Evidence informed change management in canadian healthcare organizations

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For innovation to succeed, you need: innovators, early adopters, and an early majority. Innovators are the source of proposed positive changes. They are those individuals within an organization that read scientific journals, attend conferences, and keep informed about best practices.

They are well connected with sources of evidence outside the organization, and they bring ideas back to the organization. Early a dopters are well connected within the organization. They are the leaders who have influence and authority. They can make things happen, given their formal power within the organization. These leaders believe in the value of innovation, and they support their innovators.

As one example, an early adopter leader provides release time and financial support for a nurse educator to attend a conference on medical-surgical practice innovations. The nurse educator brings back great ideas and presents them to the leadership and staff. Once an early adopter leader recognizes the potential of an innovation, the leader gets to work, planning for how to present the innovation to staff i. The leader proposes a pilot and asks for staff volunteers to help.

Those staff who step forward to trial the innovation make up the e arly m ajority. In many instances, the early majority consists of new graduate nurses who are eager to try something new. If the pilot has been successful, the rest of the staff—who have observed the positive outcomes from the pilot—will readily adopt the innovation. These staff comprise the l ate m ajority. And lastly, there are some staff, the l aggards , who remain resistant to change.

Leaders should listen to their concerns, but ultimately, if some staff members are uncomfortable with the change, it may be time for them to look for another unit or place of employment. The laggards typically represent only a small number of staff 16 per cent , and yet leaders often get sidetracked trying to convince them to change. The fact is that they may never change. Leaders, therefore, should focus their energies on the initial 20 per cent of staff at the beginning of the innovation curve i.

The third cluster of influence consists of contextual factors that facilitate or impede innovation within the organization. The leadership and the organizational culture both have major influence over innovation spread. You need evidence-informed leaders i. As Dr. The NHS is made up of health regions known as trusts.

Over a period of several years, evidence around safe staffing was ignored by the leadership within one NHS trust, the Mid Staffordshire Trust. After a public outcry by the loved ones of patients who were harmed or died due to negligent care, an independent inquiry was conducted by the NHS to find out what was going on in the Mid Staffordshire Trust. The inquiry revealed appalling care conditions due to nurse understaffing. The Mid Staffordshire Trust leadership chose to ignore over two decades of safe staffing research evidence.

For example, the numbers patient to nurse ratios and the types of nurses skill mix are directly linked to rates of patient morbidity e. Heavy nurse workloads, characterized by high patient to nurse ratios e.

Richer skill mix, with proportionally more RNs among direct care staff, is associated with better patient outcomes Needleman, The NHS was puzzled: what went wrong? Berwick, who wrote a paper on innovation, is considered an internationally renowned expert on quality and safety.

Berwick was asked by the NHS to review the inquiry report and to recommend quality and safety policy changes. In fact, doctors and nurses were afraid to speak up. There was evidence of leaders bullying and threatening doctors and nurses who complained about unsafe work conditions.

One of Dr. Leaders are essential for creating an open, transparent culture of learning, where everyone is expected to use the evidence to ensure best practice and best possible delivery of care to patients.

Leaders are essential for modelling the way for others and providing the necessary information, resources, and supports so that all nurses and other staff have the means to provide quality, safe care to patients.

Leaders are essential for promoting a culture of continuous learning, openness, and transparency toward sharing and using evidence to make a difference—what is known as a learning organization. Take a look at the following table, from Dr. Every person working in NHS-funded care has a duty to identify and help to reduce risks to the safety of patients, and to acquire the skills necessary to do so in relation to their own job, team, and adjacent teams.

Leaders of health care provider organisations, managers, clinical leaders. All members of an organization, staff and leaders alike, are expected to contribute to a learning organization culture.

Watch the following three videos on learning organizations, then answer the questions that follow:. Research on organizations from all different sectors including industry, business, and health care has shown that organizations that promote practices associated with learning organizations have significantly better outcomes, such as improved quality, efficiency, and effectiveness. When we get stuck in one way of thinking and one way of doing things habit , we miss opportunities to improve and enhance the way we work together.

