Lesson 9
Decision Making and Implementation of Plans©
Marilyn Stapleton, PhD, RN
LEARNING OBJECTIVES
The learner will describe the decision making process for using evidence-based practice.
The learner will outline the implementation strategy for changing practice based on EBP.
OVERVIEW
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Now that you have evaluated the evidence, you need to come to a determination on a practice change. Be sure to consider your institution’s performance in relation to internal (QI reports) or external benchmarks. EBP takes into consideration the patient population, the organizational characteristics, values, facilitators and barriers to the adoption of change, preferences, personalities of the players, the patient preferences and vision of the organization. This decision is not made independently by one practitioner. You will need to consult a mentor, such as a CNS, the Director of Nursing Research, an academic partner, a Professional Practice Specialist, Nurse Manager or Quality Specialist in your organization.
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Once you have made a decision to go for a practice change, you should consider the following steps:
- Obtain administrative support and garner resources (time, materials, etc.)
- Form a team. The team may consist of members from the various disciplines.
- Recruit an opinion leader to engage in the project. Opinion leaders are people who have the ability to influence others; this could be a key staff member on your unit that staff will follow. It does not need to be someone from the management team, but can be.
- Create a clear vision (or goal) and state it in writing. Establish a benchmark.
- Create a plan for the practice change (who, what, when and where). It may have many components. Write these out for everyone to see.
- Identify the process and outcome measures (covered in Lesson 8 and 10)
- Consider the barriers and facilitators that will impact on your change process (covered in Lesson 9).
- Create a timeline; break it down by month or quarter.
- Consider the organization or your unit’s culture for adopting change (See Lesson 11)
- Include a plan for education of staff.
- Plan for managing the workload issue.
- Include a mechanism to feedback progress to staff. Many facilities use the Plan-Do-Study-Act (PDSA) cycle to manage the change process. The PDSA is a tool for the implementation of process improvements.
- Include opportunities to check on progress, small increments of change should be noted.
- Plan to overcome resistance to change (resistance is expected but can be overcome)
- Reward positive behaviors; incentivize the change process.
- Celebrate successes!
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