Patterns of improvisation for evidence‐based practice in clinical settings

This paper describes our experiences from a two‐year research study to introduce evidence‐based practice (EBP) through a set of electronic information tools into two Canadian health regions. The improvisational model of technological change by Orlikowski and Hofman (1997) is used to provide the conceptual foundations for understanding the pattern of evolution associated with the tools observed in these two settings over time. Key areas to consider when changing practice identified from this study are time availability, intended use, adequate training, clinical champions, work practice fit, system refinement, around‐the‐clock support and environment influence. Health organizations should also distinguish anticipated, emergent and opportunistic changes and improvise accordingly when introducing EBP information tools in a setting that is characteristically complex, dynamic and unpredictable.