Evidence for the P.I.E.C.E.S. ™ Model

Evolution of the P.I.E.C.E.S.™ Model

The P.I.E.C.E.S.™ Learning and Development Model, which has been used widely across Canada for the last 18 years, originated in 1997 with the announcement of Ontario’s Strategy for Alzheimer Disease and Related Dementias (ADRD). The Ontario Strategy, the first comprehensive approach to Alzheimer Disease in Canada, invested a total of $68.4 million between 1999 and 2004. The Strategy included ten distinct but related initiatives focused on enhancing the quality of life for people living with ADRD, and their caregivers. Together, the ten initiatives addressed:

  • education for health care providers, caregivers and the public
  • service enhancements and expansion
  • research activities and knowledge exchange

Ontario’s Strategy for Alzheimer Disease and related Dementias (ADRD) involved a joint initiative between the Ministry of Health and Long-Term Care and the Ontario Seniors’ Secretariat (within the Ministry of Citizenship and Immigration).

Since 1999 the P.I.E.C.E.S.™ Learning and Development Model has been included in other government driven strategies across Canada to support changing relationships in health and health care. Through continuous improvement, spread and sustainability activities the approach continues to evolve.

Evaluation Reports and Relevant Literature

Evaluation reports and relevant literature include:

  1. Broad ML (2005) Beyond Transfer of Training: Engaging Systems to Improve Performance. Pfeiffer: San Francisco, CA
  2. Cross J (2007) Informal Learning: Rediscovering The Natural Pathways the Inspire Innovation and Performance. John Wylie & Sons Inc.: San Francisco, CA
  3. Coulter A. & Ellins J. (2007). Effectiveness of Strategies For Informing, Educating and Involving Patients. British Medical Journal 335(7609) 24-27.
  4. Graham ID, Logan J, Harrison MB, Strauss SE, Tetroe J, Caswell W & Robinson N. (2006) Lost in Translation: Time for a Map? Journal of Continuing Education and Health Professionals. 26(1) 13-24.
  5. Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B & Seers K (2002). Getting Evidence into Practice: The Role and Function of Facilitation. Journal of Advanced Nursing. 37(6) 577-588.
  6. Helfrich CD, Li YF, Sharp ND & Sales AE (2009). Organizational Readiness to Change Assessment (ORCA): Development of an Instrument Based on the Promoting Action on Research in Health Services (PARIHS) Framework. Implementation Science. 4. 38.
  7. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K & Titchen A (2008). Evaluating the Successful Implementation of Evidence into Practice Using the PARIHS Framework: Theoretical and Practical Challenges. Implementation Science. 3(1)
  8. Knowles MS, Holton EF & Swanson RA. (2005) The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. Butterworth – Heinemann: Burlington, MA.
  9. McAiney CA, Stolee P, Hillier LM, Harris D, Hamilton P, Kessler L, Madsen V & Le Clair K. (2007) Evaluation of the Sustained Implementation of a Mental Health Learning Initiative in Long-Term Care. International Psychogeriatrics. 19.
  10. McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A & Seers K. (2002). Getting Evidence into Practice: The Meaning of Context. Journal of Advanced Nursing. 38 (1) 94-104.
  11. Pershing, J (2006) Handbook of Human Performance Technology. Pfeiffer: San Francisco, CA
  12. Rycroft-Malone J (2004) The PARIHS Framework: A Framework for Guiding the Implementation of Evidence Based Practice. Journal of Nursing Care Quality. 19(4) 297-304.
  13. Rycroft–Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A & Estabrooks C. (2002) Ingredients for Change: Revisiting a Conceptual Framework. Qual Saf Health Care 11. 174 – 180
  14. Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A & McCormack B (2004). What Counts As Evidence in Evidence-Based Practice? Journal of Advanced Nursing. 47 (1) 81-90.
  15. Ryan, D et al. (November 5 2009) P.I.E.C.E.S.™ and U-First! In Ontario: The Perceptions of Four Stakeholder Groups. Prepared for the Ontario Community Service Association.
  16. Sinclair C & Puckniak J. Reduction of Antipsychotics Resulting in Savings of 400,000 in Six Months Using the P.I.E.C.E.S.™ Model and Quality Improvement. Winnipeg Regional Health Authority Briefing Note on CFHI Website.
  17. Stolee P, McAiney CA, Hillier L, Harris D, Hamilton P, Kessler L, Madsen V & Le Clair K (2009). Sustained Transfer of Knowledge to Practice in Long-Term Care: Facilitators and Barriers of a Mental Health Learning Initiative. Gerontology and Geriatric Education. 30(1) 1-20.
  18. Stolovitch HD & Keeps EJ. (2002) Telling Ain’t Training. American Society for Training & Development: Alexandria, VA
  19. Strauss S, Tetro J & Graham ID (2009) Knowledge Translation into Healthcare: Moving Evidence to Practice. BMJ Books.
  20. Strauss SE, Tetro J & Graham ID (2011). Knowledge Translation is the Use of Knowledge in Healthcare Decision Making. Journal of Clinical Epidemiology. 64(1) 6-10.
  21. Sullivan MP, Kessler L, Leclair JK, Stolee P & Berta W. (2004) Defining Best Practices for Specialty Geriatric Mental Health Outreach: Lessons for Implementing Mental Health Reform. Canadian Journal of Psychiatry. 49(7).
  22. Vella J. (2000) Taking Learning to Task: Creative Strategies for Teaching Adults. Jossey-Bass: San Francisco, CA


“I have nothing but good things to say. The course was easy to follow, the structure of the course was well laid out, the communication in the class was excellent and hearing all sides of the spectrum helped me understand P.I.E.C.E.S much better. I enjoyed the games, which made the course fun and easy to learn, communicating with other nurses and hearing other points of views that I had not thought of before. I thank you for a wonderful learning experience, and feel 100% more confident using P.I.E.C.E.S. in my work place setting! What a great tool to accurately assess residents without missing any important pieces of the puzzle and what an appropriate name for it, P.I.E.C.E.S. “
 – P.I.E.C.E.S. Learner

“The P.I.E.C.E.S. program has enhanced my nursing practice, it has given me an opportunity to look deeper into the behaviours of my residents. The program was very informative and well presented.” – P.I.E.C.E.S. Learner

“There is a need for all disciplines caring for patients to be educated in this program.” –  P.I.E.C.E.S. Learner

“I enjoyed all the new aspects of learning and can definitely incorporate it into my working field. I am looking forward to using this course information to benefit the resident/patient. Also, it helps that a lot of our regulated staff took this course and we are all on the same page to promote better health for the patient/resident. I will HIGHLY recommend and encourage other staff to take this course.” – P.I.E.C.E.S. Learner

“I work on a behavioural floor, the assessment tool will help my day to day practice.” –  P.I.E.C.E.S. Learner

“P.I.E.C.E.S. is a great model that allows comprehensive assessment and encourages inter-collaboration with different health care sectors, which I really like.” – P.I.E.C.E.S. Learner

“This was a very informative course. I feel that I learned a lot which I will be able to bring back and implement into my day to day practice! Thank you for making it so interesting and interactive!” – P.I.E.C.E.S. Learner