Implementing the PARiHS Framework

[Audio] Hello everyone, welcome to this presentation on the PARiHS Framework. The PARiHS Framework stands for Promoting Action on Research Implementation in Health Services. My name is Shawn Perrigo and today we will explore this framework and how it can be utilized to implement evidence-based practices in healthcare settings.".

[Audio] Although the purpose for this presentation is to discuss the PARiHS Framework, for application purposes, I thought it would be best if I first shared my PICOT question. Therefore, my PICOT questions is In children aged 6-17 who have experienced an Adverse Childhood Experience (ACE), does Trauma Informed Therapy compared to Standard Therapy result in a reduction of trauma-related symptoms, such as anxiety, depression, and the intensity of PTSD?.

[Audio] To further provide you with additional insight of my topic, I want to share a little about Trauma Informed Therapy and then we will move in to the PARiHS Framework. "Trauma Informed Therapy is a therapeutic approach designed to address the needs of adolescents who have experienced Adverse Childhood Experiences (ACEs)." ACEs can lead to significant trauma-related symptoms such as anxiety, depression, and PTSD." "Implementing TIT is crucial to help adolescents cope with and recover from these experiences." Felitti & et. 2018.

[Audio] The Promoting Action on Research Implementation in Health Services framework offers a compelling solution by emphasizing three core elements: evidence, context, and facilitation. These components are pivotal in understanding why certain practices succeed in some settings but falter in others. Evidence: The Foundation of Change At the heart of the PARIHS framework lies the recognition of evidence as the starting point for change. Robust evidence underpins clinical decision-making and shapes best practices. By systematically evaluating the strength and applicability of research findings, healthcare providers can ensure that interventions are grounded in reliable data, enhancing confidence in their efficacy. Bergström & et al. 2020.

[Audio] "The PARiHS Framework consists of three key components: Evidence, Context, and Facilitation. Evidence includes research findings, clinical expertise, and patient preferences. Context refers to the environment in which the implementation occurs, including culture, leadership, and evaluation processes. Facilitation involves the support, training, and resources necessary to implement change effectively." Bergström & et al. 2020.

[Audio] Let's delve deeper into the first component, Evidence. Evidence encompasses various sources such as research findings, clinical expertise, and patient preferences and experiences. The integration of these diverse types of evidence is crucial to support the implementation of new practices and ensure they are effective and relevant to clinical settings..

[Audio] "Next, we have Context. Context refers to the setting in which the evidence-based practices are implemented. Key elements of context include the organizational culture, leadership support, and evaluation methods. A positive and supportive context is essential for the successful implementation of evidence-based practices. It helps determine how well the evidence can be integrated into everyday practice." Rycroft-Malone, & et al. (2013)..

[Audio] "Finally, we have Facilitation. Facilitation involves the processes and activities that support the implementation of evidence-based practices. Facilitators play a crucial role in providing guidance, support, training, and resources to healthcare teams. The goal of facilitation is to ensure a smooth and effective implementation process, addressing any barriers that may arise along the way." Rycroft-Malone, & et al. (2013)..

[Audio] Let's look at the application of the PARiHS Framework. Numerous case studies from healthcare settings demonstrate its effectiveness. By applying the PARiHS Framework, healthcare providers have seen improved patient care and enhanced clinical practices. The framework provides a structured approach to implementing change, ensuring that evidence-based practices are adopted successfully..

[Audio] Contextual analysis within the PARIHS framework serves as the foundation for successful implementation by examining the unique factors that shape how healthcare practices are adopted and integrated intodaily routines. It involves a systematic exploration of the organizational environment, culture, and resources to identify facilitators and barriers to change. Bergström & et al. (2020).

[Audio] Facilitation planning within the PARIHS framework is a dynamic and iterative process aimed at promoting sustainable change in healthcare practices. By integrating evidence, understanding context, and deploying effective facilitation strategies, healthcare organizations can enhance their capacity to implement and sustain evidence-based practices, ultimately improving patient care and outcomes. Bergström & et al. (2020).