Within the trust, leaders ignored evaluation data that reported adverse events, and they ignored patient complaints and staff complaints. They focused almost exclusively on financial targets set by the government to produce balanced budgets. The NHS finally commissioned a public inquiry of Mid Staffordshire Trust after a whistle-blower group of families went to the media with stories of terrible injury to their loved ones.

Julie Bailey, one of the organizers of the movement, lost her mother. The public and the media were responsible for government action. The reporter interviews Julie Bailey, one of the organizers of the public movement who lost her mother , and Jeremy Hunt, the Minister of Health. The video is dated February 6, , shortly after the release of the Francis report on the Mid Staffordshire Trust.

In the video, Ms. Bailey also asserts that change will not happen without new leadership. The reporter, however, challenges whether or not the resignation of the current leader will take care of the problem. What do you think? The background of the position statement highlights how evidence-informed harm reduction approaches represent nursing principles. Identify those concepts of harm reduction that are associated with nursing professional standards and codes of ethics.

In British Columbia, illicit drug overdose deaths topped in , and in Alberta, there were deaths in from fentanyl overdoses Canadian Press, This opioid crisis in Canada and the US has spurred policy-makers and health care providers to seek guidance from research on mental health and addictions treatment.

Position statements are typically evidence-based documents that can be found on websites of professional organizations, regulatory colleges, unions, and the government. For students, these documents are great resources, which also provide an introduction to the professional principles that define who we are as nurses. Note the references and the use of research evidence to describe key evidence-based harm reduction strategies. A number of recent research studies are included in this position statement.

What does this mean from a leadership perspective? As nurses, we need to lead the way with respect to knowing the research evidence on topics that affect our patients, and more broadly, Canadian public health and well-being. Harm reduction is significant to nurses at local, provincial, and national levels—even globally. Another component of the study compared the efficacy of injectable heroin and hydromorphone to oral versions of these two opioids.

An interdisciplinary team of physicians, nurses, social workers, and counselors were involved in this study. This study demonstrated that injectable heroin could be substituted with injectable hydromorphone, an opioid with less social stigma than heroin.

Oral versions of both medications were not effective in curbing illicit drug use. Supervised injection sites, managed by care teams with nurses, now have a variety of evidence-based treatment options e. Return to the quote at the beginning of this chapter, rethinking it in terms of everything you have just read. Evidence-informed leaders are early adopters who seek out the best available evidence and promote evidence-informed practices among their staff.

How is evidence weighted against other factors in decision making? Notes from the submitted documents were entered into data extraction tables created with MSWord. The completed tables were used to conduct cross-document thematic analyses, the results of which were discussed with two other authors DC, MD before finalizing. During the course of the research organizational efforts were concentrated on building infrastructure and preparing the context for change.

As data collection for this study concluded the organization was shifting into a new phase of implementation focused on piloting a literature review toolkit and testing strategies for bringing the synthesized evidence into decision making processes. Thus the timing of the study did not permit any analysis of: the effectiveness of the new EIDM methods and tools; the extent to which results of literature reviews actually inform or drive decisions; or how evidence informed changes to programs or policies impact public health outcomes or organization operations.

Preliminary themes and insights arising from the analysis were continually fed back to the organization's leaders and staff to allow for member checking of the data and interpretations [ 41 ], and to ensure the research contributed real-time value to the unfolding initiative [ 25 , 42 ].

In this section we briefly describe the presence of EIDM and the EIDM-related activities and changes that occurred in the organization over the first two years of the initiative. The remainder of the results focuses on seven major themes arising from the case study data that address critical factors and dynamics for building capacity to make evidence informed decisions: 1 leadership, 2 organizational structure, 3 human resources, 4 organizational culture, 5 knowledge management, 6 communication, and 7 change management.

Prior to fall , before the new Strategic Plan and efforts to advance the EIDM priority, staff were accessing and using research evidence to inform decisions. Up to this point there were no organization-wide, formalized and standardized methods, tools or expectations to guide and manage how research evidence was brought into decision making processes.

