Understanding Whole Systems Change in Healthcare: The Case of Emerging Evidence-informed Nursing Service Delivery Models

Full Report (PDF, 314 KB)


Nancy Edwards, RN, PhD, FAHS
Professor, University of Ottawa

Doris Grinspun, RN, PhD, LLD(hon), O.ONT.
Executive Director, Registered Nurses’ Association of Ontario (RNAO)

The imperative to deliver the best care possible drives research on best practices in nursing, but what does it take to spread a guideline or recommendation from one or two units or organizations to a system-wide innovation that benefits all patients and providers and the healthcare system as a whole? What cost drivers and increased benefits come with spreading a best practice; and what supports, sustains or gets in the way of spreading evidence-informed change?

Those were the questions we set out to answer in our four-year program of research called Evidence-Informed Models of Nursing Service. Funded by the Canadian Health Services Research Foundation and other partners, the program’s goal was to improve understanding of how health systems introduce, support and spread evidence-informed innovations.

Researchers from across Canada participated in the five projects that made up our program of research, and its main focus was the best practice guidelines initiative of the Registered Nurses Association of Ontario (RNAO). Eight years after the association launched the project, the guidelines are being implemented across Canada and internationally. However, for these the longest (except for study 2, which actually looks at three innovations introduced in Ontario before RNAO launched its guideline initiative). We looked at nursing guidelines because nurses are with patients around the clock, in every sector of healthcare, and getting nurses to base their work on up-to-date, evidence-based practices, is central to delivering safe care and optimizing patient, organizational and system outcomes. The learnings of this study about spreading innovations applies to all healthcare professions and sectors.