[Audio] Now, let's discuss the implementation phase within the PARiHS Framework. Implementation is a critical stage where the evidence-based practices are put into action. The framework emphasizes a structured approach, integrating evidence, context, and facilitation to ensure successful implementation. During this phase, it's essential to: Engage stakeholders, including healthcare providers, patients, and leadership, to gain their support and commitment. Provide comprehensive training and resources to the implementation team to ensure they are well-prepared and confident in their roles. Establish clear communication channels to facilitate ongoing dialogue and feedback among all involved parties. Monitor the implementation process closely, identifying and addressing any barriers or challenges that arise. By carefully managing these aspects, the PARiHS Framework helps ensure that evidence-based practices are effectively integrated into routine clinical workflows, leading to improved pat Evaluation is another crucial component of the PARiHS Framework, as it allows us to assess the effectiveness and impact of the implemented practices. The evaluation process involves several key steps: Define clear, measurable outcomes that align with the goals of the implementation. Use both qualitative and quantitative methods to gather data on the implementation process and its impact. This may include patient outcomes, provider satisfaction, and the overall change in clinical practices. Regularly review and analyze the collected data to identify trends, successes, and areas needing improvement. Share the evaluation findings with all stakeholders to ensure transparency and foster a culture of continuous improvement. Use the insights gained from the evaluation to refine and optimize the implementation process, making necessary adjustments to enhance effectiveness. By prioritizing evaluation, the PARiHS Framework ensures that evidence-based practices are not only implemented but also sustained and continually improved, leading to lasting benefits in healthcare delivery." Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C., Crichton, N., Allen, C., Bullock, I., & Strunin, L. (2013)..

[Audio] "Ensuring the sustainability of evidence-based practices is a key objective of the PARiHS Framework. Sustainability refers to the ability of these practices to be maintained and integrated into routine healthcare operations over the long term. To achieve sustainability, it's important to: Embed Practices into Organizational Culture: Ensure that the evidence-based practices align with the values and goals of the organization. This creates a supportive environment where these practices can thrive. Ongoing Training and Support: Provide continuous education and resources to healthcare providers. This helps them stay up-to-date with best practices and feel confident in their implementation. Continuous Monitoring and Evaluation: Regularly assess the effectiveness and impact of the practices. Use the findings to make necessary adjustments and improvements. Engage Leadership: Secure ongoing support from leadership to allocate resources and champion the sustained use of evidence-based practices. Foster a Learning Environment: Encourage open communication and feedback to promote a culture of learning and adaptation. By focusing on these strategies, the PARiHS Framework helps ensure that evidence-based practices are not only implemented successfully but also sustained over time, leading to lasting improvements in healthcare quality and patient outcomes." "Scaling evidence-based practices involves expanding their implementation to broader settings or larger populations. The PARiHS Framework provides a structured approach to achieve this scaling effectively. To successfully scale practices, consider the following steps: Identify Core Elements: Determine the key components of the practice that are essential for its success. Ensure these elements are maintained during scaling. Adapt to New Contexts: While maintaining core elements, adapt the practice to fit the unique needs and contexts of new settings. This includes considering cultural, organizational, and resource differences. Build Capacity: Develop the skills and capabilities of new implementation teams through training and support. This prepares them to effectively adopt and sustain the practices. Leverage Partnerships: Collaborate with other organizations, stakeholders, and networks to share resources, knowledge, and experiences. This fosters a supportive environment for scaling. Monitor and Evaluate: Continuously assess the scaling process to identify challenges and successes. Use this feedback to refine strategies and ensure effective implementation in new settings. Scaling evidence-based practices through the PARiHS Framework ensures that the benefits of these practices are extended to more patients and healthcare settings, ultimately enhancing the overall quality of care." Reference: Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C., Crichton, N., Allen, C., Bullock, I., & Strunin, L. (2013)..

[Audio] "In conclusion, the PARiHS Framework integrates evidence, context, and facilitation to promote the effective implementation of evidence-based practices in healthcare. It offers a comprehensive model that guides healthcare improvements and ensures that new practices are grounded in solid evidence, supported by a positive context, and facilitated effectively.".

References. Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci. 2020 Aug 27;15(1):68. doi: 10.1186/s13012-020-01003-0. PMID: 32854718; PMCID: PMC7450685. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (2018). "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American Journal of Preventive Medicine, 14(4), 245-258. 3. Rycroft-Malone, J. (2014). The PARIHS framework—a framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297-304. 4. Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C., Crichton, N., Allen, C., Bullock, I., & Strunin, L. (2013). The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implementation Science, 8(1), 28..