Informants believed staff were doing the best job they could with the resources, skills and time available to support this work but they also agreed much more should and could be done to enhance individual and organizational capacity for EIDM. During the course of this research the organization invested in and advanced significant efforts to nurture a culture and develop the tools, processes and structures that would support, sustain and increase EIDM. Figure 1 offers visual depiction of the types, intensity and complexity of new activities undertaken between and The colours and positions of the circles represent general groupings of activities.

Some activities were initiated and completed in the first two years e. Color and position of circles depicts general groups of activities: red--workforce development and staffing; yellow--training and mentoring; dark green--communications; light blue--library restructuring; pink--working groups; orange--toolkits; dark blue--knowledge management; purple--clubs; light green--commissioned reviews; aqua--evaluation.

In staff continued to struggle with key barriers including inadequate access to databases and full-text articles, limited EIDM knowledge and skills, and difficulties allocating sufficient time to engage in EIDM tasks.

However, the presence of research evidence and the application of EIDM approaches were more visible and prevalent than in For example, a literature review toolkit had been developed and was being piloted, EIDM-related skills, practices, roles and expectations were becoming clearer, and in conjunction with the Strategic Plan's Workforce Development priority, a comprehensive training platform for EIDM was in development.

Through these training opportunities and experiences with the initiative, staff were gaining confidence and skills and were starting to apply EIDM knowledge, techniques and tools to literature reviews and decision making processes. Newer literature reviews conducted prior to toolkit piloting were still inconsistent and incomplete in terms of using and reporting EIDM components e. Furthermore, a number of documents revealed significant investments, concerted efforts and widespread activities intended to create or expand fiscal, human, technological and relational resources to advance the EIDM priority.

Informants agreed that successful implementation and sustainability of the EIDM initiative depended on leadership at the highest level of the organization. If they're not onboard, it's not going to happen. Across informant groups, the new MOH was seen as a strong, credible and visible leader who provided unwavering support.

Staff thought without the MOH's vision and commitment, this initiative would not have started and they believed his continued involvement will be a key factor contributing to its success.

Informants thought it was important that a significant portion of this person's time 0. To enhance leadership capacity and content expertise for this role, the AMOH participated in a two-year mentored executive training program [ 43 ].

As part of this fellowship the AMOH carried out a focused intervention project to develop a comprehensive suite of methods and tools that could be used by Specialists and Managers across the organization to conduct consistent, critical and rapid reviews of the research literature.

In , informants were not as certain that all other senior leaders had bought in. However, by winter , with over a year and half of exposure and experience, informants reported more Directors and Managers were demonstrating leadership, commitment and support for the initiative.

The continuity and stability of high level leadership was identified as a key facilitative factor for sustainability of the EIDM initiative. A number of informants predicted that if the current MOH remained and other management positions also stayed fairly stable then the initiative would progress successfully. Informants were optimistic that EIDM would eventually spread and take hold, but in they did not think it was embedded enough in the structures, functions and culture of the organization to withstand a change in key leaders.

In there was general agreement that the staff and content areas of different divisions and some teams within divisions were not well integrated. Informants suggested more events e. The EIDM initiative created the need and opportunities to build these formal and informal networks. These formally organized groups meet regularly to provide opportunities for staff with common interests and responsibilities to develop and practice skills and to discuss challenges and strategies.

In informants reported there had been many more occasions to think, exchange, train and work with colleagues throughout the organization. One person reflected " I've met a lot of people from other divisions and teams through this EIDM initiative, the club, attending workshops together, getting each other's advice. One structure that has undergone significant change is the Library.

As the initiative progressed it became clear that library services are a vital resource supporting the conduct of effective and efficient literature reviews. One informant explained " The library has become part of public health. It is structurally, symbolically, and practically starting to have much more of a relationship with the work that we do.

