The Joanna Briggs Institute clinical fellowship program: a gateway opportunity for evidence-based quality improvement and organizational culture change

Abstract

There are many benefits to the uptake of EBHC, not just in terms of practice improvement, but also in understanding individual and organisational barriers and facilitators and the process of change itself.
However, a lack of autonomy in the strategic and cultural domains of healthcare organization and delivery, is problematic. The JBI Evidence Based Clinical Fellowship Program (EBCFP) overcomes this, by providing foundational knowledge on change management, leadership, implementation, and evaluation. A constructionist approach enables participants to situate and ground their learning in their own clinical experience, expertise, and interests, all of which facilitate the translation of research into practice.
The Joanna Briggs Institute best evidence programs, tools, and resources bridge the evidence to practice gap, and enable organizations to up-skill and equip their clinical staff with specific skills, knowledge and resources. As such, the JBI programs can be considered gateway programs for practice change.
An organisational culture of Best Practice requires investment in nurses and other front-line staff as clinical leaders, as innovators, and as drivers of healthcare quality. Organizational as well as individual benefits of the JBI EBCFP include increased capacity for clinical leadership through clinicians and carers who are equipped for practice with the knowledge, skills and resources to lead evidence-based practice change, and to facilitate an organizational culture of improvement.

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The Joanna Briggs Institute clinical fellowship
program: a gateway opportunity for
evidence-based quality improvement
and organizational culture change
Practising health professionals trained and prepared for
best practice lead the provision of high quality, evidence-
based healthcare (EBHC), as many researchers have con-
sistently demonstrated.
1–5
Nurses in particular have a
high level of knowledge and acceptance of EBHC, high
uptake of EBHC principals in undergraduate and post-
graduate nursing programs, and increasing integration of
evidence in nurse-led quality improvement initiatives.
6–9
There have been many benefits to the uptake of EBHC, not
just in terms of practice improvement, but also in under-
standing individual and organizational barriers and facil-
itators and indeed the process of change itself.
10– 13
However, nurses are not always professionally enabled
to contribute to EBHC initiatives.
14,15
While EBHC has
supported nurses to make substantive contributions to
professional nursing knowledge and practice, there are
still gaps. A lack of autonomy in the strategic and cultural
domains of healthcare organization and delivery is prob-
lematic.
16
Without mechanismsto address these systemic,
organizational issues, the promise and potential contribu-
tion of nursing will not be fully realized.
The Joanna Briggs Institute (JBI) was established as an
international research institute in 1996 with a vision for a
world in which the best available evidence is used to
inform policy and practice to improve health in commu-
nities globally.
17
While many associate JBI with system-
atic reviews of the best available evidence, that is only
one element of their work. JBI is also involved with
knowledge transfer and knowledge implementation as
the JBI Model (Fig. 1) illustrates.
The JBI Evidence-Based Clinical Fellowship Program
(EBCFP) focuses on implementation and was designed
for busy healthcare practitioners, managers, and admin-
istrators, who have an interest in implementing best
practice, but may not have familiarity with the suite of
skills needed to lead and sustain practice change.
18,19
The program is delivered over 6 months; participants
attend an intensive 1-week workshop that provides
foundational knowledge on change management,
leadership, implementation, and evaluation. Following
the workshop, participants return to their clinical insti-
tution, where they conduct a rapid cycle small test of
change following a Model of EBHC.
14
After they have
collected baseline data, and implemented their change
based on best practice, participants return for a second
intensive residency, in which they work in small groups
to analyse and evaluate their data and work on dissemi-
nation. This constructionist approach enables partici-
pants to situate and ground their learning in their
own clinical experience, expertise, and interests, all of
which facilitate the translation of research into practice.
Programs such as the EBCFP are designed to help
improve the safety and quality of care provided in health
facilities; and facilitate the development of clinical auton-
omy in the strategic and cultural domains of healthcare
organization and delivery. This is a complex process that
crosses systems, resources, infrastructure, and policy and
process requirements, and requires situated contextual
know-how and operational leadership necessary for
patient and family care. Instituting a change based on
best practice needs to utilize a programmatic, standard-
ized approach that promotes the use of systems and
infrastructure to address issues of policy or practice at
the organizational level. This in turn, contributes to the
promotion of key indicators (such as hand hygiene or
surgical patient management) aligned with national or
international accreditation and benchmark standards.
The achievement of such key indicators is by neces-
sity a multidisciplinary endeavour. Graham et al.
20
and
Steel-Moses
21
argue that embarking on a trajectory for a
substantive strategic goal requires a whole of organiza-
tion investment. It involves a mission driven investment
that recognizes the value of nurses and their contribu-
tion to clinical leadership and policy and practice
improvement. Graham advocates for the use of a process
similar to that described in the knowledge to action
model for leveraging change processes based upon a
call to action that includes a situational analysis and total
International Journal of Evidence-Based Healthcare ß2020 University of Adelaide, Joanna Briggs Institute 1
EDITORIAL
©2020 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.

