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Knowledge
Base

Other Models and Theories

There exist two classifications of conceptual theories and/or models of change used as reference when implementing research into practice. There are theories and/or models that describe change but not how to go about implementing change and those that are targeted for use to guide change and cause change.

  1. Planned Action approach
  2. Classical Model approach:

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Planned Action approach

The planned implementation of research findings into practice for the purpose of guiding or causing change.

Anderson, Odden, Farrar, Fuhrman, Davis, Huddle, Armstrong & Flakes-Mosqueda
Anderson, B., Odden, A., Farrar, E., Fuhrman, S., Davis, A., Huddle, E., Armstrong, J., Flakes-Mosqueda. 'State strategies to support local school improvement' Knowledge Creation Diffusion Utilization, 1987: 9, 42-86.
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Abstract

States across the US are "actively engaged in helping school districts and schools implement research findings". Case Study conducted to give government staff information to help refine strategies for supporting local school improvement
Boissel, Amsallem, Cucherate, Nony & Haugh
Boissel J.P, Amsallem, E, Cucherate M., Nony P., Haugh M.C. 'Bridging the gap between therapeutic research results and physician prescribing decisions: knowledge transfer, a prerequisite to knowledge translation' European Journal of Clinical Pharmacology, 2004: 60: 609-616.
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Wide gap between available therapeutic research results and physician prescribing. Difficulty in transferring comprehensive research information to practicing clinicians due to information overload, growing complexity of research, as well as lack of physician skills, resources, and time.

Based on a flow-chart of the flow of information from research to physician. Propose to optimize indirect flow of information since direct flow cannot be efficient.

Bollinger & Smith
Bollinger, A. S, Smith, R.D. 'Managing Organizational Knowledge as a Strategic Asset' Journal of Knowledge Management, 2001: 5(1):8-18.
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Abstract

As a guide for action. Organizational knowledge is a strategic assess. Authors offer practical considerations for implementation of knowledge management principles.

Logically - through a KM lens
Knowledge is a resource that is valuable to an organization?s ability to innovate and compete. It exists within the individual employees, and also in a composite sense within the organization. According to the resource-based view of the firm (RBV), strategic assets are the critical determinants of an organization?s ability to maintain a sustainable competitive advantage. This paper will combine RBV theory with characteristics of knowledge to show that organizational knowledge is a strategic asset. Knowledge management is discussed frequently in the literature as a mechanism for capturing and disseminating the knowledge that exists within the organization. This paper will also explain practical considerations for implementation of knowledge management principles.

Brooten, Youngblut, Robers, Montgomery, Standing, Hemstrom & Suresky
Brooten D, Youngblut JM, Roberts B, Montgomery K, Standing T, Hemstrom M, Suresky J. 'Disseminating our breakthroughs: enacting a strategic framework' Nursing Outlook, 1999: 47(3): 133-137.
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Abstract

Significant research results on important health care problems need diffusion of the findings before they can be understood, accepted, and adopted. Publicizing the yield on the investment in research is important for the individual, the institution, the funding agency, the profession, and health care. Accelerating this rate of diffusion and adoption requires a comprehensive, well planned strategy. The purpose of this article is to present a comprehensive framework to diffuse research findings and to illustrate its implementation by the Frances Payne Bolton School of Nursing.
Lavis Framework for Knowledge Transfer
Lavis JN. 'What do we know about knowledge transfer to decision-makers?'.
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Abstract

Dr. John Lavis believes that there are five principles that should guide knowledge transfer to maximize uptake. These five key principles are:

  1. Message - What should be transferred to decision makers?
  2. Target Audience -To whom should research knowledge be transferred?
  3. Messenger - By whom should research knowledge be transferred?
  4. Knowledge transfer process and support system - How should research knowledge be transferred?
  5. Evaluation - With what effect should research knowledge be transferred?