Efforts have since focused on re-orienting the Library shifting from housing a collection of journals to offering a range of information and reference services and building the Library's connective and service capacity e. Informants believe these changes are essential to ensure the Library has sufficient capacity, expertise and connections to accommodate the increased demands that are expected with more extensive use of research evidence and more staff using a broader range of library services.

As one person expressed " It's not the physical library that matters. We still have to have some archival material, but what is the library are the people and the interaction and the service. As an organization-wide initiative EIDM is intended for all staff, regardless of their role.

Nevertheless, because of functional differences there are some staff groups that will be more exposed to the initiative and more reliant on its approaches, tools and other resources. One of these groups is the Specialists who conduct the literature reviews that are used to inform decision-making. In fall all but one division had at least two Specialists; by all divisions had staff in these roles. However, informants agreed that as EIDM becomes routine practice there will be a need to add more of these positions across the organization.

In senior leaders envisioned a new position that would focus on the Strategic Plan's Workforce Development priority and the Library, both of which intersect with EIDM. In the following year the new Manager initiated a staff training survey, coordinated requests for literature reviews, managed the Library restructuring process, and began implementing an organization-wide referencing system.

Moving forward, one of this Manager's main responsibilities is to plan and coordinate a comprehensive, organization-wide training platform for EIDM. Framing researchable questions, designing and conducting efficient and effective searches and critically appraising research evidence requires well-developed knowledge and high-level skills. In very few staff had expertise in these areas and limited training was available.

In addition, internal and external EIDM experts began coaching Specialist-Manager pairs through systematic reviews of the research literature to answer specific practice-based questions. Overall, informants thought the new training opportunities had strengthened and expanded not only their knowledge and skills, but also their internal and external relationships.

One person shared " I think it was just as much an EIDM adventure as it was a team building exercise. That was amazing. Clearly staff were being trained, but in the first two years there was not enough money, opportunity or time to train everyone.

Informants agreed it was appropriate to launch the initiative with a focus on the Specialists and Managers, but in many thought it was time to shift some attention and resources into training others.

One person asserted " People are saying, when will it be my turn? If we say wait, it's coming, people will get frustrated. We have to put something on the table. Team and divisional leaders thought guidelines need to be developed to inform decisions about which staff to send for what types and levels of training and when. It's not like there is only one package. It's understanding what intensity of training folks need to be effective contributors to the process.

Some informants talked about annual reviews as a means of providing regular and mutually accountable opportunities for staff and supervisors to identify EIDM learning needs, develop training plans, monitor progress, and assess performance. They said if the organization is promoting EIDM as a strategic priority and expects EIDM as part of routine practice then it should be explicitly added to the review and appraisal processes and products. Although not included in the formal templates, in several informants reported they had incorporated EIDM in their performance objectives and they would be using their annual reviews to demonstrate how they are developing and applying EIDM knowledge and skills.

Informants agreed there must be a fundamental shift in the culture of the organization to support EIDM. One person explained " You can't just walk in and say, you're going to do it like this, and suddenly it happens.

You've got to change the culture first and get people believing before they'll actually do it. In informants had a clear sense that the organization was ready to pursue this change. Some individuals were anxious, but for the most part staff were curious and interested in seeing the initiative move forward. In organizational readiness for EIDM-related changes continued to be strong and informants reported a positive increase in overall staff acceptance, support and commitment.

A commonly identified obstacle to embracing and integrating EIDM was the lack of time to read, to think, to write. In and informants agreed the organization reflected a culture of " doing.

There was a sense that enabling staff to make and take the time for EIDM will require more balance between thinking and doing. However, informants thought staff would struggle with the shift to a " thinker-doer " culture without on-going encouragement and explicit permission from senior leaders to designate and protect sufficient time to engage in the steps of EIDM.

In the health department did not have an organization-wide system to manage all of the information used and produced by literature reviews and decision making processes.

As one person remarked " There are piles of papers all over this place. In informants emphasized the need to develop a comprehensive knowledge management strategy that would provide a platform for coherent and transparent EIDM processes, full and rapid acquisition of information, consistent and thorough documentation, and the ability to share knowledge across the organization.

