Evidence-Based Practice (EBP) is the process of combining the best available research evidence with clinical expertise and patient values to make informed healthcare decisions. The Iowa Model of Evidence-Based Practice is a systematic framework designed to guide institutions through the translation of knowledge into practice. Developed primarily within the nursing discipline, this model provides a structured algorithm to ensure that changes in care delivery are grounded in the most current and reliable evidence. It serves as a pragmatic guide for improving patient outcomes and enhancing the quality of care across various healthcare settings.
Core Purpose and Foundational Principles
The primary goal of the Iowa Model is to bridge the gap between what is known from research and what is actually done in clinical practice. This framework was first developed by nurses and researchers at the University of Iowa Hospitals and Clinics (UIHC) to structure the process of integrating research into care delivery. Unlike models focused on individual practitioners, the Iowa Model emphasizes organizational change, aiming to establish new practices that become standardized within the entire healthcare system. It is designed to be flexible and adaptable, recognizing that each institution has unique priorities, resources, and patient populations. The model is also intentionally cyclical, meaning that the evaluation of a new practice feeds back into the system, potentially generating new questions for improvement in a continuous loop.
Identifying the Need for Change (Triggers)
The systematic process within the Iowa Model begins with the identification of a “trigger” that signals an opportunity or need for practice change. These triggers fall into two main categories: problem-focused and knowledge-focused, clearly defining the impetus for the EBP project.
Problem-focused triggers originate from undesirable clinical issues or internal organizational data, such as a sustained, high rate of catheter-associated urinary tract infections (CAUTIs) or unnecessary patient readmissions. Knowledge-focused triggers, conversely, arise from new information that suggests a better way to deliver care, such as a newly published systematic review or the release of new national clinical practice guidelines. The model emphasizes that regardless of the source, the identified topic must align with the organization’s strategic goals and be a priority for the institution before proceeding.
The Step-by-Step Implementation Process
Once a priority trigger is identified, the process moves quickly into the structured phase of implementation, beginning with forming a dedicated, interdisciplinary team. The team’s first major task is the systematic search, appraisal, and synthesis of all available evidence related to the practice question. They critically evaluate the quality and consistency of the research findings, often using established systems to grade the strength of the evidence.
A crucial decision point follows this evidence review: is there sufficient evidence to support a change in practice? If the evidence is insufficient, the process is temporarily halted, and the team may conduct further research. If the evidence is strong, the team designs a localized protocol for the practice change, which is then tested through a pilot implementation to assess the change’s feasibility and effectiveness within a specific unit or patient population. Based on the results of the pilot, the team makes the final decision to adopt the new practice, reject it, or modify it before moving to full integration across the organization.
Evaluation and Sustaining Practice Change
The culmination of the Iowa Model’s effort is the integration and long-term sustainment of the successful practice change across the entire organization. Integration involves formally incorporating the new protocol by updating organizational policies, procedures, and clinical manuals. Simultaneously, the team develops a comprehensive evaluation plan to measure the impact of the change using various metrics, such as patient outcomes and cost-effectiveness.
Sustaining the change requires continuous monitoring and maintenance to ensure the new practice does not degrade or revert to the old way over time. This involves ongoing quality improvement efforts, regular audits, and “hardwiring” the change into the system through education and documentation. The final step involves disseminating the results throughout the organization and externally, which completes the cycle and potentially creates a new trigger for future EBP projects.