Based on these principles a "Knowledge Transfer Planning Guide" was developed by the Institute for Work & Health with Dr. Lavis. http://www.chsrf.ca/kte_docs/IWH_kte_workbook.pdf

Lavis, J. N., Robertson, D., Woodside, J. M., Mcleod, C. B., & Abelson, J. (2003). How can research organizations more effectively transfer research knowledge to decision makers? Milbank Quarterly, 81(2), 221?248. Lavis, J. N., Ross, S. E., Hurley, J. E., Hohenadel, J. M., Stoddart, G. L., Woodward, C. A., et al. (2002). Examining the role of health services research in public policymaking. Milbank Quarterly, 80(1), 125?154.

Motwani, Sower & Brasier
Motwani J, Sower V, Brasier L. 'Implementing TQM in the health care sector' Health Care Manage Rev 1996 Winter;21(1):73-82.
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This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.
Moulding, Silagy & Weller
Moulding NT, Silagy CA, Weller DP. 'A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines' Qual Health Care 1999 Sep;8(3):177-83.
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Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies.
National Health and Medical Research Council
National Health and Medical Research Council. 'How to put the evidence into practice: implementation and dissemination strategies'. Reference No: CP71. 2000.
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Abstract

This handbook focuses on the issue of how to change clinical practice through dissemination and implementation of clinical guidelines or other evidence-based information. Clearly, clinical practice guidelines will not have achieved their stated purpose if clinical practice does not change and outcomes improve.
Pape
Pape TM. 'Evidence-based nursing practice: to infinity and beyond' J Contin Educ Nurs 2003 Jul-Aug;34(4):154-61; quiz 189-90.
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Abstract

BACKGROUND: Medical errors are in the news almost daily, frequently after patients have experienced ineffective and unsafe protocols. As a result, patients and family members lose trust in the healthcare system. Nursing practice is changing almost daily with advances in nursing research and improvements in technology and practice. Reading, understanding, and managing these large amounts of information have become difficult for most nurses and organizations.

METHODS: This article provides an historical background for evidence-based practice and methods for assimilating research into practice.

RESULTS: Systematic reviews and other decision-making models are discussed using specific questions for establishing policy guidelines.

CONCLUSION: Evidence-based practice encompasses implementing the best-known practices into the clinical setting using a scientific approach. As a result, safe, high-quality, and cost-effective care will be more likely to occur consistently.

Proctor
Enola K. Proctor. 'Leverage Points for the Implementation of Evidence-Based Practice' Brief Treatment and Crisis Intervention, Oxford University Press, 2004: 4:227-242 (2004).
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Adoption of evidence-based practice (EBP) is an increasingly advocated yet formidable challenge. Much work on EBP has implied simplistic solutions: if researchers would produce practice-relevant evidence-based approaches, practitioners would find, adopt, and use them. Blaming researchers for problems in supply, and practitioners for resistance in adoption, will only thwart progress at improving the quality of service. The dissemination and implementation of evidence-based practice requires a more discerning analysis of issues in agency, research, and professional cultures. Drawing on literatures on knowledge diffusion, innovation, and quality improvement, this paper proposes a conceptual framework for the multiple tasks, participants, and leverage points required for the adoption of EBP. Evidence-based practice requires attainment of four intermediate outcomes?access, adoption, implementation, and assessment?each with distinct interventions required for attainment. The framework reveals action points and leverage points for researchers, agency administrators, educators, and individual practitioners. Implementation of EBP requires supportive research, training, and organizational infrastructures.
Roberts-Gray & Gray
Roberts-Gray, C., Gray, T. 'Implementing Innovations: A Model to Bridge the Gap Between Diffusion and Utilization' Science Communication, Vol. 5, No. 2, 213-232 (1983).
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In this article a schematic model is developed to describe the processes, determinants, and required elements of support for programmed implementation of innovations in organizational settings. Implications for planning and managing programmed implementation are discussed. Integration of this model, or similar ones, into the normal practices for knowledge creation and diffusion should result in improved utilization and thereby improved return on investments made in innovation.
Rosswurm & Larrabee
Rosswurm, M., Larrabee, J. 'A model for change to evidence-based practice' Image J Nurs Sch 1999;31(4):317-22.
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PURPOSE: To describe a model that guides nurses and other healthcare professionals through a systematic process for the change to evidence-based practice. The tremendous increases in clinical research and accessibility to research findings have prepared the way for the paradigm shift from traditional and intuition-driven practice to evidence-based practice. Although several models have emerged to guide practitioners in research utilization, practitioners continue to have difficulty synthesizing empirical and contextual evidence and integrating evidence-based changes into practice.