When asked to describe the essential features of a knowledge management system informants said it should: be easily accessible, user-friendly, current, electronic and searchable; include all EIDM tools, templates and manuals; link directly to companion resources e. The organization's intranet site was identified as a logical and familiar location for the knowledge management system. However, informants cautioned against an "if you build it they will come" mentality.

They said it will be important to build awareness and provide prompts and training so staff want to, and know how to, navigate and use the system. There needs to be some thought around how we entice staff to open and use that link. People remembered the MOH introducing the concept at an All-Staff Day in and appearances by senior leaders at divisional meetings in to familiarize staff with the forthcoming Strategic Plan and the EIDM priority.

Most informants had at least heard the terms "evidence informed decision making" and "EIDM. Informants expected and wanted more communication and more clarity about EIDM and how the impending changes would influence individual and organizational practices. When asked the same question in , participants talked about EIDM as a key component of the Strategic Plan which was formally released in The document and informant data showed the language of EIDM had started to permeate the organization.

It's in their minds, in their conversations. Informants thought explicitly framing EIDM capacity building as a long-term change process allows sufficient time to set, pursue and achieve realistic individual and organizational goals. One person explained " That's why we chose that 10 year horizon. These are truly strategic, big things. If you had even a 3 year Strategic Plan, at the end of it you would say, well that was a waste of time, didn't get anything useful done, and then you give up.

This way you say, it's a huge job but we can see we're making progress. By it was obvious EIDM-related changes had been and would be much broader and more extensive. According to informants, designing and implementing the initiative has been an evolutionary and organic process.

Activities and training options were added and adapted to respond to emerging and anticipated needs, challenges and opportunities. While recognizing progress, in some informants commented on the need for more comprehensive management of the EIDM initiative and co-management of EIDM and other Strategic Plan priorities e.

One person reflected, " Change management may not have been as salient in those early conversations and actions, whereas it has grown into something that is requiring more strategy.

It's more complex than people first imagined. While the mechanics of EIDM remained a priority, by the humanistic side of the initiative was drawing attention. One person said " It's basically getting people to think about different ways of doing things.

There's a whole set of feelings around what that means, so it's not enough to put all our energies into the evidence piece. The challenge is in the balance of that. These concerns were dissipating as staff received training and had opportunities to practice skills.

In the emotional issues were shifting to potential impacts of decisions. At the outset of the initiative it was expected that rigorous evidence reviews informing decisions would lead to practice changes. But until the consequences of EIDM had not been felt. The impact was just becoming real for staff as the first reviews using the new methods and tools were being completed and used to inform decision making.

Managers appealed for training and other supports to equip themselves and their staff to handle such situations, confidently and successfully.

Political visions, practice standards, knowledge and skills, and critical appraisal tools are necessary but not sufficient to ensure effective and efficient EIDM. The characteristics and capacity of public health organizations are also key [ 1 , 44 — 48 ]. System forces, such as national practice standards may compel EIDM-related reforms, but leaders of health care organizations are the "endogenous catalysts" [ 50 ] that stimulate and propel on-the-ground change [ 1 , 49 — 55 ].

Research has identified attributes and behaviours of effective leaders of organizational transformation for EIDM, including setting, steering and staying the course for change, becoming active participants in change efforts [ 53 , 56 ], the readiness and ability to secure and re allocate human, material and fiscal resources, and nurturing a culture that is open to change and values the inclusion of research evidence in decision making [ 49 , 54 ].

One aspect of leadership the literature does not emphasize that was identified in this study is stability. Long-term involvement of a consistent group of senior leaders has reinforced the presence, prominence and permanence of PPH's EIDM initiative. Consistent with other research on organizational change and capacity building for EIDM [ 50 , 51 , 53 , 55 , 56 ], the findings of this study demonstrate the value of enhancing formal and informal relational structures.

