The Implementation of Evidence to Improve Falls Prevention: Lessons from a Case Study in Aged Care

Purpose: This paper reports on a study investigating the construction of falls prevention evidence within an aged care organization. It describes how the structure and culture of an aged care organization influences the construction of falls prevention evidence by staff. Method: An instrumental single case study design grounded in an interpretive, constructivist paradigm drew on data collected in 2010 from a document review, observations, and informal interviews with nursing and allied health staff. An iterative analysis used a model of diffusion determinants. Results: The aged care organization which served as the case for this study linked its cultural strengths of vision, leadership, and innovativeness with its decision making structures to resources from its external environment to implement falls prevention strategies that were both best practice and innovative. The case study demonstrated that in addition to known individual and organizational barriers to the use of evidence, the nature of evidence itself can act as a barrier when it is constructed into a norm which directs practice in a particular direction thus obscuring alternatives. Conclusion: Organizations can reflect on how their culture and structure can influence the effective use of evidence, the contribution to creating a social norm that inhibits the creative research, and the management required to address complex health issues.