Abstract

This study evaluated the dissemination and implementation of a Coordinated Stroke Strategy across four Ontario regional networks over 2.5 years. This study revealed that creating new structures for disseminating evidence is insufficient. An existing infrastructure, resources for network development, a high intensity of dissemination efforts, and involvement of champions and clinical leaders are paramount for building and sharing knowledge at the organizational level in order to successfully implement evidenced-based health care strategies. Background: Evidence-based practice is fundamental to effective health care; however, incorporating research into practice may be challenging. At the provincial level, the development of the Coordinated Stroke Strategy (CSS) was initiated and supported by the Heart and Stroke Foundation. Regions were given full autonomy to develop their own dissemination plan. The joint participation of clinical and administrative leaders led to government investment and expansion of the CSS.

Methods: The purpose of this evaluative study was to examine how stroke care evidence was disseminated across four Ontario regional networks and used in the implementation of health system change, under the CSS. Researchers examined: (a) inter-organizational clinical capacity and regional reach of each network prior to implementation of the program (b) new collaborative relationships developed for dissemination (c) dissemination of evidence-based clinical and administrative changes implemented by the networks, and the extent to which stroke care was coordinated across two or more points on the continuum of care, and (d) the knowledge creation process of each network. The dissemination of the CSS program within each of the 4 regions was tracked over 2.5 years. Data were collected using templates, surveys, the stroke registry, and semi-structured interviews with managers, clinicians, clinician-researchers, and evidence disseminators.

Findings: While all regions made some changes in stroke care, only 2 regions significantly increased the access of eligible patients to a clot-busting drug (i.e. tPA), and subsequently, demonstrated improved clinical outcomes. Regions with an existing infrastructure and/or resources for network development were more successful in building knowledge at the inter-organization level. A high intensity of dissemination efforts plus the involvement of clinical and administrative champions and leaders were paramount for knowledge creation and sharing across organizations and the continuum of care.

Conclusions: Creating new structures for disseminating evidence is insufficient. An existing infrastructure, resources for network development, a high intensity of dissemination efforts, and involvement of champions and clinical leaders are paramount for building and sharing knowledge at the organizational level in order to successfully implement evidenced-based health care strategies.

Reference: Lemieux-Charles L, McGuire W, Blidner I. Building interorganizational knowledge for evidence-based health system change. Health Care Management Review 2002; 27(3): 48-59.