title: Integrative review of benefit levers' characteristics for system-wide spread of best healthcare practices.
abstract: OBJECTIVE
  To critically analyse the characteristics of the benefit levers that are required for effective system-wide spread of evidence-based practice.
  
  
  BACKGROUND
  Evidence-based nursing practice is the cornerstone of quality patient care and merits system-wide implementation. Achieving system-wide spread of evidence-based innovations requires adoption of four benefit levers (the facilitators for spreading innovations), conceptualized by Edwards and Grinspun: alignment, leadership for change, permeation plans and supporting and reinforcing structures. Although these concepts have been explored and described in primary studies, they were only recently identified as benefit levers and their characteristics have not been reviewed in the context of health care using an integrative literature review.
  
  
  METHODS
  An integrative literature review using an adapted Whittemore and Knafl design.
  
  
  METHODS
  A comprehensive search using multiple sites such as Scopus, EBSCOhost, ProQuest, ScienceDirect, Cochrane Library, Nexus, SAePublications, Sabinet, Google Scholar and grey literature was conducted (January-March 2012) and updated (December 2014). After reading the abstracts, titles and full-text articles, forty (N = 40) research and non-research documents met the inclusion criteria.
  
  
  METHODS
  Thirty-five documents remained after critical appraisal. A systematic approach was used to analyse and synthesize the data and formulate concluding statements.
  
  
  RESULTS
  Data revealed characteristics about alignment (personal, organizational and contextual attributes), permeation plans (phases), leadership for change (types, strategies, position, attitude and support) and supporting and reinforcing structures (types and requirements).
  
  
  CONCLUSIONS
  Benefit levers should be used to promote the spread of evidence-based practices. However, more studies concerning benefit levers, specifically regarding 'alignment' and 'permeation plans', are required to promote system-wide spread of best healthcare practices.
authors.affiliation: Department of Nursing Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa.
authors.forename: Wilma
authors.initials: W
authors.lastname: ten Ham
authors.affiliation: INSINQ Research Focus Area, Potchefstroom Campus, North-West University, South Africa.
authors.forename: Karin
authors.initials: K
authors.lastname: Minnie
authors.affiliation: INSINQ Research Focus Area, Potchefstroom Campus, North-West University, South Africa.
authors.forename: Christa
authors.initials: C
authors.lastname: van der Walt
mesh_terms: D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards*; D055318:Evidence-Based Nursing / Q000379:methods* / Q000592:standards*; D006801:Humans; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic
keywords: benefit levers; best practices; evidence-based practice; implementation; innovation; integrative literature review; nurses; nursing; spread