Background: Nurses and midwives are central to the implementation and delivery of\nquality care through evidence-based practice (EBP). However, implementation of EBP in nursing and\nmidwifery is under-researched with few examples of systematic and sustained change. The Registered\nNurses Association of Ontarioâ??s Best-Practice Spotlight Organization (BPSO) Program was adopted\nin South Australia as a framework to systematically implement EBP in two diverse and complex\nhealthcare settings. Methods: The study was a post-implementation, mixed-method evaluation\nconducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative\ndata. Proctorâ??s implementation evaluation framework guided the evaluation design. Information\nsources included; interviews, focus groups, questionnaires, and document review. Results: Clinical\nand executive staff (n = 109 participants) from a broad range of stakeholder groups participated in\nthe interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting\nprogram implementation were identified; these pertained to embedding continuity into the programâ??s\nimplementation and delivery, a robust governance structure, and executive sponsorship. Barriers\nto implementation were also identified. These barriers pertained to organizational or workforce\nchallenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend\ntraining, and a lack of organizational commitment to the program, especially at an executive level.\nAs a result of successful implementation, it was observed that over three years, the BPSO program\npositively influenced the uptake and implementation of EBP by clinicians and the organizations into\nwhich they were introduced. Conclusions: The BPSO model can be translocated to new healthcare\nsystems and has the potential to act as a mechanism for establishing and sustaining EBP change.\nThis study was the first to apply an implementation evaluation framework to the BPSO program,\nwhich allowed for structured analysis of facilitating or impeding factors that affected implementation\nsuccess. The findings have important implications for other health systems looking to translocate\nthe same or similar EBP programs, as well as contributing to the growing body of implementation\nevaluation literature.
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