BUSI 619 Week 6 Discussion Board Forum 7 Example

Discussion Board Forum 7: Implementing and Sustaining Evidence-Based Change

BUSI 619 Quality Assessment and Evidence Based Decision Making, Discussion Board Forum 7

Thread by [Student Name]

The health system, its program and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

My literature review concluded that patient navigation shortens the time from an abnormal screening result to a diagnosis, especially for patients with several chronic conditions, older adults and those facing practical barriers. Our system's leaders have accepted that conclusion and approved four navigator positions. The temptation now is to hire the navigators, hand them a list of patients and wait for results. This week's chapters warn against exactly that. Melnyk and Fineout-Overholt (2015) explain that evidence does not change practice by itself: organizations need a deliberate implementation plan, leaders who support it, staff with the skills to use evidence and a way to sustain the change after the initial attention fades. A navigation program that launches without a plan is likely to repeat the problem the Oregon trial revealed, where navigation reached only part of the patients who should have received it.

The first decision is which implementation model to use. Chays-Amania et al. (2025) reviewed the implementation models used for evidence-based practice in nursing settings, including the Iowa Model, the Stetler Model, the Johns Hopkins model, the Stevens Star Model, the PARIHS framework and the ARCC model, and argued that a structured project should first choose a model, then select one or more implementation strategies and finally plan how implementation outcomes will be evaluated. That sequence is useful because it makes a team settle, before launch, what evidence will show the program running as designed, not only whether outcomes improve.

For our system, I would choose the ARCC model, named for its aim of joining research and clinical practice through close collaboration, because its central strategy, developing evidence-based practice mentors, fits a program that depends on frontline staff changing their routines. Evidence suggests this approach can build durable capability. Gorsuch et al. (2020) evaluated a five-day ARCC-based skill-building immersion for nursing teams in the Air Force Medical Service that included executive leaders, mid-level leaders and direct care nurses, and found that participants' evidence-based practice knowledge, skills, competencies and beliefs improved significantly and remained improved 12 months later as teams carried out projects.

Our plan would start in two clinics with the longest delays, using a nurse mentor to coach navigators and clinic staff on the evidence and the workflow. We would measure implementation, the share of eligible patients offered navigation and the number of contact attempts, alongside the outcome of time to resolution, and expand to the other clinics after six months if both measures look sound. Leadership support is the third strategy, and probably the one most often missing from small programs. The chief medical officer would review the two measures monthly with the clinic managers, which signals that navigation is a system priority rather than a side project, and the navigators would have a direct path to the imaging and endoscopy schedulers, since the trials showed that much of the delay sits in the scheduling of diagnostic tests. Finally, the program would budget for a one-year evaluation, because the evidence shows navigation's benefit appears after the first three months and an early verdict could end a working program.

James warned believers not to be hearers of the word only, deceiving themselves, but doers of it (English Standard Version Bible, 2001/2016, James 1:22). An organization that reads the evidence and changes nothing is a hearer only, and its patients wait the same months they waited before.

Reply to Kayla

Kayla, your thread proposed training a group of evidence-based practice mentors at your hospital so that each unit has someone who can help staff turn research into practice. I think the evidence supports your idea, and Melnyk and Fineout-Overholt (2015) describe mentors as one of the strongest levers for building an evidence-based culture. Koçak et al. (2025) tested a structured mentor nurse training program grounded in the ARCC model and guided by the Johns Hopkins process, using a controlled quasi-experiment with 26 nurses in the intervention group and 26 in the control group. After 16 hours of face-to-face training and three hours online, the nurses who were trained scored clearly higher than controls on evidence knowledge and overall competence, and their mentoring abilities, coaching and role modeling among them, grew as well, by moderate to large margins.

Mentors also work better when they have a place to use their skills. Chignolli et al. (2026) report on a nurse council within an academic hospital's shared governance structure that spent a year, coached by experts and following ARCC and the seven-step process, on the question of preventing falls. The members wrote their own question, searched and judged the studies, pulled the findings together and saw the hospital rewrite its falls policy as a result, gaining knowledge and confidence along the way.

Those two studies suggest a structure for your plan: train mentors, then give them a standing forum, such as a practice council, with protected time to lead real projects. Mentors who are trained but never released from their regular assignments tend to lose their skills, since evidence-based practice competence is built by doing projects, not only by attending classes. Paul instructed Timothy to hand the teaching he had received to trustworthy believers equipped to instruct a further generation (English Standard Version Bible, 2001/2016, 2 Timothy 2:2), which describes the multiplication a mentor program aims for: each mentor who teaches others extends the reach of the evidence far beyond what a single expert could do. Mentor selection matters too. The most helpful mentors are usually respected clinicians whom colleagues already ask for advice, not necessarily those with the most formal education, and choosing them by reputation as well as credentials helps the program gain trust quickly. Pairing each new mentor with an experienced one for the first project would also help, since the Koçak study measured mentoring skill gains after training but could not show how mentors performed once they were on their own. Your hospital could track how many projects each mentor leads and how many staff they coach each year, which would show whether the program is building capacity or only certificates. How many hours a month would your hospital protect for each mentor?

