Bridging the gap between evidence and practice in Japan

Authors: Naoko Nishimura, Ryotaro Tsuchiya, Toyo Sakaguchi and Tomiko Toda

The term 'evidence-based medicine' has been used for over three decades since it was first established in the 1990s. However, Japan has only recently adopted this approach based on accumulated evidence from systematic reviews and other reputable sources.

Traditionally, Japanese nurses have relied on clinical experience, overlooking the value of synthesised evidence and implementation frameworks. Consequently, there is a prevailing sense of inadequacy in addressing the complexities of diverse health issues in Japan. Compounding this, there is a lack of systematic methods for sourcing evidence relevant to specific care fields and translating it into practice. Additionally, the nursing profession in Japan has yet to establish metrics for assessing the integration of evidence into practice or generating new evidence through research. In light of these challenges, it becomes imperative to establish measurable outcomes that demonstrate how evidence-based nursing care can enhance healthcare services in Japan.

The Otemae University Implementation Centre, A JBI Affiliated Group, was established in 2019, and the fourth center in Japan to adopt JBI methodology for evidence-based practice, which is underpinned by the JBI Model of Evidence-based Healthcare. Notably, in 2021, we commenced the Evidence Implementation Training Program (EITP), making Otemae University Implementation Centre the first in Japan to do so. Our objective was to introduce evidence-based practices to address challenges within our respective sites. The EITP initiative was embraced by staff from its inception and evolved into a cohesive group advocating for this methodology.

This report highlights three key factors that facilitated the transition from the introduction of the EITP to the establishment of an engaged evidence implementation organisation.

1. Topic selection

The first factor is the careful selection of a topic addressing timely issues perceived as needing improvement within the field. Just prioritising initiatives without considering the field's actual needs can lead to a disconnection between leadership and staff, resulting in passivity and demotivation among the team, ultimately jeopardising the project's success. However, through iterative discussions with frontline staff, thorough analysis of existing challenges, and the objective and subjective identification of essential themes, each team member was able to engage in the project with a genuine sense of urgency and purpose, rather than feeling compelled to participate.

2. Selecting the right implementation framework

Secondly, the EITP program operates within a structured framework derived from the JBI Model of Evidence-based Healthcare. This JBI Evidence Implementation Framework involves identifying issues, assessing baseline compliance, undertaking the GRiP (Getting Research into Practice) approach, and executing interventions and follow-up measures to yield outcomes. This systematic structure is crucial for ensuring that the program's objectives, timelines, team roles and specific tasks are easily comprehensible to core members, ward staff and frontline practitioners.

The program's adoption was facilitated by the clear framework and GRIP approach, which outlines a set matrix guiding the implementation process. Using JBI PACES software and JBI EBP Database audit criteria (accessible via JBI PACES), all these steps could be seamlessly conducted, ensuring a systematic organisation of the program. Following each step diligently allowed for clear traceability of actions leading to results.

3. Sustainability

In addition to the aforementioned cultural characteristics in Japan, the three project leaders identified other barriers that hinder sustainability. Evidence implementation is not a one-time project but must be sustainable.

Most Nurse Managers in Japanese hospitals regularly rotate and move to different wards. Therefore, to sustain evidence implementation, it is necessary to train the next leader before the leader who led the project moves on. In addition, training programs and work management that incorporates the latest evidence and practice in the field are fundamental to the continuation of clinical audit.

The Otemae University Implementation Centre is a member of the JBI Collaboration