ORGANIZING FRAMEWORK: The model is based on theoretical and research literature related to evidence-based practice, research utilization, standardized language, and change theory. In this model, practitioners are guided through the entire process of developing and integrating an evidence-based practice change. The model supports evidence-based practice changes derived from a combination of quantitative and qualitative data, clinical expertise, and contextual evidence.

METHODS: The model was developed using sources identified on searches of Medline, CINAHL, and systematic reviews available on the Internet. Review topics were focused on evidence-based medicine and nursing, research utilization, and change process. Other sources included clinical expertise and quality-improvement information.

CONCLUSIONS: Practitioners need skills and resources to appraise, synthesize, and diffuse the best evidence into practice. Patient outcomes must reflect discipline-specific and interdisciplinary accountabilities. Collaboration between researchers and practitioners within and among disciplines will enhance the diffusion of evidence-based practice innovations.

Simmons, Brown & Diaz
Simmons, R, Brown, J, Diaz, M. 'Facilitating large scale transitions to quality of care:. an idea whose time has come' Stud Fam Plann 2002 Mar;33(1):61-75.
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In the field of reproductive health, investigation of the transfer of knowledge gained from demonstration and pilot projects to large public-sector programs typically has not been considered a relevant domain for research or other investigation. This article draws on a range of research in the social sciences and presents two frameworks for understanding the critical attributes of successful expansion of small-scale innovations. Seven key lessons are developed using examples from family planning where scaling up was an explicit objective, including the early Taichung Study of Taiwan, the Chinese Experiment in Quality of Care, the Bangladesh MCH-FP Extension Project, the Navrongo Project in Ghana, and the Reprolatina Project in Brazil. Unless small, innovative projects concern themselves from the outset with determining how their innovations can be put to use on a larger scale, they risk remaining irrelevant for policy and program development.
Stetler
Stetler, C.B. 'Updating the Stetler model of research utilization to facilitate evidence based practice' Nurs Outlook 2001 Nov-Dec;49(6):272-9.
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The evidence-based practice movement raises questions about the continuing viability of research utilization models. This manuscript describes the updated, practitioner-oriented Stetler Model. First developed in 1976 with Marram, it was refined in 1994 with conceptual underpinnings and a set of assumptions. The model has been further refined on the basis of a related utilization-focused integrative review methodology, targeted evidence concepts, and continuing experience through use of the model with clinical nurse specialists. The revised model continues to focus on a series of judgmental activities about the appropriateness, desirability, feasibility, and manner of using research findings in an individual's or group's practice.
Targett & Barnes
Targett, D. and S. Barnes. 'A Framework for Strategic IS Implementation in the UK Health Sector. Topics in Health Information Management' Topics in Health Information Management, 1999 19(4): 62-74.
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The implementation of information technologies in the United Kingdom health sector is a relatively recent phenomenon. Many of the developments have followed the patterns in the United States. One such example is that of Case Mix, introduced strategically as part of the Resource Management Initiative and aimed at the facilitation of both clinical and financial audit. Moreover, Case Mix was implemented alongside significant changes in hospital structure and culture, requiring clinicians to get involved in management tasks and decision making within the structure of the hospital, supported by a new information infrastructure. The success of such systems has varied significantly. A number of lessons can be learned from the way that the implementation was approached.

This article stems from a research project focusing longitudinally on the implementation of Case Mix in four UK hospitals. It draws a number of findings from the cases, and importantly, explicates a framework for strategic information systems implementation, as generated from the cases and supported by the extant literature. Such a framework has implications for both theory and practice, and assists in the understanding of what is often a dynamic and poorly understood situation

Titler, Kleiber, Steelman, Rakel, Budreau, Everett, et al
Titler, M.G., Kleiber, C., Steelman, V.J., Rakel, B.A., Budreau, G., Everett, L.Q., et al. 'The Iowa Model of Evidence-Based Practice to Promote Quality Care' Crit Care Nurs Clin North Am 2001 Dec;13(4):497-509.
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The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.
Tracy, Dufault, Kogut, Martin, Rossi & Willey-Tempkin
Tracy, S., Dufault, M., Kogut, S., Martin, V., Rossi, S., and Willey-Tempkin, C. 'Translating best practices in nondrug postoperative pain management' Nurs Res 2006 Mar-Apr;55(2 Suppl):S57-67.
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The research-to-practice gap is at the heart of the problem in the underuse of nondrug complementary methods to manage postoperative pain.

