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The ARCC model — Advancing Research and Clinical practice through close Collaboration — implements evidence-based practice (EBP) through a different mechanism than the Iowa Model or the Johns Hopkins Nursing EBP Model (PET). Those two are decision-pathway and appraisal-process frameworks: a trigger enters a sequence of gates or a Practice question/Evidence/Translation cycle, and the model’s job is to structure that sequence. ARCC starts somewhere else entirely — with an assessment of the organisation’s culture and readiness for EBP — and its central mechanism isn’t a gate or a cycle, it’s a person: the EBP mentor, a clinician who works directly with point-of-care staff to build EBP skills and sustain the change. That’s the distinction worth understanding before choosing a model: ARCC is built for organisations that already know EBP knowledge and belief in EBP aren’t the same thing, and that closing the gap between them takes ongoing coaching, not a better checklist.
Where ARCC Comes From
ARCC was developed by Bernadette Melnyk and Ellen Fineout-Overholt, whose research programme has produced most of the model’s validated instruments and outcome studies. Representative primary sources:
- Melnyk, B.M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). “A Test of the ARCC© Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes.” Worldviews on Evidence-Based Nursing.
- Melnyk, B.M., Tan, A., Hsieh, A.P., & Gallagher-Ford, L. (2021). “Evidence-Based Practice Culture and Mentorship Predict EBP Implementation.” Worldviews on Evidence-Based Nursing.
- Melnyk, B.M., Hsieh, A.P., & Mu, J. (2022). “Psychometric Properties of the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice.” Worldviews on Evidence-Based Nursing, 19(5), 380–387.
- Melnyk, B.M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). “Correlates Among Cognitive Beliefs and EBP Mentors.” Nursing Outlook.
The developers describe ARCC as grounded in Cognitive Behavioral Theory and Control Theory — the working idea being that a clinician’s beliefs about whether EBP is worth the effort and whether they’re capable of doing it (not just their knowledge of the steps) are what actually predict whether a practice change sticks. That’s why the 2010 and later ARCC studies measure EBP beliefs as a formal variable alongside EBP implementation, and why the model treats belief-building — something a mentor does, not something a protocol document does — as core rather than incidental.
The EBP Mentor Is the Active Ingredient
In ARCC, the EBP mentor isn’t an add-on role bolted onto a process model — the mentor is the implementation strategy. An EBP mentor is typically an advanced practice nurse or experienced clinician with three things Melnyk and colleagues’ instruments are built to measure separately: in-depth knowledge and skill in the EBP process itself, mentoring and coaching skills for working one-on-one with point-of-care staff, and individual and organisational change-management skills for the parts of implementation that have nothing to do with appraising evidence — scheduling, workflow friction, unit culture, resistance.
Two things follow from putting a person at the centre of the model rather than a document or a gate. First, ARCC scales through relationships, not paperwork: a mentor works alongside a handful of clinicians at a time, embedded on the unit, present for the parts of practice change that a written protocol can’t anticipate. Second, the model needed — and now has — a validated way to measure mentor capacity directly rather than assuming it: Melnyk, Hsieh, and Mu’s 2022 psychometric validation of the EBP Mentorship Scale gives organisations an instrument to assess mentors’ own competency, not just count how many mentor job titles exist on an org chart.
It Starts With an Organisational Culture and Readiness Assessment
Where Iowa starts with a trigger and JHNEBP starts with a practice question, ARCC starts with the organisation itself. Before any mentor is deployed or any protocol is written, ARCC calls for assessing organisational culture and readiness for system-wide EBP integration — using the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRS), the instrument Melnyk and colleagues formally validated in their 2022 psychometric study (Worldviews on Evidence-Based Nursing, 19(5), 380–387).
The point of running this assessment first, rather than jumping straight to a clinical question, is to surface the organisational-level barriers and facilitators that determine whether mentor-led implementation has anywhere to land: leadership visibility and support for EBP, whether time and resources are actually allocated (not just endorsed in a mission statement), how clinicians currently rate their own EBP beliefs and implementation behaviours, and where existing pockets of EBP mentorship or champions already exist to build on. A unit that scores low on readiness needs a different first move — leadership engagement, protected time, an initial mentor cohort — than one that scores high and can move straight to point-of-care coaching. Skipping this step is the most common way an ARCC-labelled initiative fails: deploying mentors into a culture that hasn’t been assessed, and discovering the barrier was never clinical knowledge in the first place.
How the ARCC Cycle Runs in Practice
Put together, the model runs as an ongoing cycle rather than a one-time rollout:
- Assess organisational culture and readiness using the OCRS (or an equivalent locally-adapted instrument), identifying strengths to build on and barriers to address before deployment.
- Identify and prepare EBP mentors — clinicians with (or being developed toward) the EBP-process, coaching, and change-management skills the role requires, assessed against an instrument like the EBP Mentorship Scale rather than assumed from seniority alone.
- Deploy mentors at the point of care, working directly with clinicians on specific practice questions — coaching through evidence appraisal, protocol development, and the workflow adjustments a practice change actually requires.