Reply to Jonah

Jonah, your thread argued that evidence-based practice should include stopping practices that lack evidence, and you proposed ending routine daily blood tests on your step-down unit. I agree, and the textbook's discussion of sustaining change applies to removal as much as to addition. The evidence suggests, though, that de-implementation is often harder than adding something new, because low-value practices are protected by habit, convenience and reassurance.

Yeo et al. (2026) reported a two-phase effort to reduce routine laboratory testing in a surgical intensive care unit. The first phase relied on education, visual reminders, shared decision-making, nurse empowerment to question orders and audit with feedback, and laboratory tests per patient-day actually rose slightly, from 12.9 to 13.3. A second phase added electronic prompts and frequent digital reminders, but use returned to baseline and no sustained reduction occurred. The authors concluded that education and behavioral strategies alone were not enough and that lasting change would require system redesign, such as modifying order sets and embedding decision support. Ganguli et al. (2019) show why the effort matters: among Medicare patients having cataract surgery, routine preoperative electrocardiograms triggered cascades of further tests, visits and diagnoses that added up to $565 per beneficiary who received one.

For your unit, I would suggest starting with the order set itself, working with the hospitalists who wrote it so they see the change as theirs, removing daily labs as a default and requiring a reason for each one, before running education. A design change makes the right choice the easy one, while education asks busy clinicians to resist a default every day. The Yeo team reached the same conclusion only after two phases of effort, so starting with the system change could save your unit a year. Paul urged the Philippians to forget what lies behind and strain forward to what lies ahead (English Standard Version Bible, 2001/2016, Philippians 3:13), and letting go of a long habit takes that kind of deliberate turning. You might also measure the right outcome. The ICU team in the Yeo study tracked tests per patient-day, but on your unit the more useful measure may be the share of patients with no lab draw on a given day, which is easier for staff to understand and to see improve. Patients should hear about the change as well, ideally before the first morning without a blood draw, since some expect a daily blood test as a sign of good care and may ask for it. A short explanation from nurses that fewer needle sticks mean less blood loss and better sleep can turn a potential complaint into appreciation, and it shows patients the change was made for them. Does your hospital's order set committee review defaults for evidence on a regular schedule?

References

Chays-Amania, A., Schwingrouber, J., & Colson, S. (2025). Using implementation science to implement evidence-based practice: A discursive paper. Journal of Advanced Nursing, 81(11), 8050-8061. https://doi.org/10.1111/jan.16571

Chignolli, H., Frank-Scott, C., Gibson, J., Ring, L., Stromberg, K., & Zellefrow, C. (2026). Empowering nurses through shared governance: A council-led evidence-based initiative driving practice and policy advancement. Worldviews on Evidence-Based Nursing, 23(4), e70147. https://doi.org/10.1111/wvn.70147

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Ganguli, I., Lupo, C., Mainor, A. J., Raymond, S., Wang, Q., Orav, E. J., Chang, C. H., Morden, N. E., Rosenthal, M. B., Colla, C. H., & Sequist, T. D. (2019). Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries. JAMA Internal Medicine, 179(9), 1211-1219. https://doi.org/10.1001/jamainternmed.2019.1739

Gorsuch, C. R. P. F., Gallagher Ford, L., Koshy Thomas, B., Melnyk, B. M., & Connor, L. (2020). Impact of a formal educational skill-building program based on the ARCC model to enhance evidence-based practice competency in nurse teams. Worldviews on Evidence-Based Nursing, 17(4), 258-268. https://doi.org/10.1111/wvn.12463

Koçak, V., Arslan, S., & Aldem Budak, M. (2025). Effectiveness of evidence-based practice-based mentor nurse training program: A quasi-experimental controlled study design. Worldviews on Evidence-Based Nursing, 22(4), e70069. https://doi.org/10.1111/wvn.70069

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.

Yeo, C. F. C., Goh, S., Zeng, R., Goh, J., Tan, W. J., Yeo, J. X., & Lie, S. A. (2026). De-implementation of routine laboratory testing in a surgical intensive care unit: Lessons from a two-phase quality improvement initiative. BMJ Open Quality, 15(3). https://doi.org/10.1136/bmjoq-2026-004415