = 0.017)

-Increased use of EIDM (d = 0.55, p = 0.007)

There was no association between clinicians’ attitudes towards EIDM and their use of EIDM

High (Quasi-experimental study)

 Williams, 2019 [71]

Single group pre-post study

Metabolic specialist centres, Australia and New Zealand, 2015–2017

Primary care

Metabolic dietetic service within organization

The metabolic dietetic service established:

-Electronic referral alert

-Metabolic sick day nutrition plans available to all clinical staff

-Metabolic diet codes and specialised formula recipes

Quantitative: Admissions for patients with inborn errors of metabolism (chart audit)

There was a reduction in total admissions of patients with inborn errors of metabolism (36 vs. 11 across the audit periods; unclear if this was a statistically significant finding.)

Moderate (Quasi-experimental study)

 Williams, 2017 [72]

Single group pre-post study

Children’s mental health agencies, large midwestern urban area, USA, 2010–2013

Primary care

CEOs and administrators, and front-line clinical teams at organizations

External facilitators supported leadership, staff and an internal liaison. Principles of EIDM were integrated into the organizations’ operating procedures. Organizational infrastructure and tools to enable EIDM were developed. Staff and leadership mental models to support EIDM were enabled

Quantitative: Intentions to adopt EIDM, barriers to EIDM (surveys), Unit-level enactment of Availability, Responsiveness, and Continuity principles and completion of planned activities (ARC principles questionnaire), Organizational proficiency culture for EIDM (Organizational Social Context measure)

Following implementation, clinicians exhibited:

-Higher odds of adopting EIDM (OR = 3.19, p = 0.003)

-Greater use of EIDM with clients (p = 0.003)

-Fewer EIDM barriers (p = 0.026)

Intention to use EIDM was the only predictor of EIDM adoption (p = 0.032) and EIDM use (p = 0.002)

High (Quasi-experimental study)