- Build supporting infrastructure — evidence-based clinical protocols and algorithms, EBP rounds, journal clubs — that give mentored clinicians places to practise and reinforce EBP skills between one-on-one coaching sessions.
- Evaluate outcomes across three levels — clinician-level (EBP beliefs and implementation behaviours), and patient/system-level (the outcomes the practice change was meant to affect) — and feed what’s found back into mentor support and the next readiness assessment.
Nothing in that cycle is a go/no-go gate the way Iowa’s decision points are, and nothing in it is an appraisal-tool step the way JHNEBP’s Evidence phase is. The cycle repeats and compounds: each round of mentoring should leave the unit with more mentor capacity and higher measured EBP beliefs than the round before, which is the specific, measurable thing ARCC’s own instruments are designed to track over time.
An Illustrative Readiness-Assessment Walkthrough
The scenario and numbers below are an illustrative composite, generated for this explanation and not drawn from any real unit, organisation, or published study — they exist only to show the arithmetic a readiness assessment involves, not to represent a real result. Suppose a 12-person unit completes a 6-item, 1–5 Likert-style organisational-readiness style survey ahead of a mentor-deployment decision. Averaging responses gives a per-item mean and an overall mean:
- Per-item means across the 6 items: 2.75, 2.92, 3.33, 2.92, 3.08, 2.67 (out of 5)
- Overall mean across all 72 responses: 2.95 out of 5
A unit reading a result clustered in the middle of the scale, like this one, with no single item standing out as unusually low, is exactly the case where ARCC’s design matters most: there’s no single obvious barrier to fix first, which is the signal for starting with broad mentor engagement and leadership visibility rather than one targeted intervention. A unit whose lowest item stood out much further below the others — say, leadership support scored well below every other item — would instead point at a specific, narrower fix before mentors are deployed at all. The exercise is illustrative of that reasoning, not a claim about what any real organisation would find.
ARCC vs Iowa vs JHNEBP
All three are legitimate, widely-used EBP implementation models; they answer different organisational needs, not competing versions of the same idea:
- Iowa Model — best fit when the organisation already has a specific trigger (a clinical problem or new evidence) and needs a structured decision pathway, including explicit “no” branches, to decide whether and how to act. See the Iowa Model guide.
- Johns Hopkins Nursing EBP Model (PET) — best fit when the organisation needs a practice-question-driven process bundled with its own evidence-appraisal tools, so individual clinicians or teams can grade evidence quality without borrowing an instrument from elsewhere. See the JHNEBP guide.
- ARCC — best fit when the organisation’s actual barrier isn’t a single decision or a single evidence question, but sustaining EBP behaviour and belief across a whole unit or system over time, and it’s willing to invest in dedicated mentor capacity to do that.
They aren’t mutually exclusive: an organisation running ARCC can still use JHNEBP’s appraisal tools for the “how do we grade this evidence” step inside a mentor-led project, the same way CASRAI’s model-selection guide discusses combining Iowa’s gate structure with JHNEBP’s appraisal instruments. What ARCC adds that neither of the other two is built to provide is the organisational-readiness assessment up front and the ongoing mentor relationship that sustains the change afterward.
When ARCC Fits — and When It Doesn’t
- Fits: system-wide or unit-wide EBP initiatives where sustaining behaviour change over months, not a single decision, is the actual challenge; organisations able to release staff into a real EBP mentor role, not just an honorary title; settings where an organisational culture/readiness assessment is itself useful information, not a formality to skip.
- Doesn’t fit: a single clinician working through one specific practice question alone, with no organisational mentoring infrastructure available — that’s closer to what the Stetler Model of research utilisation is built for. It also doesn’t fit an organisation that needs a bundled evidence-appraisal instrument as the main gap; JHNEBP is the more direct answer there.
Frequently Asked Questions
Do you need a formal EBP mentor job title to use the ARCC model?
No, but you do need someone functioning in that role with real coaching time protected for it. ARCC’s own instruments (the EBP Mentorship Scale, the OCRS) are built to assess actual mentor competency and organisational readiness, not job-title presence — an unstaffed “EBP mentor” line on an org chart doesn’t produce the model’s mechanism.
Is the organisational-readiness assessment a one-time step?
It’s the starting point of each cycle, not a single gate passed once. Because ARCC treats outcomes evaluation as feeding back into the next round of mentor support, re-assessing culture and readiness periodically is part of how the model is meant to run, not an optional add-on.
How is ARCC different from just “having EBP champions”?
An informal champion role usually has no assessment instrument behind it and no protected coaching time built in. ARCC’s mentor role is specifically defined against validated measures of EBP-process knowledge, coaching skill, and change-management skill, and the model expects mentors to work directly and repeatedly with point-of-care clinicians rather than serving as an informal internal advocate.
Can ARCC and the Iowa Model or JHNEBP be used together?
Yes — they operate at different levels. ARCC’s mentor and readiness-assessment layer can sit around a specific decision pathway (Iowa) or appraisal process (JHNEBP) that a mentored team is working through for one practice question, without conflict.
