Shifting Sands: A Case Study of Process Change in Scaling Up for Evidence-based Practice

By Melanie Barwick, Melissa Kimber and Gwendolyn Fearing.

Published by The Organization Collection

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Article: Print $US10.00
Article: Electronic $US5.00

Background: Despite a push to implement evidence-based practices in behavioral healthcare, few studies have focused on the processes involved in this endeavor. This study describes the organizational transformation process at a large child and youth mental health service provider organization in Ontario, Canada. A detailed qualitative analysis of the change processes involved in shifting all service delivery to evidence-based practices examined process themes over time (4 years) and mapped these processes against the NIRN model of implementation. Methods/Design: This was a prospective single case study of process change in a child and youth mental health service provider organization using participant observation and verbatim field notes to capture elements of the change process over time (4 years).
Results: Process themes from this real world change initiative did map onto the NIRN model of scaling up for organizational change. Emergent themes provide a rich, detailed description of the scaling up activities with respect to organizational change, building on the stages laid out by NIRN.
Discussion: Findings have implications for the viable field use of the NIRN model for scaling up change and implementation of evidence-based practices in behavioural healthcare. Lessons learned provide greater definition of issues related to EBP change implementation that can assist other organizations.

Keywords: Implementation, Evidence-based Practice, Organizational Change, Practice Change

International Journal of Knowledge, Culture and Change Management, Volume 10, Issue 8, pp.97-114. Article: Print (Spiral Bound). Article: Electronic (PDF File; 1.192MB).

Dr. Melanie Barwick

Psychologist and Health Systems Scientist, Community Health Systems Resource Group and the Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

Dr. Barwick is a Registered Psychologist with a primary role as a Health Systems Scientist in the Community Health Systems Resource Group at SickKids. She is Associate Scientist and inaugural Director of Knowledge Translation in the Child Health Evaluative Sciences program of SickKids’ Research Institute, and holds appointments as Assistant Professor in the Department of Psychiatry and the Dalla Lana School of Public Health at the University of Toronto. She leads Ontario’s outcome measurement initiative to implement an outcome measure in 117 children’s mental health service provider organizations across the province. In this practice context she studies innovative health knowledge translation strategies, has developed the Scientist Knowledge Translation Training program, and is funded to lead a 5-year CIHR Emerging Team in Knowledge Translation for Child and Youth Mental Health that will develop and evaluate an innovative implementation model to bring evidence based practices into both the children’s mental health and education sectors.

Melissa Kimber

Clinical Research Project Coordinator, Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, Ontario, Canada

Melissa Kimber is a PhD Candidate in the Department of Clinical Epidemiology and Biostatistics at McMaster University, and is currently a Clinical Research Coordinator in the Department of Psychiatry and Behavioural Neurosciences at McMaster University. For the current paper, Melissa was the Clinical Research Project Coordinator for the final year of study.

Gwendolyn Fearing

Research Assistant, Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, Ontario, Canada

Gwendolyn Fearing has a Bachelor of Arts degree in Psychology and Sociology. She was a clinical project research assistant at the Hospital for Sick Children in the Community Health Systems Resource Group and is now pursuing a Bachelor of Social Work at McMaster University.

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