NUR 590 DQ: Overcoming Barriers to the Implementation of EBP Proposal
Barriers to change in health care organizations vary depending on the organization’s culture, resources, and leaders-staff relationship, among other factors. Potential obstacles in my institution include inadequate resources, resistance to change from staff, and lack of leadership support. The resource problem is typical in intensive, evidence-based practice (EBP) projects that require the organization to incorporate new technologies or train the staff for an extended time. As Cho et al. (2021) suggested, resistance to change occurs when the staff does not understand the proposed change’s benefits or is comfortable with the status quo. Leaders may hinder change when they are highly committed to other projects or when a project is likely to consume massive resources.
There is no universal way of overcoming barriers since they vary with situations, leaders, and the type of EBP projects. One way to overcome the identified barriers is to ensure that leaders understand the projected outcomes. The second strategy is to engage stakeholders closely to earn their support and implement change quickly (Petkovic et al., 2020). The other intervention is to seek external help to drive initial projects and mentor the staff and leaders. A solid communication plan is also essential to ensure that all levels of the institution are reached- this can help build the required momentum and earn institutional-wide support.
Using the PDCA Model and Rationale
Change models provide an orderly approach to implementing change. According to Ross (2019), the Plan, Do, Check, Act (PDCA) cycle is an effective change implementation model for changes that require continuous observation and evaluation before full-scale implementation. As a result, I would use the PDCA model in my institution for projects that require small-scale testing of improvements before acting on the test results. Fortunately, the model can be appropriate for most quality improvement (QI) and EBP projects since change proponents should identify flaws in such projects and improve where necessary to ensure that they are up to the desired standards. I would use the PDCA model for QI and EBP projects since it facilitates change in phases. It involves determining the goals and needed changes, implementing, results evaluation, and stabilizing change (Ross, 2019). The model also encourages intensive planning, which should be the foundation of successful change in health care organizations.
Change is part of organizational growth that leaders should prioritize and support. They should commit material, human, and financial resources to support progressive change. Despite such commitment, change leaders should also understand the potential barriers and impacts. Such barriers include resistance to change, lack of leadership support, and inadequate resources. The other important part of successful change is selecting an effective model. The PDCA EBP model is effective for QI and EBP projects since it encourages small-scale testing of improvements and taking action based on test results (standardizing and stabilizing change).
Cho, Y., Kim, M., & Choi, M. (2021). Factors associated with nurses’ user resistance to change of electronic health record systems. BMC Medical Informatics and Decision Making, 21(1), 218. https://doi.org/10.1186/s12911-021-01581-z
Petkovic, J., Riddle, A., Akl, E. A., Khabsa, J., Lytvyn, L., Atwere, P., … & Tugwell, P. (2020). Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Systematic Reviews, 9(1), 1-11. https://doi.org/10.1186/s13643-020-1272-5
Ross, T. K. (2019). Applying lean six sigma in health care. Jones & Bartlett Learning.
Topic 5 DQ 2
Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. What strategies can you implement to gain stakeholder support for the project implementation? Provide a suggestion you would give to a colleague who is struggling with obtaining stakeholder support.
- Propose an implementation plan for the evidence-based practice proposal.
- Propose strategies for overcoming barriers to the implementation of the evidence-based practice proposal.
Evidence-Based Practice Project Proposal: Implementation Plan
In 1,250-1,500 words, discuss the implementation plan for your evidence-based practice project proposal. When required, create the appropriate form, table, image, or graph to fully illustrate that aspect of the intervention plan and include them in an appendix of your paper. You will use the implementation plan, including the associated documents in your appendices, in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.
Include the following:
- Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Include a draft of the form as an appendix at the end of your paper.
- Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Based on the timeline you created, describe the amount of time needed to complete this project. Include a draft of the timeline as an appendix at the end of your paper.
- Develop a budget and resource list. Consider the clinical tools or process changes that would need to take place. Based on the budget and resource list you developed: (a) describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution; (b) outline the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Include a draft of the budget and resource list as an appendix at the end of your paper.
- Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Provide rationale to support your selection.
- Describe the methods and instruments (questionnaire, scale, or test) to be used for monitoring the implementation of the proposed solution. Include the method or instrument as an appendix at the end of your paper.
- Explain the process for delivering the intervention and indicate if any training will be needed.
- Discuss the stakeholders that are needed to implement the plan.
- Consider all of the aspects of your implementation plan and discuss potential barriers or challenges to the plan. Propose strategies for overcoming these.
- Establish the feasibility of the implementation plan.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
NUR 590 Topic 5 DQ 1
Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. What strategies can you implement to gain stakeholder support for the project implementation. Provide a suggestion you would give to a colleague who is struggling with obtaining stakeholder support.
Cohesive Collaboration is important to the survival of and success of an organization. Implementation plans can face numerous challenges as a result of lack of knowledge of the problems hurting an organization. This lack of knowledge is common in many organizations were leaders and management are disconnected from day to day operations that help to run the organization. When a person rises through the ranks of the organization into a leadership role they have knowledge of and experience that other managers lack if they hired from the outside. The person who rises through the ranks has more understanding of the how the organization works, the weakness that exist, the organizations strength and how the organization needs to function in order to survive. Where there is s disconnect between stakeholders in higher positions and those working the day to day operations, noting will get done.
Some of the things that one might experience during the implementation phase are resistance and timing. “Lack of time is often cited as a barrier to implementing EBP. In addition, uncertainty or lack of knowledge about the EBP process is also a barrier, which includes critiquing and appraising the literature related to the clinical problem being addressed” (Ginex, 2018). In busy hospitals lack of time to study and understand new changes and policies can be a barrier. On time of this, resistance to change can also be a barrier. In there is already a flow that nurses are accustomed to even if it is chaotic, having to change that flow requires learning something new or changing ones workflow habits and that can cause resistance to change.
The one suggestion I would give to a fellow colleague would be for them to ask questions, slow down the pace in order for them to understand the new policy and give themselves time to become accustom to it and to always remember that it will take them time to learn something new before they can master it.
Ginex, P. (2018). Overcome Barriers to Applying an Evidence-Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-chang
Stakeholders are the people involved in carrying out the process under review or individuals who become affected with the change in practice (“John Hopkins Nursing”, 2021). It is important to determine the potential stakeholder barriers that will be encountered in order to address them accordingly. The two stakeholder barriers that can be experienced are resistance to change and lack of authority. Physicians, who are one of the main stakeholders, are perceived to be the least supportive in EBP implementation (Jordan et al., 2021). Without their support, it can make the implementation process difficult. Resistance of practitioners to change from traditional practices to newer concepts introduced in EBP can be a barrier to the implementation process (Jordan et al., 2021). Moreover, some staff nurses feel that they lack authority to make changes in their unit or they do not have the “power” to implement the EBP project. One study suggested that majority of the nurses in a private ICU reported that they lacked the authority to change practice in order to facilitate the implementation of EBP (Jordan et al., 2021).
There are several strategies to gain stakeholder support. First, the support of physicians for the implementation of EBP should be encouraged (Jordan et al., 2021). It is important to keep an open communication between the researcher and physicians. Explaining the goals and benefits of the EBP project in improving patient care can help gain their support. Second, it is recommended to carefully identify individual barriers versus organizational barriers at an early stage (Jordan et al., 2021). Lastly, identifying your stakeholders as well as engaging them early in the EBP process is important because stakeholder buy-in is important for its successful implementation (“John Hopkins Nursing”, 2021). The goal is to gain their trust and confidence and gain as much support as possible for the successful project implementation.
Jordan, P., Bowers, C., Cur, M. & Morton, D. (2016). Barriers to implementing evidence-based practice in a
private intensive care unit in the eastern cape. SAJCC, 32(2). DOI:10.7196/SAJCC.2016.v32i2.253
“John Hopkins Nursing”. (2021). Upstate Medical University. https://guides.upstate.edu/c.php?g=1023176&p=7411256