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Cited by 1,985Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

Enabling the implementation of evidence based practice: a conceptual framework.

Open access
Kitson, A, Harvey, G, McCormack, B·1998·Quality in Health Care
DOI 10.1136/qshc.7.3.149PMC PMC2483604
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Abstract

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.

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Crossref · 10.1136/qshc.7.3.149

Cites

21 of 21 references verified0 citation errors · 0 not checkable

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  • Successful implementation is reported as equally dependent on the quality of evidence, the context in which the evidence is introduced, the skill of the facilitators involved in implementation, and the method by which it is implemented.

    “Successful implementation is reported as equally dependent on the quality of evidence, the context in which the evidence is introduced, the skill of the facilitators involved in implementation, and the method by which it is implemented (37).”

    From Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis (2023) · cites this paper as [37]

    The Conclusion (page not available) gives equal importance to evidence, context, and the method of facilitating change. The Facilitation defined section identifies facilitators’ skills as relevant, but treats them as part of facilitation, not as a fourth factor with separate equal standing. (LLM, conf=0.84)

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  • We followed the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework to implement ACT because this methodology focuses on generating solutions to practical problems and has the ability to empower practitioners by engaging them in the research process and implementation activities.

    “We followed the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework 13 to implement ACT as this methodology focuses on generating solutions to practical problems and has the ability to empower practitioners by engaging them in the research process and implementation activities. 14-16”

    From Introducing acceptance and commitment therapy to a physiotherapy-led pain rehabilitation programme: An action research study (2016) · cites this paper as [13]

  • Poor theoretical underpinning makes it difficult to understand and explain how and why implementation succeeds or fails, thus restraining opportunities to identify factors that predict the likelihood of implementation success and develop better strategies to achieve more successful implementation.

    “Poor theoretical underpinning makes it difficult to understand and explain how and why implementation succeeds or fails, thus restraining opportunities to identify factors that predict the likelihood of implementation success and develop better strategies to achieve more successful implementation.”

    From Making sense of implementation theories, models and frameworks (2015) · cites this paper as [5]

  • PARIHS can be used by anyone attempting to get evidence into practice or researching or trying to better understand implementation processes and influences, suggesting that it has ambitions beyond its primary function as a determinant framework.

    “Somewhat similarly, PARIHS [5] can be used by “anyone either attempting to get evidence into practice, or anyone who is researching or trying to better understand implementation processes and influences” ([64]:120), suggesting that it has ambitions that go beyond its primary function as a determinant framework.”

    From Making sense of implementation theories, models and frameworks (2015) · cites this paper as [5]

  • The discipline-specific approach in targeted innovations, settings, and end-users has resulted in multiple and potentially disparate frameworks being developed and used.

    “This discipline-specific approach in the targeted innovations, settings, and end-users, has resulted in multiple and potentially disparate frameworks being developed and used [4,6-12].”

    From A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework (2015) · cites this paper as [4]

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Cites

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Research works printed but not linked: 15

  1. [1]1. Kitson, Harvey, McCormack on August 8, 2023 by guest. Protected by copyright. http://qualitysafety.bmj.com/ Qual Health Care: first published as 10.1136/qshc.7.3.149 on 1 September 1998. Downloaded from
  2. [3]3. The co-ordinated implementation model. Milbank Q 1993; 71:445.
  3. [7]7. Oxman A. No magic bullets -a systematic review of 102 trials of interventions to help health care professional deliver services more eVectively or eYciently. London, UK. North East Thames Regional Health Authority. 1994.
  4. [11]11. Kitson AL, Harvey G, Hyndman S, et al. The impact of a nursing quality assurance approach, the dynamic standard setting system (DySSSy ), on nursing practice and patient out- comes. The ODySSSy project. Oxford: National Institute for Nursing, 1994. (Report No 4, Vols I, II, III.)
  5. [12]12. Harvey G. Which way to quality? A study of the implementation of four quality assurance tools. Oxford: National Institute for Nursing, 1993. (Report No 5.)
  6. [14]14. McCormack B. A report of the work of the Community Hospi- tal Nursing Development Unit 1993-4. Oxford. Oxfordshire Community NHS Trust. 1995. (Unpublished report.)
  7. [15]15. McCormack B. Community hospitals project final report. Oxford: Oxfordshire Community NHS Trust, 1995.
  8. [19]19. Kitson A.L. Evidence based nursing-fact or fiction? Paper given at Evidence Based Nursing Conference, 1 st February 1997, London: Royal College of Nursing, 1997.
  9. [21]21. Senge PM. The leader's new work: building learning organisations. Sloan Management Review 1990;(fall):7-23.
  10. [24]24. Sveiby KE, Lloyd T. Managing know-how. London: Bloomsbury, 1987 24
  11. [27]27. Deming WE. Out of crisis. Cambridge: Cambridge Univer- sity Press, 1991.
  12. [35]35. Rogers B. DiVusions of innovations. 3rd ed. New York: Free Press; 1993.
  13. [37]37. Stokes H, Thompson D, Seers K. The Implementation of multidisciplinary guidelines for cardiac rehabilitation. Oxford: RCN Institute, 1996.
  14. [39]39. McCormack B, Wright J. An evaluation of the quality of patient care and the development of case management in a reha- bilitation setting for older people. Oxford: RCN Institute, 1998.
  15. [40]40. Loftus-Hills A, DuV L. The use of national standards to improve nutritional care for older adults: a case study. Oxford: RCN Institute, 1998.

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Authors
Kitson, A., Harvey, G., & McCormack, B.
Affiliations
Royal College of Nursing (GB)
ORCID
Venue
Quality in Health Care
Publisher
BMJ
Published
1998-09
Volume
7
Issue
3
Pages
149-158
ISSN
  • 1475-3898 (ISSN-L)
  • 0963-8172
  • 1475-3901
DOI
10.1136/qshc.7.3.149
PMC
PMC2483604
OpenAlex
W2046339686
Cited by
1,985
References
21
Citations by year
2026: 61 · 2025: 71 · 2024: 108 · 2023: 87 · 2022: 116 · 2021: 133 · 2020: 113 · 2019: 88 · 2018: 89 · 2017: 87 · 2016: 80 · 2015: 114 · 2014: 88 · 2013: 112 · 2012: 84
FWCI
26.48
Type
journal article
Language
en
Open access
Locations
  • BMJ Quality & Safety (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
evidence-based practice, research utilization, level of evidence, implementation context, implementation facilitation, conceptual framework, clinical effectiveness, implementation checklist
MeSH terms
United Kingdom, Health Services Research, Humans, Research Design, State Medicine, Models, Organizational, Practice Guidelines as Topic, Evidence-Based Medicine

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