Transcript Slide 1

What PARIHS is
about
Introducing the
PARIHS Group
Brendan McCormack
Jo Rycroft-Malone
Alison Kitson
Angie Titchen
Kate Seers
Gill Harvey
Despite growing acknowledgement within the
research community that the implementation of
research into practice is a complex and messy
task, conceptual models describing the process
still tend to be uni-dimensional, suggesting
some linearity and logic .
(Kitson, Harvey & McCormack, 1998)
Promoting Action on Research
Implementation in Health Services
SI =
SI
E
C
F
=
=
=
=
f(E,C,F)
successful implementation
evidence
context
facilitation
Successful implementation is a
function of the relation between:
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the nature of the evidence
the context or environment in which
the proposed change is to be
implemented and
the way or method by which the
change is facilitated
Framework Development
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Practical experience from:
– Research projects
– Quality Improvement initiatives
– Practice Development programme
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Theoretical - concept development
Empirical inquiry - content validity
Developing & testing interventions
Tool and ‘toolkit’ development
Checking out the framework
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Numerous conference presentations
Workshop/Group exercises
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1998 publication in Quality in Health Care
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Establishing a level of face validity
Concept analysis of evidence, context and facilitation
– published in Journal of Advanced Nursing
2002 publication in Quality in Health Care
Focus groups
Case study
2004 publication in Journal of Clinical Nursing
2008 publication in Implementation Science
‘Hypothesis’
The successful implementation of evidence into
practice is more likely to occur in situations
where the research evidence is strong (‘high’),
there is consensus about it and it matches
patients’ preferences, the context is conducive to
change/the new practice (‘high’), and
appropriate approaches and mechanisms of
facilitation are in place (‘high’).
High
Evidence
Low
Context
High
The Nature of Evidence
Information and knowledge upon which
decisions about care are based:
1.
2.
3.
4.
Research
Clinical Experience
Patient Experience
Local Information/Data
1. Research evidence
Low
•Poorly conceived & conducted
research
•Social construction not acknowledged
•Lack of certainty not acknowledged
•Importance not weighted
•Conclusions not drawn
2. Clinical experience
Low
•Not reflected on or tested
•Lack of consensus
•Not viewed as part of the decision
•Importance not weighted
•Conclusions not drawn
High
•Well conceived & robust research
•One part of the decision
•Social construction acknowledged
•Lack of certainty acknowledged
•Importance weighted
•Conclusions drawn
High
•Reflected on, tested by individuals
and groups
•Consensus between similar groups
•Seen as one part of the decision
•Importance weighted
•Conclusions drawn
3. Patient experience
Low
•Not valued as evidence
•Multiple biographies not used
•Lack of partnership working
•Importance not weighted
•Conclusions not drawn
High
•Valued as evidence
•Multiple biographies used
•Partnerships with hc professionals
•Importance weighted
•Conclusions drawn
4. Local information/data
Low
•Not valued as evidence
•Not systematically or rigorously
collected & analysed
•Not evaluated & reflected upon
•Importance not weighted
•Conclusions not drawn
High
•Valued as evidence
•Collected & analysed
systematically & rigorously
•Evaluated & reflected upon
•Importance weighted
•Conclusions drawn
Evidence-informed practice is….
