Hamilton Health Sciences (HHS) is a local hospital network that is world-renowned for healthcare research, with a strong focus on evidence-based practice and continuous quality improvement. However, many gaps remain between what is known from research evidence and what is done in practice. HHS established a program to optimize the use of clinical and knowledge translation (KT) research to address evidence-practice gaps and health-related challenges at HHS hospitals and improve patient care.
The Centre for Evidence-Based Implementation (CEBI) (www.hhscebi.ca) was initiated in 2016, with initial funding provided by HHS for a three-year pilot phase. The program comprises a scientific director, a program manager, and two project coordinators. An advisory committee including HHS administrative and clinical leaders and researchers provided advice regarding CEBI’s strategic direction and project prioritization. Core activities included actively participating in HHS-initiated implementation and quality improvement projects, providing KT consultation, and providing training in KT science and practice for HHS leaders, physicians and staff. Key aspects of implementation for which CEBI provided assistance included project planning, barrier and facilitator assessment, selection and design of appropriate implementation strategies, evaluation, and sustainability planning. Projects ranged in scope from single unit projects to HHS-wide initiatives. CEBI worked alongside other HHS groups including: quality and value improvement, patient experience and safety, health information technology services, the health sciences library, and communications.
During the three-year pilot phase, CEBI actively contributed to five core projects, including projects intended to reduce patient violence towards hospital staff, reduce harms associated with procedural sedation, decrease the incidence of hospital-acquired infections, improve rehabilitation of critically ill children, and improve patient safety related to cardiac investigations. Consultation services were provided to multiple project teams and forty-nine participants attended CEBI-led KT training sessions. Informal feedback from HHS stakeholders about CEBI’s involvement in HHS projects was positive. Key challenges included building a culture that values implementation based on best evidence from KT science, project delays due to resource limitations and competing priorities of clinical teams, limitations of data to measure clinical outcomes, and difficulty in measuring the direct impact of CEBI’s contribution to projects. Changes to CEBI’s mandate and funding model beyond the pilot phase is resulting in a transition from assistance with hospital-led quality improvement projects to implementation of impactful HHS-led research findings in the HHS community.
The CEBI program can serve as a model for similar programs in other hospital networks. Positive results of the program’s three-year pilot phase suggest that a hospital network-funded program to assist with evidence-based implementation and quality improvement projects, to provide consultation from a KT perspective, and to build KT capacity among hospital clinicians and staff, is feasible and effective for advancing practice that is based on the best available clinical and KT research evidence. As the CEBI program continues and evolves, it seeks to build linkages with similar programs across Canada to identify opportunities for collaboration and shared learning.