1. There is seldom one simple explanation for any gap between evidence and practice. Obstacles to (and enablers of) change operate at one or more of system, team, professional and patient levels. Plans to tackle evidence-practice gaps usually need coordinated efforts across different levels.
2. It is unlikely that you will be able to address all barriers. Focus on those you judge most important and are able to change.
3. Lack of knowledge is seldom the main explanation for evidence-practice gaps. Consider wider factors such as ‘know-how’ (practical knowledge and skills), recall (being prompted to do the right thing at the right time for the right patient), and having sufficient time and resources (of course).
4. Consider what you can stop doing in order to make more time for the evidence-based practices and actions you really, really want to do.
5. Consider the effectiveness and possible unintended consequences when choosing an approach to change practice. For example, computerised prompts can help change specific behaviours (such as prescribing or test ordering) and are more likely to work if users need to provide a justification for over-riding recommendations. But people will circumvent them if they are too intrusive or disruptive.
6. Effective action plans turn long-term goals into small manageable steps; these work best of they are specific, realistic and to the point.
7. Set realistic goals for change which are genuinely achievable, not fanciful.
8. Ensure that any goals for change are within the control of the people who need to change. That sounds rather obvious but is easily overlooked.
9. Focus on making changes to clinical practice which are supported by the strongest clinical evidence.
10. Making continuous and cumulative improvements in evidence-based care can deliver major improvements in population health.