Clubs, committees and other groups provide opportunities for staff to get involved, exchange ideas, gain experience, assume responsibility, and take ownership. Structures that bring staff together are important, but some authors argue the pressing priority for advancing EIDM is building organizational structures that facilitate access to knowledge [ 1 , 50 , 52 , 54 ]. Strategic goals, critical appraisal skills and enthusiasm for EIDM are of limited use if organizations lack the infrastructure to acquire research evidence.

It is not enough for public health professionals to rely on academic or personal connections to help find and obtain research for decision making. These organizations need direct and easy access to technology for EIDM, to information specialists and to full-text research literature.

Recognizing the critical importance of this aspect of capacity building for EIDM, PPH has invested significant time, effort and funds to develop its internal library infrastructure and expertise. There is agreement in the literature and with the findings of this study that, in general, the public health workforce lacks research methods and critical appraisal skills, and that more formal and advanced training is needed on the concepts, tools, technologies and applications of EIDM [ 49 , 50 , 52 ].

At the outset of PPH's initiative, very few staff had the requisite skills to conduct efficient and effective reviews of the literature but by a large number of staff had participated in EIDM training workshops and plans were underway for an organization-wide training platform. By designating a significant portion of a senior leader's time to advance the EIDM priority and creating several new positions dedicated to EIDM-related work, PPH also counteracted concerns about negative impacts on performance when efforts are under-staffed or rely on volunteers [ 1 , 50 ].

Including EIDM-related expectations and opportunities within an organization's performance, accountability and incentive structures is another facilitative factor identified in the literature [ 49 , 51 — 53 , 55 , 57 ] and in the findings of this study.

What the literature does not address but was critical to advance training and increase the number of EIDM-related staff positions in this case, was the organization's decision to commit significant long-term core funding for these activities and salaries.

A supportive culture has been identified as a key contextual determinant of change to promote EIDM in health-related settings [ 55 ]. The results of this study mirror what other authors [ 49 , 52 , 53 , 55 ] suggest are key characteristics of such cultures, for example: valuing people, learning, and the use of research evidence; encouraging innovation, out-of-the-box thinking and risk-taking; and making time for critical reflection a priority.

As demonstrated in this study, there is value in beginning with a long-term Strategic Plan that explicitly anticipates and allows sufficient time for EIDM to become part of the everyday and expected routines of the organization and its workforce.

There is increasing recognition of the critical importance of knowledge management for effective EIDM [ 1 , 59 ]. As learned in this study, EIDM approaches require, use and produce significant volumes of information. However, the structures, technology and expertise within organizations either do not exist or are not are not well matched to manage this knowledge. Capacity building efforts at PPH included plans to create an in-house knowledge management system.

While there is certainly value in an organization taking steps to manage its internal knowledge, there would be greater value in a comprehensive knowledge management system that serves the public health sector as a whole.

The application of knowledge may be different across settings, but the issues facing health units and the sources of research on these problems would likely be the same or very similar. Making available the work already done by one organization to synthesize, appraise and use evidence for decision making to others would contribute to maximizing efficiencies, reducing duplication, and increasing transparency and consistency. To this end, some internet-based platforms have been developed to help improve access to, and retrieval and use of scientific evidence and other forms of knowledge for decision making in public health [e.

In addition, public health leaders in Canada have begun thinking and talking about developing a national strategy for knowledge management [ 61 , 62 ]; operationalizing this vision, though challenging, would provide much needed system level capacity for EIDM. A number of authors address the importance of and mechanisms for communication in organizational change and capacity building for EIDM. They emphasize the need for senior leaders to communicate early and continuously about the rationale, plans, activities, progress and practical implications of change [ 54 , 57 ].

They also discuss designating and using multiple channels to increase awareness, promote dialogue, and generate widespread buy-in and adoption [ 1 , 54 , 56 ]. Furthermore, research has demonstrated the value of developing a comprehensive communication strategy that includes dedicated resources [ 50 ].

While the nature of communication regarding the EIDM initiative reflected some of the qualities described in the literature, this is an area where more concerted and systematic efforts are needed at PPH.

