Know the difference.

Some use the terms evidence-based practice (EBP), quality improvement (QI), and implementation science (IS) interchangeably. However important differences exist. Clinicians must understand those differences and use the correct terminology.

Evidence-based practice

When clinicians use EBP, they take into consideration the best available research evidence, clinical experience/expertise, and patient preferences. Considering all three areas helps ensure high-quality, safe, and effective care. EBP relies on searching, appraising, and synthesizing research evidence, and then determining a recommendation for practice change. EBP provides less guidance on implementation.

Quality improvement

While EBP focuses on external (research) evidence, QI uses local (internal) data to improve processes tailored to the local context. Rather than obtaining data pre- and postintervention and using statistical analyses to determine significance (used in research), changes in QI require evaluation over time using run or statistical process control charts to identify clinically meaningful improvements.

Evidence-based practice quality improvement

Evidence-based practice quality improvement (EBPQI), a relatively new concept, combines external evidence with local data to improve the quality of care. Waldrop and Dunlap’s article on the Mountain Model of EBPQI offers additional information.

Implementation science

IS, the scientific study of methods and strategies, facilitates the uptake of EBP and research into regular use by clinicians. This form of research generates new knowledge. Rather than focusing on the evidence-based change that requires translation into practice, IS looks at how to effectively implement the change. IS aims to provide evidence on effective implementation strategies so clinicians can use those strategies to implement best practices.

Frequently, nurses settle for using implementation strategies they’re comfortable with but which may not be effective, such as emailing a PowerPoint presentation to staff to educate them about a change. IS provides evidence on more effective strategies, such as educational outreach visits (similar to in-services) where staff can ask questions or online games designed to improve staff understanding of an evidence-based change. The use of more than one strategy can increase implementation effectiveness. Reynolds and Granger’s IS toolkit for clinicians provides further information.

Takeaways

Clinicians must use correct terminology for their initiatives. They may label an initiative as QI when they’ve actually designed a quasi-experimental pre- and postintervention research study. In QI, small tests of change are implemented and evaluated over time; data shouldn’t be collected at only two timepoints.

Simply implementing an EBP isn’t the same as conducting IS research. DNP graduates receive training to lead EBPQI projects. Although DNP-prepared nurses may use implementation strategies to apply changes, they’re not trained to conduct IS research.

Nurses can use EBP, QI, and IS principles in clinical practice to improve the quality of patient care. We need all strategies to narrow the research-to-practice gap; it typically takes up to 17 years to translate evidence into practice.

Staci S. Reynolds is a clinical professor at Duke University School of Nursing in Durham, North Carolina. Julee B. Waldrop is professor emeritus at the University of North Carolina Chapel Hill and a consulting associate at Duke University School of Nursing.

References

Boehm LM, Stolldorf DP, Jeffery AD. Implementation science training and resources for nurses and nurse scientists. J Nurs Scholarsh. 2020;52(1):47-54. doi:10.1111/jnu.12510

Dunlap JJ, Waldrop JB. Introduction to Evidence-Based Practice and Quality Improvement for Professional Nursing Practice: A Competency Based Approach. San Diego, CA: Cognella Academic Publishing; 2024.

Provost LP, Murray SK. The Health Care Data Guide: Learning from Data for Improvement. 2nd ed. San Francisco, CA: Jossey-Bass; 2022.

Reynolds SS, Granger BB. Implementation science toolkit for clinicians: Improving adoption of evidence in practice. Dimens Crit Care Nurs. 2023;42(1):33-41. doi:10.1097/DCC.0000000000000556

Reynolds SS, Waldrop J. Misuse of the P value: Using quality improvement analyses to identify clinically significant improvements. Dimens Crit Care Nurs. 2024;43(2):96-101. doi:10.1097/DCC.0000000000000623

Waldrop J, Dunlap JJ. The Mountain Model for evidence-based practice quality improvement initiatives. Am J Nurs. 2024;124(5):32-7. doi:10.1097/01.NAJ.0001014540.57079.72

Waldrop JB, Reynolds SS. Letter to the editor. Nurs Outlook. 2024;72(3):102154. doi:10.1016/j.outlook.2024.102154

Waldrop JB, Reynolds S. Perpetuating confusion about the DNP degree. West J Nurs Res. 2023;45(10):974. doi:10.1177/01939459231194559