Aligning Culture, Infrastructure to Support EBP

Jun 02, 2020

Added to Collection

Article in Critical Care Nurse outlines how Rady Children’s Hospital developed an integrated system to make evidence-based practice the hospital-wide standard of care

ALISO VIEJO, Calif. – June 2, 2020 – Identifying and resolving barriers to the successful implementation of evidence-based practice (EBP) helped a hospital make EBP an integrated part of its organizational culture, according to an article in the June issue of Critical Care Nurse (CCN).

EBP can result in improved quality of care, lower costs and better patient outcomes. Yet, lack of leadership support, inadequate knowledge and skills, limited funding, time constraints, competing organizational priorities and other barriers often lead to a project-by-project approach and impede comprehensive implementation.

Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice” describes how Rady Children’s Hospital in San Diego developed strategies to increase adoption of EBP and overcome barriers to its implementation. The multifaceted process led to an integrated system that provides a repeatable road map for other institutions aiming to develop practices and documents based on the best evidence to support patient outcomes.

A key element to Rady’s approach is participating in a regional collaborative training program with EBP experts from a variety of hospitals and academic institutions. During the annual nine-month program, participants learn how to design and successfully implement an EBP project at their organization and present their findings. The hospital sends several teams of two nurses (a fellow and a mentor) to the training program each year, which adds to the in-house EBP knowledge and skills. To date, 60 fellows have completed the program, resulting in the implementation of 51 EBP projects.

Leadership also became vested in the culture change, making EBP implementation a high priority. Facilitating EBP is specified in the strategic plan, and resources are provided to implement and sustain it.

Co-author Suzan Miller-Hoover, DNP, RN, CCNS, is a nurse scientist and owner of SRMH Consulting in Pine, Arizona. She is among the EBP experts who worked with Rady leadership and nursing staff on the project.

“It’s not enough for leaders to support EBP and staff to possess the knowledge and skills to implement it. Resources that guide nursing practice have to be aligned with best practice,” she said. “We have shown that a systematic approach to identifying and resolving barriers, educating staff and evaluating our efforts can lead to the successful adoption of evidence-based best practices and standardize care.”

The EBP team also identified issues related to infrastructure, including fragmented resources, inconsistent guidance and lack of organization. A special task force spent a year to review, revise and restructure resource documents. The system is now easier to navigate, consistently structured, evidence based and with a solid process for review and revision. An algorithm depicts the decision-making process to ensure that future staff members understand the process and rationale behind it.

The revised process includes a new document management system and centralized intranet site for policies and procedures, competency validation tools and other EBP resources.

The document review revealed that clinical units had their own standards of care and that policies and procedures often varied slightly from unit to unit. The team then developed a standard of nursing care for all patients as well as clinical practice documents for other elements of nursing care.

Standing orders and standardized procedures were also consolidated and reviewed to align with best practices. Duplications and inconsistencies were identified and deleted, and the process influenced staff orientation and reduced variations in care for staff members floating between departments.

The process would have been incomplete without an ongoing effort to assess and document competency. Core competencies serve as the foundation for hospital-wide orientation and are identical for all units. They, along with unit-specific competencies, must be completed by the end of orientation. Specialty-based skills and those potentially needed by float nurses assigned to specific units are validated only for staff members who have already demonstrated competencies in all other areas.

Education related to competency validation is now included in the curriculum for the transition to practice program for new graduates, onboarding of new staff members, clinical nurse specialist and educator orientation, and preceptor and charge nurse workshops.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world's largest specialty nursing organization, with more than 120,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Viejo, CA 92656; 949-362-2000;;;