Analysis

Translating evidence into practice: a model for large scale knowledge translation

BMJ 2008; 337 doi: 10.1136/bmj.a1714 (Published 6 October 2008)
Cite this as: BMJ 2008;337:a1714

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  1. Peter J Pronovost, professor1,
  2. Sean M Berenholtz, assistant professor1,
  3. Dale M Needham, assistant professor2
  1. 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Quality and Safety Research Group, 1909 Thames Street, Baltimore, MD 21231, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Baltimore, MD 21287, USA
  1. Correspondence to: P J Pronovost ppronovo{at}jhmi.edu
  • Accepted 17 July 2008

Changes that can improve patients’ health are often difficult to get into practice, even when backed by good evidence. Peter Pronovost, Sean Berenholtz, and Dale Needham describe a collaborative model that has been shown to work

Evidence based therapies that prevent morbidity or death are often not translated into clinical practice. One reason is that research often neglects how to deliver therapies to patients.1 Consequently, errors of omission are prevalent and cause substantial preventable harm.2

Attempts to increase the reliable use of evidence based therapies have generally focused on changing doctors’ behaviour.3 However, doctors work in a healthcare team within a larger hospital system, which must be considered when attempting to improve the reliability of patient care.

Models to increase the reliable use of evidence based therapies typically focus on translating evidence into practice or on the best methods to run a collaborative; few if any have done both.4 Our model embeds an explicit method for knowledge translation in a collaborative model for broader dissemination of knowledge into practice.

Model to translate evidence into practice

We have described an integrated approach to improve the reliability of care5 that has been associated with substantial and sustained reductions in bloodstream infections associated with central lines.6 The approach has five key components:

  • A focus on systems (how we organise work) rather than care of individual patients

  • Engagement of local interdisciplinary teams to assume ownership of the improvement project

  • Creation of centralised support for the technical work

  • Encouraging local adaptation of the intervention

  • Creating a collaborative culture within the local unit and larger system.

This approach has matured into the Johns Hopkins Quality and Safety Research Group translating evidence into practice model (figure⇓). The resources required to develop, implement, and evaluate programmes using this model are substantial. Thus, the model is …

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