Context
Evidence from
research
Evidence from
patients’ experience
Outcome
person-centred,
evidenceinformed
care
Shared decision-making
Evidence from
clinical experience
Evidence from
other sources
of robust
information
Context
Rycroft-Malone et al 2004
Context of Implementation
The environment or setting in which the
proposed changes is to be implemented:
Culture
 Leadership
 Evaluation
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Receptive context
High
Low
Cultural
Physical
Social
Cultural
System
Professional/social networks
Boundaries
clearly defined &
acknowledged
Appropriate & transparent decision-making processes
Resources – human, financial, equipment – allocated
Integrates & fits with organisation’s strategic goals
Receptive context
Culture
Low
•Not valued as evidence
•Not systematically or rigorously
collected & analysed
•Not evaluated & reflected upon
•Importance not weighted
•Conclusions not drawn
Leadership
Low
•Command & control
•Lack of role clarity
•Ineffective team work
•Ineffective organisational structures
•Hierarchical, autocratic decisionmaking processes
High
•Valued as evidence
•Collected & analysed
systematically & rigorously
•Evaluated & reflected upon
•Importance weighted
•Conclusions drawn
High
•Transformational leadership
•Role clarity
•Effective team work
•Effective organisational structures
•Democratic, inclusive decisionmaking processes
Evaluation
Low
•Evaluation methods and sources of
information limited
•No/limited feedback on performance
High
•Feedback on individual, team,
system performance
•Use of multiple sources of infomation for evaluation
•Use of multiple methods: clinical,
performance, economic, experience
Facilitation
The process of enabling or making things
easier
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Appropriate
Purpose
Role
Skills
Low
No mechanisms or
inappropriate
approach and/or methods of
facilitation in place
High
Appropriate mechanisms
of facilitation in place
Purpose, Role, Skills
Purpose
Task
Holistic
Role
Doing for others
•Episodic contact
•Practical/technical help
•Didactic, traditional approach
to teaching
•External agents
•Low intensity - extensive coverage
Skills & Attributes
Doing for others
•Project management skills
•Technical skills
•Marketing skills
•Subject/technical/clinical
credibility
Enabling others
•Sustained partnership
•Developmental
•Adult learning approach to
teaching
•Internal/external agents
•High intensity - limited coverage
Enabling others
•Co-counselling
•Critical reflection
•Giving meaning
•Flexibility of role
•Realness/authenticity
Working hypotheses
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Most successful implementation will occur
when evidence is ‘high’, practitioners agree
about it, the context is developed, and
where there is appropriate facilitation
Least successful implementation occurs
when context and facilitation are inadequate
Poor contexts can be overcome by
appropriate facilitation
Chances of successful implementation are
still weak, even in an adequate context, but
where there’s inappropriate facilitation
How is/has it been used?
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As
As
As
As
a conceptual framework
an evaluative framework
a map
a set of hypotheses
See the world map for examples!
Questions/challenges
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Is it greater than the sum of its parts?
How do the elements interact?
What factors are more important –
weighting?
Dynamics of high to low – do they
work? Is it comprehensive (enough)?
How does the individual fit into the
framework?
Next steps
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PARIHS collaboration
Tool development
– Measuring/evaluating evidence, context,
facilitation
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Intervention research
– e.g. FIRE – EU grant
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Capability building through education
& training opportunities
Publications
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Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A (2008) Evaluating the successful
implementation of evidence into practice using the PARIHS framework: Theoretical and practical challenges,
Implementation Science, 3(1), 7th January 2008
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Rycroft-Malone J, Harvey G, Seers K, Kitson A. McCormack B, & Titchen A. (2004) An exploration of the
factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13, 913-924
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Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B (2004) What counts as evidence in
evidence-based practice? Journal of Advanced Nursing, 47(1): 81-90.
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Rycroft-Malone J. (2004) The PARIHS framework – A framework for guiding the implementation of
evidence-based practice. Journal of Nursing Care Quality, 19(4), 297-304.
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Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, Seers K (2002) Getting
evidence into practice: the role and function of facilitation. Journal of Advanced Nursing, 37(6): 577-588.
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McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K (2002) Getting evidence into
practice: the meaning of context. Journal of Advanced Nursing, 38(1): 94-104.
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Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C (2002) Ingredients
for change: revisiting a conceptual framework. Quality in Healthcare, 11(2): 174-180.
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Rycroft-Malone J, Harvey G, Kitson A, McCormack B, Seers K, Titchen A (2002) Getting evidence into
practice: ingredients for change. Nursing Standard, 16(37): 38-43.
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Kitson A, Harvey G, McCormack B (1998) Enabling the implementation of evidence based practice: a
conceptual framework. Quality in Health Care, 7,3: 149-158.