PURPOSE: To show how the six steps of the Collaborative Research Utilization (CRU) model can be used to translate research into practice, using an example of nondrug pain management protocols.

The CRU model was used to translate empirically tested nondrug interventions for surgical pain management enhancement into cost-effective, easy-to-use, best-practice nursing interventions, using tailored patient teaching.

RESULTS: The preliminary findings of the substudy in the context of the CRU model are reported.

DISCUSSION: The CRU model was successful in changing patients' knowledge, attitudes, and use of nondrug interventions for pain management. Further research is needed in heterogeneous populations. Organization receptivity to research and a well-integrated computerized documentation system for cueing clinicians' pain management practices are key for effectiveness of change.

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Classical Model approach

Explains or describes how change occurs but not how to cause change. These classical models can be further divided into subcategories:

Cognitive psychology theories of change

Huberman
Huberman, M. 'Steps toward an integrated model of research utilization' Knowledge: Creation, Diffusion, Utilization Vol. 8, No. 4, June 1987 pp. 586-611.
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No abstract available.
Rogers
Rogers E.M. 'Diffusion of preventive innovations' Addictive Behaviors 27 (2002) 989-993.
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The present paper draws on the diffusion of innovations model to derive a series of strategies for speeding up the spread and implementation of new ideas in preventing addiction. Preventive innovations usually require an action at one point in time in order to avoid an unwanted future condition. Hence, preventive innovations diffuse rather slowly, in part due to delayed rewards from adoption. Here we suggest five strategies, based on diffusion theory, for speeding up the diffusion of preventive innovations.

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Educational theories

The "4E" Framework
Marianne Farkas, Alan M. Jette, Sharon Tennstedt, Stephen M. Haley, Virginia Quinn. 'Knowledge Dissemination and Utilization in Gerontology: An Organizing Framework' The Gerontologist Vol. 43, Special Issue I, 2003, 47-56.
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Purpose: Enabling valuable research findings to be used by the field requires a strategic approach to dissemination and utilization rather than simply making constituencies aware of the information. This article describes a conceptual framework for the dissemination and utilization of information, along with examples of its use by the Boston University Royal Center for Enhancement of Late Life Function.

Design and Methods: The framework identifies dissemination/utilization goals of exposure, experience, expertise, and embedding ("4 E") and relates each goal to strategies targeted for specific users.

Results and Implications: The Boston University center exposed the field to information through presentations, print- and Web-based information, provided consumers and family members with new findings through motivational videotapes, developed expertise-level training programs, and embedded the new findings within organizations and systems. The 4 E framework can translate critical research outcomes into useful information to assist the field to better care and support available for individuals in late life.

Boyd & Menlo
Boyd R.D., Menlo A. 'Solving Problems of Practice in Education: A Prescriptive Model for the Use of Scientific' Knowledge: Creation, Diffusion, Utilization, 1984: 6(1), 59-74.
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Educators make assumptions about findings that are in harmony with their own existing approaches. Educators pay little attention to important methodological factors in studies when assessing them. Problem of translating research into practice exists in many fields. Many perspectives do not begin with the individual confronting a problem in practice. From the development of the statement of the problem by the practitioner to the identification of appropriate scientific information and the translation of this information back to the problem requires a good deal of careful and thoughtful work.

This article is the outgrowth of a project that began initially as a shared concern as to how adult educators were making use of research.

