# Presentation: 356783

## PARiHS FrameworkPromoting Action on Research Implementation in Health Services

**Spinal Cord Injury QUERI IRC**
**Philip M. Ullrich, Ph.D. **
**Spinal Cord Injury QUERI IRC**

**Philip M. Ullrich, Ph.D. **
**Spinal Cord Injury QUERI IRC**

**PARiHS Framework****Promoting Action on Research ****Implementation in Health Services**

## PARiHS Framework: History Features Proposed utility Future work

**Spinal Cord Injury QUERI IRC**
**Philip M. Ullrich, Ph.D. **
**Spinal Cord Injury QUERI IRC**

**PARiHS Framework:**** History**** Features**** Proposed utility**** Future work**

**Notes:**
History and development

Nature 

## PARiHS Origins

**Royal College of Nursing Institute, UK**
**1990s**

**Contemporary models of the processes of implementing research into practice are inadequate.**
**Unidimensional**
**Non-interactive**

**Notes:**
Premise: Contemporary models of the processes of implementing research into practice are inadequate

RCN worked on the development of a conceptual framework which represents the interaction of numerous factors influencing the uptake of research evidence into practice.  

## PARiHS Framework developmental aims:

**Accurately represent the complexities of implementation.**

**Useful for guiding clinicians charged with implementing research into practice.**

** ****Useful for explaining variability in the**
**   ****success of implementation projects.**

**Notes:**
RCN began developing the PARiHS framework to be 
Representative of the complexities of factors influencing the uptake of research evidence into practice

used by researchers to explain variability in success of implementation projects
Help clinicians think about implementation strategies..  

## PARiHS Framework Elements

**Evidence.**
**Context.**
**Facilitation.**

**Notes:**
I first want to introduce the framework in terms of its primary factors or elements.

The PARiHS framework proposes that successful implementation of evidence into practice is a function of three broad interactive elements (evidence, context, and facilitation).  I will describe each element in turn, noting specific subelements that are part of the framework. 

## Evidence Sub-elements:

**Research evidence.**
**Low: Anecdotal evidence, descriptive.**
**High: RCTs, evidence-based guidelines.**

**Clinical experience.**
**Low: Expert opinion divided.**
**High: Consensus.**

**Patient preferences and experiences.**
**Low: Patients not involved.**
**High: Partnership with patients.**

**Local information.**

**Notes:**
Research: RCTs, systematic reviews, evidence-based guidelines
Clinical: clinical experiences reflected upon and tested by individuals and groups

## Context Sub-elements:

**Culture.**
**Low: Task driven, low morale.**
**High: Learning organization, patient-centered.**

**Leadership.**
**Low: Poor organization, diffuse roles.**
**High: Clear roles, effective organization.**

**Evaluation.**
**Low: Absence of audit and feedback**
**High: Routine audit and feedback.**

**Notes:**
Culture

Leadership

Evaluation

## Facilitation Sub-elements:

**Characteristics (of the facilitator).**
**Low: Low respect, credibility, empathy.**
**High: High respect, credibility, empathy.**

**Role.**
**Low: Lack of role clarity.**
**High: Clear roles.**

**Style.**
**Low: Inflexible, sporadic.**
**High: Flexible, consistent.**

**Notes:**
Facilitation defined

Characteristics of facilitator

Role

Style

## PARiHS Framework: Elements and Subelements

**Evidence****.**
**Research**
**Clinical experience**
**Patient experience**
**Local knowledge**
**Context****.**
**Culture**
**Leadership**
**Evaluation**
**Facilitation.**
**Characteristics**
**Role**
**Style**

**Notes:**
So when the framework is viewed in its entire spectrum of elements and subelements, a greater appreciation for its complexity is gained.  

## PARiHS Framework

**Successful implementation is most likely to occur when:**
**Scientific evidence is viewed as sound and fitting with professional and patient beliefs.**

**The healthcare context is receptive to implementation in terms of supportive leadership, culture, and evaluative systems.**

**There are appropriate mechanisms in place to facilitate implementation.**

**Notes:**
Summarizing the model with its three elements.

## PARiHS Framework developmental history:

**1998 - 2002.  Development, conceptual analysis.**

**2003 to present.  Diagnostic/evaluative tool development.**

**2001-2003.  Empirical case studies.**

## PARiHS Framework current knowledge base:

**Numerous case reports available, in support of face validity and practical appeal.**

**Theoretical positions of the framework are still in development.**

**One published instrument related to PARiHS.**

## PARiHS Diagnostic and Evaluative utility?

- PARiHS Diagnostic and Evaluative grid:

**Kitson et al., 2008.**

**Notes:**

Proposed evaluative approach based upon PARiHS framework.

## Conclusions:

**PARiHS framework has long been the subject of theoretical development.**

**Empirical foundations for the framework have not developed at pace with theory.**

**Exploratory work in applying PARiHS to implementation interventions is encouraging.**

## PARiHS Framework future work:

**Develop methods for linking theory with specific interventions and tools.**

**Refine and clarify the framework .**

**Measure development and validation.**