Integrative review of benefit levers’ characteristics for system-wide spread of best healthcare practices

Aim To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice. Background Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun: alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review. Design An integrative literature review using an adapted Whittemore and Knafl design. Data sources A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Google Scholar and grey literature was conducted (January-March 2012) and updated (December 2014). After reading the abstracts, titles and full-text articles, forty (N = 40) research and non-research documents met the inclusion criteria. Review methods Thirty-five documents remained after critical appraisal. A systematic approach was used to analyse and synthesize the data and formulate concluding statements. Results Data revealed characteristics about alignment (personal, organizational and contextual attributes), permeation plans (phases), leadership for change (types, strategies, position, attitude and support) and supporting and reinforcing structures (types and requirements). Conclusion Benefit levers should be used to promote the spread of evidence-based practices. However, more studies concerning benefit levers, specifically regarding ‘alignment’ and ‘permeation plans’, are required to promote system-wide spread of best healthcare practices.