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Change management

Berwick
Donald M. Berwick. 'Disseminating Innovations in Health Care' JAMA: Journal of the American Medical Association 2003: 289(15): 1969-1975.
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Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly?if at all. Diffusion of innovations is a major challenge in all industries including health care. This article examines the theory and research on the dissemination of innovations and suggests applications of that theory to health care. It explores in detail 3 clusters of influence on the rate of diffusion of innovations within an organization: the perceptions of the innovation, the characteristics of the individuals who may adopt the change, and contextual and managerial factors within the organization. This theory makes plausible at least 7 recommendations for health care executives who want to accelerate the rate of diffusion of innovations within their organizations: find sound innovations, find and support "innovators," invest in "early adopters," make early adopter activity observable, trust and enable reinvention, create slack for change, and lead by example

Enormous amount of scientific knowledge remains unused. Health care fails to deliver the best care it could. Failing to use available science is costly and harmful.

This article explores the wider literature and theory of the dissemination of innovations to shed light on the specific case of health care.

Bloodgood & Morrow
Bloodgood, J. M., Morrow, J. L. 'Strategic Organizational Change: Exploring the Roles of Environmental Structure, Internal Conscious Awareness and Knowledge' Journal of Management Studies, 2003, 40:7.
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Move beyond the focus on choice vs. determinism by considering the role that knowledge-based resources may play when firms attempt strategic change (1762)

Examining the role of knowledge in predicting the direction and performance outcomes of strategic organizational change (1762).Whittington (1988) is used to introduce the aspects of environmental structure and internal awareness into the establishment of strategic choice. Subsequently, the tacit and explicit characteristics of knowledge resources are combined with Nonaka & Takeuchi's (1995) modes of knowledge conversion to illustrate how strategy implementation and knowledge influence firm performance (1761).

Burrows & McLeish
Burrows D., McLeish K. 'A model for research-based practice' Journal of Clinical Nursing 4(4) 243-247.
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Nursing practice is based on experience, tradition, intuition, common sense, untested theory and sometimes research. There are a number of reasons why nurses may see research as irrelevant to their practice. This paper provides a model identifying possible strategies to help nurses develop research-based practice
Farmer & Chesson
Farmer J., Chesson R. 'Health care management: models for evidence-based practice' Journal of Management in Medicine Vol. 15 No. 4, 2001, pp. 266-282.
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Presents models suggesting how research evidence can best be operationalised within health care commissioning. Models were derived from data gathered from surveys of Scottish health board managers and GP fundholders regarding the use of information in commissioning from 1995 to 1997. Feedback on the models was obtained subsequently from practitioners in 1998. Two models, one for health board managers and the other for GPs, are presented. These include critical success factors in achieving evidence-based commissioning and factors that are likely to predispose and precipitate evidence-based practice. Given a culture demanding transparency, accountability and continuing improvement, the models provide tools for reflection, evaluation and planning. In addition, they identify a pragmatic role for managers in evidence-based commissioning and provide a framework for audit.
Seidel & Cox
Seidel R. J., Cox, K. E. 'Management issues in implementing education and training technology' Technology Application in Education: A learning View, pp.323-339, Mahwah, New Jersey: Lawrence Erlbaum Associates, Publishers.
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No abstract available.

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Organizational theory

Best, Moor, Holmes, Clark, Bruce, Lieschow, Bucholz & Krajnack
Best A, Moor G, Holmes B, Clark P, Bruce T, Lieschow S, Bucholz K, Krajnack J. 'Health. Promotion Dissemination and Systems Thinking: Toward an Integrative Model' American Journal of Health Behavior, 2003: 27 (Suppl 3) S206-S216.
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To help close the gap between health promotion research and practice by using systems thinking. Still large gap between evidence-based practice in research literature and what is seen in practice. A lack of systems thinking lies at the heart of our limited dissemination and implication success to date./ To improve population health

Reviews three current national initiatives in the US directed towards reducing tobacco use. Examines a project (ISIS) that has introduced systems thinking to tobacco control and then samples the literature on systems thinking and speculates on ways in which greater systems thinking might improve our models for dissemination.

