A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study

Barriers and facilitators in implementing evidence-based practice: a parallel cross-sectional mixed methods study among nursing administrators

BACKGROUND

Evidence-based practice (EBP) is a cornerstone of quality healthcare, yet a significant gap persists between nursing administrators' advocacy for EBP and its clinical adoption, particularly in resource-constrained settings.

AIM

This study investigates barriers and facilitators to EBP adoption as perceived by nursing administrators in Saudi Arabian hospitals to inform tailored interventions.

DESIGN

A parallel mixed-method, cross-sectional design was employed.

METHODS

A total of 385 nursing administrators from 12 stratified hospital types in the Northern Region of Saudi Arabia completed structured surveys assessing EBP barriers and facilitators. Semi-structured interviews with 40 purposively sampled participants provided qualitative insights. Data were analyzed using descriptive, correlational, and thematic approaches.

RESULTS

Key barriers included insufficient staffing and time resources, particularly in private and specialized hospitals (mean = 4.05, SD = 1.46, p < 0.05). Supportive organizational policies (p = 0.015) and leadership experience significantly influenced EBP adoption. Barriers, such as resource constraints, were negatively correlated with willingness to adopt EBP (r = -0.17 to -0.35), while multifaceted strategies explained 27% of the variance in implementation intentions. Qualitative findings highlighted that 92% prioritized patient care quality, while 80% emphasized cost-benefit trade-offs.

CONCLUSION

This study highlights the critical role of organizational support, leadership advocacy, and tailored interventions in overcoming EBP barriers. Gender diversity among administrators and the influence of hierarchical dynamics in Saudi Arabian healthcare settings provide novel insights for improving EBP adoption.

IMPLICATIONS FOR THE PROFESSION

The findings provide actionable strategies for policymakers and nursing leaders to enhance EBP adoption, fostering improved healthcare outcomes and leadership effectiveness.

CLINICAL TRIAL NUMBER

Not applicable.

[Critical factors for institutionalizing evidence-informed decision-making in healthcare organizationsFactores críticos para la institucionalización de la toma de decisiones basada en la evidencia en las organizaciones de salud]

Objective

To map critical factors for sustainable processes in the institutionalization of evidence-informed decision-making in public health organizations.

Method

A rapid critical interpretative synthesis was carried out based on searches conducted in databases, websites, and reference lists, with findings categorized into an appropriate framework.

Results

Twenty studies were analyzed and six dimensions of critical factors were addressed: 1) governance, aimed at dealing with difficulties in the organizational context and motivation for change, together with a management style that has a long-term vision and invests in communication tools; 2) standardized routine processes, involving the characteristics of information that facilitate its incorporation into organizational practices; 3) leadership and commitment, revealing the importance of identifying and engaging leaders who can influence the adoption of evidence-informed policies in organizations; 4) resources, which correspond to the need for training programs that ensure the availability of a team with the skills needed to identify research evidence within a supportive organizational infrastructure; 5) partnerships, collective action, and support, which show the importance of involving stakeholders in collaborative processes, using exchange structures; and 6) culture, related to efforts to bring research and policy closer together, so that they are more receptive to organizational changes.

Conclusion

The identified critical factors can provide a reference framework to support improvement planning and the institutionalization of evidence use. The results are applicable to organizations that formulate and implement public health policies and other social policies.

The Relationship Between Medical Error Attitudes of Surgical Nurses and Evidence-based Work Environment

BACKGROUND

It is important for health care professionals to use evidence-based practice during  surgical procedures to ensure patient safety and prevent medical errors.

AIMS

The aim of this study was to examine the relationship between surgical nurses' perceptions of their work environment's support for evidence-based practice and their attitudes toward medical errors.

METHODS

The descriptive cross-sectional study was conducted between February and May 2023. A total of 105 nurses participated in the study. A personal information form, a medical errors attitude scale, and an evidence-based practice work environment scale were used to collect the data.

RESULTS

It was determined that 92 (87.6%) of the participants used evidence-based practice. It was determined that the answers given by the nurses to the scales had very high reliability, and the mean score of the attitude scale in medical errors was 3.90 (Cronbach-α coefficient 0.770), and the mean score of the evidence-based practice work environment scale was 2.90 (Cronbach-α coefficient 0.840). In addition, according to the correlation, a positive, weak, and statistically significant correlation was found between the total scores of the attitude scale in medical errors and the evidence-based practice work environment scale ( P <0.05).

CONCLUSION

As a result of the study, it was determined that nurses' attitudes toward preventing medical errors were positive and their perceptions of support for evidence-based practice work environments were high. In this direction, it can be said that the attitudes toward preventing medical errors of nurses whose working environment is supported by evidence-based practice can be positively affected and error tendencies in surgical clinics can be reduced.

