The PARIHS framework—a framework for guiding the implementation of evidence-based practice

Abstract

Against a background of rising health costs, a management ethos of “doing things right,” and a drive for quality improvement, evidence-based healthcare has evolved. It has emerged as one of the dominant themes of practice, management, and education in health services across the globe. Mounting pressure is being exerted to ensure that the delivery of care is evidence based and clinically effective. Yet if you have been involved in implementing change, getting research into practice, or improving the quality of patient care, you know what a complex, messy, and demanding task it can be. If it was straightforward, the production of “evidence,” perhaps in the form of guidelines followed by an education or a teaching package, would lead to an expectation that practitioners would automatically integrate it into their everyday practice. But we know that this is not the case, and often practice lags behind what is known to be current best practice.

Against this context, research and practice development teams within the Royal College of Nursing (RCN) Institute in the United Kingdom have accumulated experience and knowledge about implementation and changing practice from their involvement in a number of different research, practice development, and quality improvement projects.1–4 Analysis of work such as this indicates that a number of key factors appear to play a role in successful implementation.5,6 The Promoting Action on Research Implementation in Health Services (PARIHS) framework represents the interplay and interdependence of these factors. This multidimensional framework was developed in an attempt to represent the complexity of the change processes involved in implementing research-based practice.