Bock
Bock, F. 'The intelligent approach to knowledge management: viewing KM in terms of content, culture, process, and infrastructure' Knowledge Management Review, 1999, Vol 2: 1: 22-25.
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Knowledge sharing often breaks down because of the "not invented here" syndrome or the inability of teams to align their efforts in the service of a shared purpose. Much knowledge is tacit. Not all knowledge has to be shared with everybody. A general, undiscriminating KT fad will create extra cost, inefficiency and confusion.

At Arthur D Little (ADL), we find it useful to think about knowledge management in terms of four integrated dimensions: content, culture, process, and infrastructure

Cretin
Cretin S. 'Putting clinical guidelines into practice' Implementing clinical practice guidelines, Chicago: AHA press. 1999.
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Describes strategies to implement clinical practice guidelines effectively and provides a framework for understanding elements needed for successful implementation; 1. Create tension for change 2. Identify an effective alternative 3. Provide social support 4. Develop self-efficacy skills 5. Build a supporting infrastructure 6. Include a mechanism for feedback and evaluation

Abstract from: http://www.iceberg-grebeci.ohri.ca/research/kt_theories_db.html

Kitson, Ahmed, Harvey, Seers & Thompson
Kitson A, Ahmed L, Harvey G, Seers K, Thompson D. 'From research to practice: one organisational model for promoting research-based practice' Journal of Advanced Nursing, 1996, Vol. 23, pg 430-440.
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This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework ? generating knowledge, implementing research into practice and evaluating the effectiveness of programmes ? are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.
Kotter & Schlesinger
Kotter, J.P., L.A. Schlesinger. 'Choosing Strategies for Change' Harvard Business Review, Mar/Apr79, Vol. 57 Issue 2, p106-114.
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No abstract available.
Krueger
Krueger J.C. 'Utilisation of nursing research: the planning. process' Journal of Nursing Administration Vol. 8, Issue 1, January 1978 pg. 6-9.
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No abstract available.
The QUERI Process
Demakis J, McQueen L, Kizer K, Feussner JR. 'Quality Enhancement Research Initiative (QUERI): a collaboration between research and clinical practice' Medical Care Volume 38(6) Supplement 1, June 2000; pp.I17-I25.
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This article provides an overview of the Quality Enhancement Research Initiative (QUERI), an ambitious attempt to develop a data-driven national quality-improvement program for the Veterans Health Administration (VHA) that is fully integrated within VHA's Strategic Framework for Quality Management, as discussed elsewhere in this supplement. QUERI is designed to ensure the systematic translation of findings and products (quality tools that promote use of research findings) to promote optimal patient outcomes and system-wide improvements. In developing QUERI, a framework was created to integrate structural elements (organizational characteristics) and process considerations (those actions and action sequences associated with positive change) with outcomes (both at the patient level and at the systems level). In developing this framework, a process for translation of evidence into action was born. The QUERI process depends on having or discovering accurate information about what services are needed, who needs them, how they should be provided, and relevant outcomes and costs. This article describes the 6-step QUERI process and presents an overview of relevant programmatic details, including QUERI's rigorous review process, and VHA's unique qualifications for establishing a national model for quality improvement.
Rosén & Jansson
Rosén M, Jansson B. 'How to act - implementing health and safety promotion at the organisational level' Health Policy and Planning 15(3), 2000 pp. 247-254.
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This interdisciplinary review focuses on strategies for implementing health and safety promotion activities in organizations. Theories are summarized in a checklist and illustrated by some practical examples from Sweden and abroad. The points illustrated appear obvious and logical, but they are seldom applied in practise.
Rosenheck
Rosenheck R. 'Stages in the implementation of innovative clinical programs in complex organizations' Journal of Nervous and Mental Disease Vol. 189, No. 12, 2001 pg 812-821.
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Organizational processes can have an important impact on the introduction of innovative treatments into practice. Conceptual frameworks from organization theory and experiences implementing several hundred specialized mental health programs in the Department of Veterans Affairs (VA) over the past 15 years are used to illustrate stages and processes in the implementation of new treatment models. Four phases in the implementation of new treatments in complex organizational settings are described: a) the decision to implement, b) initial implementation, c) sustained implementation, and d) termination or transformation. Key strategies for moving research into practice include constructing decision-making coalitions, linking new initiatives to legitimate goals and values, quantitative monitoring of implementation and performance, and the development of self-sustaining communities of practice as well as learning organizations. Effective dissemination of new treatment methods requires different organizational strategies at different phases of implementation
Scullion
Scullion PA. 'Effective dissemination strategies' Nurse Researcher Vol. 10 No. 1, 2002 pg. 67-77.
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Dissemination of research findings or other key messages is increasingly acknowledged as a vital yet complex process. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and provide valuable insights. It is argued that the process of dissemination needs to be afforded greater emphasis by project-funding bodies, research supervisors, researchers, and those responsible for implementing changes in clinical practice. Important initiatives are acknowledged before the concept of dissemination is explored. The source, message, medium and target groups, all key elements in the dissemination process, are then examined. It is argued that dissemination needs to be carefully considered at the design stage of research projects in relation to each of these elements. This paper concludes that the current commitment to research and evidence-based practice will have limited impact on patient care until a similar commitment to dissemination is evident at both corporate and individual levels.
Stevens
Stevens KR. 'ACE Star Model of EBP: Knowledge Transformation'.
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No abstract available.
The Transtheoretical Model
Prochaska, J.M., Prochaska, J.O., Levesque, D.A. 'A transtheoretical approach to changing organizations' Administration and Policy in Mental Health Vol. 28, No. 4, March 2001 pp. 247-261.
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Several authors have reflected on the underdeveloped state of organizational change theory, research, and practice. This field needs an integrative framework that can synthesize major approaches to change. The Transtheoretical Model has the potential to do for organizational change what it has done for individual behavior change. Conceptually the stages-of-change dimension can be used to integrate principles and processes of change from divergent models of change. Practically, the stages-of-change dimension can be applied by leaders to reduce resistance, increase participation, reduce dropout, and increase change progress among employees.