Decision support systems for waste-to-energy technologies: A systematic literature review of methods and future directions for sustainable implementation in Ghana

Waste-to-energy (WtE) technologies play a crucial role in sustainable waste management and energy production. Decision-making in this context requires a comprehensive and structured approach to balance the environmental, socio-economic, and technical dimensions. This systematic literature review aims to provide an overview of the applications of Decision Support Systems (DSS) in the field of WtE, identify key trends, and outline future research directions. The study utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach in analyzing and synthesizing a diverse range of studies to identify key observations, trends, and a pathway for future research. The study has addressed its primary objectives through a rigorous analysis of existing scholarship, identification of essential decision-making criteria, assessment of DSS methodologies' efficacy, and identification of knowledge gaps and future research directions. The review reveals that DSS methodologies, particularly Multi-Criteria Decision Analysis (MCDA), Geographic Information Systems (GIS), and Life Cycle Assessment (LCA), have significantly contributed to enhancing decision-making processes in the WtE sector globally. These tools have demonstrated their effectiveness in handling the complex, multi-faceted nature of WtE technology selection and implementation, addressing issues ranging from site selection to technology ranking based on multiple criteria. The research identifies key criteria for WtE technology selection in Ghana, including technical feasibility, environmental impact, economic viability, social acceptability, and energy efficiency. The study also highlights significant gaps in the current application of DSS to WtE technologies, particularly in the context of developing nations like Ghana. Many existing DSS approaches fail to adequately account for local socio-economic factors, rely on static data, and do not fully incorporate diverse stakeholder perspectives. Adapting global DSS applications to the Ghanaian context requires careful consideration of local priorities, data availability, and the role of the informal waste sector. The review proposes a holistic approach to DSS development, emphasizing the need for context-specific, dynamic, and inclusive methodologies. Future research directions identified by this study include the development of Ghana-specific DSS models, integration of real-time data collection methodologies, creation of user-friendly interfaces for local decision-makers, and exploration of emerging technologies such as blockchain and IoT or Machine learning (ML) for enhancing DSS in WtE management.

Evaluating the Adoption of Evidence-Based Management Practices in Eye Hospitals

Background: Delivering sustainable, high-quality eye care requires a comprehensive understanding of patient conditions, clinical evidence, patients' preferences, demand patterns, quality supplies, outcomes, financial sustainability, and satisfaction metrics. Evidence-based management (EBM) offers a structured approach to align actions with evidence, enabling effective decision-making and better organizational outcomes. Evaluating current practices against EBM principles fosters awareness and promotes an EBM culture in eye hospitals, supporting improved and sustainable service delivery. Methods: A descriptive cross-sectional survey was conducted in 2023-2024 among 94 eye hospitals worldwide, selected from two networks, using the Centre for Evidence-Based Management (CEBM) assessment questionnaire. Follow-up reminders resulted in 43 responses. Data analysis utilized frequency distributions and Pearson's correlation to explore relationships between variables. Results: A strong positive correlation was observed between data accessibility and the capacity to interpret data in fostering evidence-based decision-making (r = 0.69, p < 0.01). Additionally, leveraging internal expertise and engaging stakeholders in assessing and utilizing data showed a moderate association with EBM practices (r = 0.48, p < 0.01). Conclusions: Eye hospitals demonstrate alignment with EBM principles, though regional variations exist. Organizations with robust data utilization systems, analytical expertise, and a commitment to continuous improvement are more effective in practicing EBM. Educational and peer-learning initiatives can further support hospitals in adopting EBM principles, strengthening their capacity for evidence-based decision-making, and enhancing eye care services.

Facilitating Utilization of Evidence-Informed Management by Nurse Managers in Healthcare Facilities: An Integrative Literature Review

Methods

An integrative review of the literature was conducted, including peer-reviewed articles published between 2010 and 2022. The databases used were BioMed Central, CINAHL Complete, MEDLINE Complete, PubMed (via EBSCOhost), the Complimentary Index (Taylor and Francis, Elsevier, Wiley, and Springer), Sabinet, ScienceDirect, and Scopus, followed by a manual search using Google Scholar and a citation search. Johns Hopkins Nursing Evidence-based Practice Research and non-Research evidence tools were used for appraisal. Thematic analysis was used to synthesize the extracted data.

Results

Based on thirteen determinants influencing nurse managers' utilization of evidence-informed management practices, three themes were identified from a total of thirteen relevant studies: (1) Nurse manager determinants in utilization of evidence-informed management (Microlevel); (2) Organizational determinants in utilization of evidence-informed management (Mesolevel); (3) External stakeholders and context determinants of utilization of evidence-informed management practices (Macrolevel).