organizational engagement for implementation of
EBHC.
20
The need for a roadmap and steps in planning
aligns well with the work of Steele-Moses,
21
who also
advocate for a gap analysis to inform the scope of work,
effective planning, inclusivity of top down support for
clinical practice transformation, and adequate resourcing
of the planning phase.
21
Adequate resourcing includes
finance, staff time, integration with relevant committees,
and regular high-level program activity review.
21
JBI Clinical Fellows work with other clinicians, admin-
istrators and managers as required to scope the problem
and develop a plan for implementing best practice to
address the compliance gaps found in the baseline audit.
The implementation phase is a facilitated project that
starts with the identification of potential barriers to best
practice, moves to solution building where strategies to
overcome the barriers are developed, and the resources
needed to implement are identified. As per the JBI
Model, the facilitation of change is step two in the
implementation of best practice and is where most of
the fellowship time is allocated. Implementation contin-
ues through an evaluation cycle that provides
Figure 1. The Joanna Briggs Institute model of evidence-based healthcare.
EDITORIAL
2International Journal of Evidence-Based Healthcare ß2020 University of Adelaide, Joanna Briggs Institute
©2020 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.

measurable data on care processes and patient out-
comes that were identified as important during the
context analysis.
The JBI suite of best evidence programs, tools, and
resources facilitate the implementation of change based
on best practice, and surveys consistently demonstrate
that clinicians possess both the knowledge and motiva-
tion to participate and indeed lead such programs of
work. By bridging the evidence to practice gap, and
enabling organizations to up-skill and equip their clinical
staff with specific skills, knowledge and resources, the JBI
programs can be considered gateway programs for
practice change.
Investing in nurses and the practising professions as
clinical leaders, innovators, and drivers of healthcare
quality is well supported by high-quality systematic
reviews. Creating a collective organizational culture of
improvement, as well as the tangible individual benefits
of the JBI EBCFP include honing important project man-
agement skills, instilling a sense of empowerment and
mastery, and increasing capacity for clinical leadership
by the clinicians and carers who are equipped with the
knowledge, skills and resources to lead evidence-based
practice change. Investing in staff for EBHC is something
we can all support.
Acknowledgements
Conflicts of interest
The authors report no conflicts of interest.
Craig Lockwood PhD,
1
Daphne Stannard PhD, RN,
2
Zoe Jordan PhD
1
and Kylie Porritt PhD, RN
1
1
Joanna Briggs Institute, University of Adelaide, Adelaide,
South Australia, Australia,
2
Adult Medical/Surgical & EBP/
Nursing Research, San Francisco State University,
San Francisco, California, USA
Correspondence:
Dr Craig Lockwood, PhD, Director
Implementation Science, Joanna Briggs Institute, Floor 3,
55 King William Road, Norwich Centre, North Adelaide,
Adelaide 5006, SA, Australia.
E-mail:
craig.lockwood@adelaide.edu.au
DOI:10.1097/XEB.0000000000000221
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