Informants in this study recognized the lack of and need for an organization-wide, comprehensive, EIDM-specific communication plan and senior leaders indicated that developing and resourcing this strategy would be a key priority of future efforts. Crow [ 51 ] states "we are beginning to realize that the change itself is not usually the problem.

The problem is our reaction to change" p. Like Crow, many authors [ 52 , 53 , 57 , 63 ] identify the need for management strategies that help leaders acknowledge and address staff emotions related to change, new expectations and altered responsibilities. Efforts to build capacity for EIDM must focus on the tasks and resources required to conduct evidence reviews, but to be successful, they must also identify and respond to the needs of the people who perform this work [ 57 ].

The findings of this study reinforce the utility of change management frameworks and highlight the importance of recognizing and addressing the range of negative and positive emotional reactions to EIDM and to organizational change.

It is clear there are many catalysts and components of organizational change to promote EIDM. Implementing a comprehensive EIDM strategy is similar to the implementation of large scale enterprise technologies such as customer relationship management CRM or performance measurement systems. It requires contextual preparation, incremental efforts, adaptive capacity, on-going resource investments, attention to human needs, and an awareness of the interdependence of intervention elements and stakeholder groups.

This case study demonstrates the complexity and expansiveness of the activities, factors and dynamics involved in making EIDM a standard feature of public health practice. It also reinforces the notion that EIDM cannot be pursued or achieved by an organization in isolation.

Partnerships with other health settings, access to external knowledge sources, and inputs from provincial and national public health agencies are necessary to realize EIDM's potential to have consequential and sustainable impacts on public health services and health outcomes.

There are several limitations of this research. First, as a single-site case study no assumptions can be made regarding the generalizability of the findings. Public health and other health care organizations interested in applying the knowledge will need to consider contextual similarities and differences to assess the theoretical transferability of the findings to their unique settings [ 41 ].

Second, the scope of the study focused only on the first two years of a year strategic initiative. The timeframe of the study also precluded any evaluation of actual performance or outcomes related to EIDM. Finally, the decision was made to only include staff responsible for literature reviews and individuals most involved in the initial roll out of the EIDM initiative.

Therefore, this study does not consider the perspectives of the front-line professionals who will eventually be involved in and impacted by the organization-level change.

Further research is needed to expand our understanding of, and provide practical guidance for organizational capacity building for EIDM. It will be important to continue studying the characteristics and effectiveness of strategies used to increase and improve uptake of research evidence in health care decision making. Studies that include after action reviews [ 64 ] and summative evaluations [ 31 ] are needed to demonstrate if and how EIDM approaches and organizational changes are actually impacting public health policy and practice.

Longitudinal research will be important to assess the sustainability of organizational changes and strategies to promote EIDM. It would be useful if research could identify the appropriate combination, sequence, duration, intensity and audiences for the range of EIDM-related activities.

To contribute to a more general theory of organizational capacity building for EIDM, multi-site case studies are needed that compare and contrast the dynamics, resources, mechanisms and impacts of EIDM initiatives in different organizational contexts. Finally, public health is not the only sector pursuing efforts to build organizational capacity for EIDM [e.

As demonstrated in this study, the process of building capacity to become an evidence informed decision making organization involves a number of key features and dynamics. It needs a vision and strong leadership to move it forward.

It involves many different staff and it positions staff in new working relationships.

In organizations healthcare evidence canadian change informed management kaiser permanente hospital anaheim ca

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Evidence informed change management in canadian healthcare organizations	These form the foundation upon which organizational design arrangements and structures are built. Figure 1 offers visual depiction of the types, intensity and complexity of new activities undertaken between and In Step 1 of the framework, the NHS emphasizes the importance of understanding where one wants to go with change and why this changed state is desirable i. Key sources on systems change and learning click here [e. Areas for potential change implementation abound in the current system. These innovations have primarily been focused on the implementation of multidisciplinary teams to 26 Change Management in Healthcare Literature Review provide more comprehensive primary healthcare to communities [40].
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