Evidence-based practice is held as the gold standard in patient care, yet research suggests it takes hospitals and clinics about 17 years to adopt a practice or treatment after proof shows it helps patients.
Why such a long delay? Part of it is the challenge of adapting practices to fit the environment. Leaders have to balance two conflicting needs: to adhere to standards and to customize for the local context.
Based on our research on organizational change and our conversations with hundreds of health care providers, we’ve outlined four approaches to help health care leaders adapt evidence-based practices while staying close to their foundational base:
UNDERSTAND THE DATA: Sometimes you need to adapt a practice because the data behind it doesn’t match your own context. What if the evidence base is constructed from different patient populations, hospitals with different structures or cultures, or countries with different regulatory environments and payment structures? Leaders should also consider whether existing data is sufficient to support implementing a new practice, or if additional data should be collected first.
LOOK AT YOUR RESOURCES: Are the specific resources used in the original implementation not feasible or desirable in one’s local context? For example, for many smaller hospitals, costs prohibit administering brand-name drugs. Resource-related adaptations shift the reactions to evidence-based practices from “We don’t have the resources to do that” to “How can we apply these practices with the resources we have?” Adaptations require understanding the purpose or goal of the new practice to determine appropriate substitutes.
DEFINE YOUR GOALS: Defining your goals in terms of a patient-centered outcome will help you generate appropriate modifications. For example, many hospitals have the goal of reducing inpatient length of stay. But that may leaders to focus just on the inpatient length of stay itself and rush patients out of the hospital before they are ready. If instead the goal is to optimize recovery from illness or surgery, the focus shifts to the patient experience, and reduction in inpatient length of stay is simply the residue of a provider and patient-friendly program.
IDENTIFY YOUR PREFERENCES: Personal preferences of powerful individuals or coalitions of care providers too often becomes the motivating force behind whether or not to adopt evidence-based practices. Preferences driven by subjective, idiosyncratic reasoning inhibit adopting new approaches that can attain better health outcomes, reduce expenses and decrease errors. So health care leaders need to determine why providers have certain preferences.
When weighing if and how to adapt evidence-based practices, you need to consider both the technical and human elements involved. If responses from the providers include resistance about available resources, consider substitutes that would address these concerns, yet still attain the results the evidence supports. If staff reacts to the new best practice by asking “why are we doing this,” reaffirming the higher-order goals may help explain why adopting the practice is crucial.
Listen, understand the context and your people, and then revise the new practice when necessary. Leaders who can move fluidly across these approaches create a disciplined and adaptive way to implement evidence-based practice — one that fosters joint problem-solving, facilitates agreement and relieves the tensions associated with customizing research recommendations.
Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.