Evidence-based practice: The key to advancing quality and safety in healthcare

To significantly impact the improvement of quality in healthcare, one needs to apply evidence-based practice (EBP). Without EBP, healthcare providers are at risk for variances in care that could seriously affect patient outcomes.

A "no-brainer," right? Yet, healthcare organizations throughout the U.S. continue to grapple with how to apply EBP. A recently published study conducted in collaboration with Elsevier Clinical Solutions and the Ohio State University College of Nursing surveyed 256 nurse executives about their beliefs and perceptions of EBP, along with some environmental aspects of their organizations.1 Among the study's cardinal findings: even though all the respondents indicated that quality and safety were the highest priority within their organizations, focusing on EBP was the lowest. This presents a dilemma of sorts, because In order to achieve quality and safety, EBP must be applied.

Why is there such a contradiction between focusing on quality and safety, and EBP? And what must healthcare organizations do to achieve parity among these three goals? The answer lies in:

• Developing the right organizational culture
• Education and leading with nurses
• Employing models and framework and,
• Advancing an interprofessional approach.

Establishing the right organizational culture
Simply disseminating evidence-based resources throughout an organization and expecting clinicians to implement evidence-based guidelines is not enough. In fact, clinicians often admit that they do not know where to find the evidence-based resources within their organization. EBP requires real behavior change, from long-held practices and organizational cultures of "this is the way we've always done it here," to practice supported by science. Leaders who truly embrace a culture of EBP encourage their clinicians to ask questions. If a culture of inquiry does not exist in which people who don't understand ask questions, practice will not change.

Transformation to an EBP culture requires a dynamic team vision along with clear expectations from leaders that EBP is the foundation of all care delivered within their organization. One way to do this is to embed the organization's vision, mission and strategic plan with its expectations for EBP, as well as making sure that EBP is incorporated in the onboarding process for all new clinicians. Also, those clinicians who fall short on some EBP competencies when hired should be provided with some form of continuing education, including skill-building activities, until they achieve full competency.

Education and leading with nurses
Nurses are the largest workforce in the U.S. healthcare system. If we lead with nurses, we can make a tremendous impact. According to The Future of Nursing Report by the Institute of Medicine, this means pushing nurses to practice at the top of their license and embrace EBP.

We must bridge the gap between education and practice. For pre-licensure in nursing schools, both faculty and students are hungry for tools that help them apply EBP. Post-licensure, using EBP in the work setting helps nurses apply it and advances their critical thinking. Overall, nurses should be expected to meet new EBP competencies for practicing, which means that baccalaureate and associate degree programs must teach students EBP.

Employing Models and Framework
Models and frameworks are critical to EBP. Having a model and/or framework can guide the transformational process by applying evidence at the point of care while integrating the commitment of EBP with other organizational goals.2 Too often, EBP is thought of as a theoretical concept that is difficult to embrace, but that's just not the case. Employing models and/or frameworks also engages clinicians and scholars who are experts in their respective fields.

Advancing an interprofessional approach
Nursing and other interprofessional healthcare executives must build a culture and environment that supports evidence-based care implementation and sustainability to achieve the best patient outcomes.3 Evidence-based councils composed of a team of interdisciplinary clinicians can also enhance EBP throughout an organization and lead to a higher quality of care and improved outcomes.

Physicians in particular, who have primarily relied on clinical trials in the past are now viewing evidence-based methodologies as additional options to arriving at quality-focused, value-based care. Along with nurses and other allied health professionals, they are beginning to adopt interprofessional EBP as a cornerstone to greatly improve the momentum of this movement.

Probably one of the greatest challenges – and opportunities – for EBP is applying it across the care continuum. EBP is very much aligned with the Affordable Care Act and movement from fee-based to value-based service. So, in looking at EBP's application across the continuum of care, consider this: does it make sense for a patient with heart failure to receive care as an inpatient in a hospital setting that employs evidence-based guidelines and methodologies, to then be sent home and receive care at a heart clinic that doesn't use an evidence-based approach to care?

We now have a great opportunity to establish EBP as a standard pillar across all healthcare settings to ensure that each patient receives evidence-based, consistent care from all providers. In addition, using EBP can enable patients to become more active participants in their healthcare.

As we look ahead to the future, EBP can be incorporated as a standard component of healthcare in all care settings in several ways: first, we need for the evidence to become more evident in the workflow. This involves transitioning from static documents to information that is actionable and evident to clinicians. Next, it is important that integration of EBP with EHR vendors is facilitated in a way that makes it usable to clinicians in their everyday practice. And let's not forget to continue to advance an interprofessional approach.

Evidence-based practice can provide an exceptional opportunity to optimize patient care and outcomes by creating and leveraging the right tools, culture, education and patient engagement skills in the overall care process.

A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States," Worldviews on Evidence-Based Nursing, 2016; 13:1, 6-14

2,Informatics-enabled interprofessional education and collaborative practice: A framework-driven approach, Journal of Interprofessional Education & Practice, March 5, 2015

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