Table 2.

Representative quotes for high- and low-performing sites on evidence-based practice (EBP)

Theme	High-performing characteristics and quotes	Low-performing characteristics and quotes
Training approach	Regular Practice: “We had annual [EBP] workshops and that is where the nurses were taught and became a champion for their unit…[Nurses] meet [in EBP committee] to inform us about what they are doing and also provide guidance to each other…Nursing Grand rounds monthly…a lot of e-mails about courses and education offered to all staff.” Site E-HEBP/LPCC	As Needed: “Upon orientation to the facility they do [EBP training] up front. It’s also done annually and then as needed if you are falling down on scores…On the as needed basis, they will be coming and say, ‘Hey, I need 15 minutes of your time for this training.’” Site J-LEBP/LPCC
EBP emphasis	Organizational: “We try to identify all patients in hospital who have heart failure that we can consult appropriately. Also, more careful review of patients being reviewed by the peer review process.” Site A-HEBP/HPCC	Individual: “[EBP is] medical education, that’s my training as a resident and fellow. My responsibility to keep up; that’s why I go to conferences and read journals.” Site I-LEBP/HPCC
Guidelines & support	Bottom-up: “Depending on how sophisticated…I’ll ask [residents] to do a more involved QI project. For interns, ask them to just look at their panel, 45–60 patients, see who has cholesterol or high blood pressure out of bounds, and have them write up a plan for me for 15–20 patients with specific criteria that need to be addressed.” Site B-HEBP/HPCC	Top Down: “Generally a top-down activity. The [regional network] usually has some requirement that we have to implement certain bundles, and then we pretty much just educate people and monitor.” Site I-LEBP/HPCC
Tools for EBP	Development: “Pretty good evidence that you need to ask people to be [HIV tested]…put in place an HIV clinical reminder…Wasn’t mandated from above; it was done locally based on the evidence that these reminders had worked on other things, so why don’t we do that.” Site D-HEBP/LPCC	Distribution: “Now that we’ve learned [guidelines] are automatic and besides the computer system reminds us, so we don’t need checklists…If not doing what’s on the list then there must be a reason….” Site L-LEBP/LPCC
Academic influences	Positive: “The fact that this is a closely-affiliated teaching hospital vastly improves the penetration of evidence into medical practice because…And especially the residents and students, who are not only being taught, but they’re being tested, and they’re being plied with literature, and they’re always challenging the senior staff as to why they’re doing or not doing what the evidence says….” Site B-HEBP/HPCC	Negative: “It’s hard, also because this is a teaching hospital, new residents every year, different culture set. People work well on teams when trust is established…hard to build [trust] so we must be as transparent as we can.” Site L-LEBP/LPCC

Note. QI = quality improvement; HIV = human immunodeficiency virus; HEBP = high evidenced-based practice; LEBP = low evidence-based practice; HPCC = high patient-centered care; LPCC = low patient-centered care.