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Over the past several decades, the paradigm of risk has become increasingly salient for understanding how health care is provided. In more recent years, we have seen an expanding body of literature...

Background Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. Methods A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved. Results Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints? Conclusions This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.

Background It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. Methods This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. Discussion Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621. Electronic supplementary material The online version of this article (10.1186/s13012-018-0752-7) contains supplementary material, which is available to authorized users.

Access to drinkable water is essential to human life. The consequence of unsafe drinking water can be damaging to communities and catastrophic to human health. Today, one in five First Nation communities in Canada is on a boil water advisory, with some advisories lasting over 10 years. Factors contributing to this problem stretch back to colonial structures and institutional arrangement that reproduce woefully inadequate community drinking water systems. Notwithstanding these challenges, First Nation communities remain diligent, adaptive, and innovative in their efforts to provide drinkable water to their community members. One example is through the practice of source water protection planning. Source water is untreated water from groundwater or surface water that supplies drinking water for human consumption. Source water protection is operationalized through land and water planning activities aimed at reducing the risk of contamination from entering a public drinking water supply. Here, we introduce a source water protection planning process at Muskowekwan First Nation, Treaty 4, Saskatchewan. The planning process followed a community-based participatory approach guided by trust, respect, and reciprocity between community members and university researchers. Community members identified threats to the drinking water source followed by restorative land management actions to reduce those threats. The result of this process produced much more than a planning document but engaged multiple community members in a process of empowerment and self-determination. The process of plan-making produced many unintended results including human&ndash, land connectivity, reconnection with the water spirit, as well as the reclaiming of indigenous planning. Source water protection planning may not correct all the current water system inadequacies that exist on many First Nations, but it will empower communities to take action to protect their drinking water sources for future generations as a pathway to local water security.