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Quality improvement

Funk, Tornquist & Champagne
Funk, S. G., Tornquist, E. M., Champagne, M. T. 'A model for improving the dissemination of nursing research' Western Journal of Nursing Research 1989, 11(3), 361-367.
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No abstract available.
Improving Chronic Illness Care
Improving your practice.
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The purpose of this manual is to help you begin improving care for your chronically ill patients. It is designed not only to impart information about how to improve, but also to help you to take action on the information you read. The materials are laid out in a step-by-step fashion with "To Do" lists at the end of each section.
Keefe
Keefe M.R. 'An integrated approach to incorporating research findings into practice' The American Journal of Maternal/Child Nursing Vol. 18, March/April 1993 pp. 65-70.
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No abstract available.
King, Barnard & Hoehn
King D., Barnard K.E., Hoehn R. 'Disseminating the results of nursing research'.
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No abstract available.
Power of One Model
Jacobson A. 'Research utilization in nursing: the power of one' Orthopaedic Nursing Vol. 19, No. 6, November/December 2000 pp. 61-65.
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Abstract

Common barriers to research utilization in nursing include characteristics of the setting in which nurses practice, nurses themselves, and nursing's dependence on rituals and traditions in practice. Nurses can overcome these barriers by questioning their practice and adopting attitudes and values that prioritize research utilization. The "Power of One" Model of Research Utilization guides nurses to examine everyday practices, assess their research foundations, and implement and evaluate changes to research-based practice.
Rycroft-Malone, Harvey, Seers, Kitson, McCormack & Titchen
Rycroft-Malone, J. Harvey, G. Seers, K. Kitson, A. McCormack, B. & Titchen, A. 'An exploration of the factors that influence the implementation of evidence into practice' Journal of Clinical Nursing Vol. 13 2004 pg. 913-924.
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Abstract

BACKGROUND: The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry.

AIMS AND OBJECTIVES: The aim of the study was to address the following questions:

  • What factors do practitioners identify as the most important in enabling implementation of evidence into practice?
  • What are the factors practitioners identify that mediate the implementation of evidence into practice?
  • Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice?

DESIGN AND METHODS: The study was conducted in two phases.
Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites.
Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17).

RESULTS:A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources.

CONCLUSIONS: The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves.

RELEVANCE TO CLINICAL PRACTICE: Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.

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