TABLE 2.

Summary of findings, implications and potential actions

Key findings	Implications for next steps	Examples of action taken
Perception that evidence-informed decision-making equates with “using research” (primarily quantitative) results	Develop strategies/tools to promote more comprehensive understanding of meaning of “evidence” in decision-making Focus on process of decision-making vs. specific content (research used)	Reframing of research question for the research project “What is Evidence” (one-page tool developed to address these perceptions directly) developed and circulated through participating RHAs
Skepticism because “politics trumps evidence”	Develop strategies to frame political judgment as a recognized form of evidence in decision-making, while promoting transparency on how various forms of evidence are used in decision-making	See above
Lack of time and resources major barrier	Develop strategies (e.g., redefine roles) to allow “protected time” Develop strategies to integrate evidence into existing processes vs. viewing as “add-on”	In one RHA, revising resource allocation processes to promote evidence use; developing tools to aid in this process
Focus on “external” barriers – issues that individual RHAs cannot address alone	Develop tools to differentiate between internal and external barriers, and encourage RHAs to focus on barriers they can affect	Internal/External Barriers framework presented at Rural and Northern Health Care Day
Issues related to leadership, communication and organizational structure	Increase awareness of importance of these factors	Presentation of Phase 1 report at senior management tables
Culture of crisis management, constant change	Promote questioning of inevitability of crisis management approach; disentangle workload from acceptance of crisis management culture	As above
More than workload – fractured attention	Provide protected “space” for reflective decision-making	As above
Technology – too much, too little	Ensure that both strategies to (a) improve IT support and (b) minimize potential disruptive effects of communication technology are promoted	One RHA instituted “no cellphone/no Blackberry” rule at senior management meetings
Research capacity and data availability viewed as less important barriers to evidence-informed decisions	Strategies to increase use of evidence should focus on barriers viewed as more important by RHA planners and decision-makers	Library access identified as key issue: trial membership with university library instituted Need for skills in weighing evidence identified: guide developed
Few differences in identified barriers related to RHA size, complexity	Further research required to explore transferability of findings