Conclusion

The themes were found to be interconnected and interdependent, facilitating the effective utilization of evidence-informed management by nurse managers at micro-, meso-, and macrolevels, but highlight the need for strengthening health systems and support. Future studies are required to provide a more comprehensive understanding of the determinants influencing nurse managers' utilization of evidence-informed management practices. Implications for Nursing Management. For nurse managers to optimally utilize evidence-informed management, executive management and policymakers require to provide resources and support such as continuous education, incentives, effective communication, funding structures, and ownership.

Value of concerted and hospital hemodialysis through a multi-criteria decision analysis

OBJECTIVE

To evaluate the value of the provision of contracted versus hospital dialysis services for the treatment of chronic kidney disease in Spain using the multicriteria decision analysis methodology.

METHOD

The EVIDEM (Evidence and Value: Impact on Decision Making) evaluation framework was used to calculate the estimated value of both dialysis delivery models (arranged vs. hospital) through a virtual workshop in which different profiles participated: directors and managers, professionals and heads of units and representatives of patients and relatives. The scores were combined using an additive lineal model, which combined the weight of the model with the individual score of the criteria, and each value was transformed to a scale between 0 and 1.

RESULTS

The estimated value for arranged dialysis was 0.29 (DS: ±0.2) and 0.39 (DS: ±0.2) for hospital dialysis. All profiles gave a higher value to hospital hemodialysis compared to contracted hemodialysis. The highest value for hospital dialysis was for patients (0.44), with the lowest mean value for directors (0.36) and the range for arranged dialysis being between patients (0.31) and intermediate positions (0.27).

CONCLUSIONS

Hospital hemodialysis obtained a higher value than concerted dialysis. In general, the panelists affirmed that it is a useful and interesting exercise and that, to a certain extent, it provides security in decision-making, since it allows ordering, rationalizing and considering, in an explicit and transparent manner, the different criteria involved.

Dissemination of Evidence by Cochrane Public Health Europe in German-Speaking Countries: An Online Stakeholder Survey

Objectives: To investigate the reach and impact of "Infomails", email summaries of Cochrane reviews in German, regularly disseminated by Cochrane Public Health Europe (CPHE) to stakeholders in Austria, Germany and Switzerland. Methods: We analysed email campaign reports from 15 Infomails delivered until November 2020. Furthermore, we invited all previous Infomail recipients to participate in an online survey on the impact and perceptions regarding our Infomails in November 2020. We analysed the results using descriptive statistics. Results: The Infomails' open rate ranged from 10.9% to 39.3% (median 26.0%), and the median click rate on the embedded links was 28.0% (range 8.6-53.8%), highest for nutrition and prevention topics. Out of 1259 recipients, 267 (21.2%) completed our survey. Infomails were most used in discussions, writing reports or statements, for policy or strategy development or programme or guideline development. Persons who remembered receiving Infomails rated them as useful, comprehensible or informative. Conclusion: Infomails summarising recent Cochrane reviews were considered useful for the daily work of public health stakeholders in German-speaking countries. Regular targeted messaging may increase the perceived usefulness.

How COVID-19 affects the use of evidence informed policymaking among iranian health policymakers and managers

BACKGROUND

The COVID-19 pandemic increased the need for new valid scientific evidence to support urgent clinical and policy decision making; as well as improved processes for the rapid synthesis, uptake and application of that evidence. Evidence informed policymaking (EIPM) can be considered as a way to access and use the results of evidence in practice. This study aimed to determine what effects COVID-19 had on the way Iranian health managers and policymakers use evidence in their decisions.

METHODS

This study was conducted in 2021 applying a qualitative research design. Data was collected through semi-structured interviews. Thirty health care managers, policy makers and medical university faculty members were recruited as the study participants, initially via a purposive sample, followed by snowballing. A conventional content analysis presented by Hsieh and Shannon (2005) was applied for data analysis.

RESULTS

Ten main themes emerged from the data including: 1) roles and duties of knowledge brokers (KBs); 2-5) the roles, benefits, barriers and necessities of applying Knowledge Translation Exchange (KTE) tools; 6-8) the facilitators, benefits and barriers to the application of evidence during COVID-19; 9) challenges of rapid evidence production evidence during COVID-19 and 10) consequences of not applying evidence during COVID-19. According to the present conceptual framework, KBs act as an intermediator between the large amounts of knowledge produced and decision makers. KTE tools should be applied to enhance EIPM during COVID-19. Attention should be paid to the facilitators, barriers, benefits and necessities of evidence application during COVID-19 to avoid negative consequences for the health system.

CONCLUSIONS

Results of this study show that developing KTE tools and activating KBs can be among the main strategies to produce applied actionable messages for policymakers to move toward EIPM; and that this applies even when rapid decision making is required, such as during the COVID-19 pandemic. It is strongly recommended to reinforce the local capacities through supporting scientific networks and relationships between research centers and local and national policymakers. At the same time, attention to local barriers to and facilitators of the application of evidence while facing a pandemic can pave the way to better identification of health system`s problems and rapid responses.