National Collaborating Centre for Methods and Tools

You have just read a groundbreaking systematic review or practice guideline and the results have the potential to change messaging in an upcoming communication campaign, or perhaps the way a program is currently being run in your organization. What is the best way to help move this research evidence into practice within your organization? What steps should you take?

This thread will highlight several resources NCCMT has available within the registry of KT methods and tools to help guide the process of adopting new evidence across your organization.

If you have previously used any of these resources, or have others that you would like to suggest – feel free to join in the discussion!

Kirsten

When an organization is considering adopting an innovation or a change in practice, it can be both an exciting and challenging time. Organizational change can signal progress. It can mean taking a new direction that will assist the organization in being responsive to new trends, or shifting or letting go of processes and programs that may no longer be working.

Since I’ve been working on the Registry as a Research Assistant, we have come across a number of methods and tools that provide a structured approach to an organizational change process. In this thread we will highlight several of these resources. These resources recognize that organizational change isn’t easy or straightforward. These resources can be used to help guide planning for how to implement change across your organization.

One tool that first comes to mind is the workbook, Will It Work Here? A Decisionmaker's Guide to Adopting Innovations. This tool can be used to assess the suitability of an innovation and an organization’s level of readiness before adopting the innovation. It uses a modular format that allows users to go directly to the sections relevant to them.

This tool is based on the core concepts of Rogers' Diffusion of Innovations theory and consists of the following sections:

• Module I: Does the Innovation Fit?
• Module II: Should We Do It Here?
• Module III: Can We Do It Here?
• Module IV: How Will We Do It Here?

To see a summary statement on this KT tool, check out: Tools to guide decision making: Adopting innovations

Sunita

Hi Sunita,

Thanks for sharing!

So let’s assume that your organization would like to move forward to implement a new innovation or change in practice, perhaps after using the tool you recommended. Are there tools you would recommend to help guide the implementation process?

Kirsten

Hi Kirsten,

There are two resources in the Registry that come to mind to support implementation of a change project.

One helpful tool is the Registered Nurses’ Association of Ontario Toolkit: Implementation of clinical practice guidelines. The RNAO Toolkit was developed for practice guidelines, but the steps and resources highlighted in this tool could be used for any change initiative. This toolkit outlines steps in section 4, Deciding on Your Implementation, that helps you consider what implementation strategies are most appropriate for your organization to implement the proposed change. To see a summary statement on this toolkit, check out: Implementing best practice guidelines: The RNAO Toolkit.

Another resource that could be used along with the RNAO toolkit is the NHS How to change practice: Understand, identify and overcome barriers to change. This guide helps organizations understand barriers to change at the individual practitioner level, including understanding the knowledge, beliefs, attitudes and behaviours of people and how these factors might impact on a change initiative. Using this guide would fall under step 2 (engaging your stakeholders) and step 3 (assess your readiness) in the RNAO toolkit to help you identify barriers to your change project. There is also information on approaches you could use to overcome these barriers, such as training workshops, opinion leaders, etc. To see a summary statement on this guide, see: A guide for identifying and overcoming individual-level barriers to change.

I hope these are helpful! What do you think? Has anyone used of any these resources?

Sunita

Hi Sunita,
Interesting posts! I was trying to access the NHS tool How to change practice and despite my best attempts I can't access the full tool. There does not seem to be a link on the page. Can you check it out and see where I'm going wrong?
Bev

Hi Bev,

Here's a link to the NHS tool Sunita mentioned above: http://www.nice.org.uk/media/D33/8D/Howtochangepractice1.pdf

After taking a look, feel free to let us know what you think! Was this resource helpful?

Are there any others on this topic that you have used at Peel Public Health?

Kirsten

Hi Kirsten and Bev,

The last two resources we talked about were good tools to support the implementation of a change initiative. I also wanted to highlight one resource you could use to provide an organizing framework for how to implement an innovation. The Ottawa Model of Research Use (OMRU) by Ian Graham and Jo Logan provides a useful approach for developing a change strategy. There are six steps in this model. The OMRU is particularly helpful since it delineates that you need to consider:

• The environment in which you will implement your change initiative (your organization, external environment, human resources)
• The innovation itself (the new policy or program)
• The strategies you will use to support people in changing their practice (in order to implement the innovation)
• How you will evaluate the new program and the strategies used to change practice (the knowledge translation strategies).

To see a summary statement on the Ottawa Model of Research Use, click here.

I will briefly mention another method developed by Robert Rosenheck with the Department of Veterans Affairs in the US. From his work in the VA, he looked at implementing new programs in large organizations. This resource is helpful since it examines how innovations are sustained long-term and become part of routine practice, in addition to looking at how to phase out a program that is not working well. The abstract for this article is available here.

To see a summary statement on Rosenheck’s article, click here.

Sunita

Hi Sunita,

Earlier in this thread you mentioned that adopting an innovation across an organization can be a challenging process to work through. It means asking staff to change the way they work and this can be a difficult process for everyone involved.

Can you recommend a resource that speaks to some of the emotional challenges individual staff may experience when undergoing a change process? Are there existing strategies/frameworks to work through some of these change processes?

Kirsten

Hi Kirsten,

One resource that comes to mind that looks at organizational change management from within the education sector is JISC InfoNet’s InfoKit: Change Management. This resource provides helpful strategies to support people with their emotional responses during a change. This toolkit recognizes that people exhibiting resistance is a normal response to change as people let go of previous roles and identities before being able to adopt new roles and responsibilities. It outlines a number of stages that staff may go through during a major change including:

• Shock and denial
• Distrust
• Anger and guilt
• Depression, anxiety and stress
• Regret

Many of these emotions arise because people are feeling uncertain about how the change will impact themselves and their work. On pg. 31-34, different fears and emotional responses to change are described. The resource suggests responses and strategies to address each fear. To see a summary statement on this resource with a description of content areas covered, click here.

Sunita