The evidence-based practice (EBP) process starts with a clinical question and then proceeds to searching and critically appraising the evidence. Once you have determined that a practice change is necessary, the next step is to integrate that evidence with clinical expertise and patient preferences and values. The last step in EBP is to evaluate the outcomes and disseminate the results. On paper, this flows in an orderly fashion. As clinicians, however, we know that it’s not often that easy or straightforward to change clinical practice. We often face barriers that can make it hard to change, but strategies exist to help facilitate practice change.
Barriers to EBP Change
Time and knowledge: When asked what they need more of, busy clinicians will often say time is their priority. 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.
Resistance: We’ve all probably heard the phrase “because we’ve always done it this way” when asking why we do what we do every day. Changing this culture can be a challenge, but as EBP becomes the norm in health care, it should be easier to overcome. One person alone is insufficient to change a practice, which is why having a culture that supports a spirit of inquiry and an evidence-based approach to care is so important.
Strategies to Overcome
Stakeholders: One of the first and most important things you can do is to engage the appropriate stakeholders. Doing this builds trust and enables you to learn from their experience and provide input on the project. Stakeholders can also play a role in identifying outcome measures. Having buy-in from the start will help you to plan a better project and implementation strategy.
Administration support: Similarly, having support from your administration from the beginning is a key factor in success. Administration may be able to inform you about other projects that used similar implementation techniques and how they worked. Also, administration plays a key role in developing an organizational culture that supports EBP.
Changing the way we practice is really changing a behavior, but behavior change isn’t easy. It takes persistence, perseverance, and a willingness to be open to new options along the way. You will hit barriers, but you will also learn strategies that will help you to overcome them. Working together, we can ensure an EBP environment that will lead to better outcomes for our patients and ourselves.