Learning Objectives
By the end of this section, you will be able to:
- Define evidence-based practice
- Discuss the components of nursing research and its applicability to patient care
- Differentiate between evidence-based practice in nursing and nursing research
- Discuss the applicability and impact of quality improvement initiatives on patient care
The process of evidence-based practice involves making clinical decisions based on the best available evidence from the most up-to-date research. By keeping up with the latest research, nurses can implement EBP into their patient care. Nurses using EBP promote better outcomes with reduced costs and increased patient satisfaction. Implementing EBP requires lifelong learning and a desire for QI in your nursing practice. It also requires disseminating evidence-backed results so other nurses can implement the same processes into their own practice—with the ultimate goal of improving policies throughout the health-care system. The ultimate return on this investment will be nursing excellence.
EBP in Nursing
EBP enables nurses to implement best practices into patient care. Not only does EBP maintain the relevance of health-care practices, it also ensures practices remain current. Nurses involved in the delivery of care are instrumental in analyzing the data, or evidence, from current research and refining the processes related to QIs (which you will learn about later in this module). This firsthand knowledge is vital to continuous improvement of quality patient care.
EBP in nursing requires the critical thinking and judgment skills that come with experience and training. The nurse’s decision-making process should include using research-based evidence in combination with their clinical expertise while also incorporating the patient’s values and expectations into the process. This can be accomplished through the following actions:
- asking clear questions to determine the patient’s desired goals
- learning to locate evidence from credible sources and read research reports critically
- analyzing the validity of the evidence and research
- applying the evidence to clinical practice, combining your nursing expertise with the new information
- assessing the outcome to determine its efficacy and how it might benefit other patients
Using EBP in your nursing practice begins with identifying the specific issue or problem to solve. Nurses can then locate solutions that are appropriate for the population they are working with and share them with their patients and families to ensure they are part of the decision-making process. Doing all this enhances nursing autonomy, fine tunes critical thinking and confidence, and sharpens the nursing practice with new interventions and protocols.
Nurses who incorporate EBP into their practice also become more familiar with new technologies and treatments while promoting the growth of science in nursing and closing the gap between theory and practice. All these benefits help to ensure positive patient outcomes (Faubion, n.d.).
History of EBP in Nursing
Some believe the origins of EBP trace back to the 1800s, when Florence Nightingale gathered data and formulated conclusions related to unsanitary conditions and failing health while working as a nurse in military hospitals during the Crimean War (1854–1856). Nightingale brought to nursing a systemic, knowledge-based approach that relied on the best possible research and access to government statistics and expertise. Nightingale recognized that health data that governments routinely collected were not being used to inform decisions about health policy. Unfortunately, when Nightingale initially presented her ideas and philosophies, they were largely ignored, though her insights about using the best available evidence provided a useful framework for her own nursing practice.
The formal term evidence-based practice gained prominence in the latter part of the 20th century; however, along with Florence Nightingale, several major developments in the field of professional nursing paved the way for the integration of evidence into nursing care. Nursing research began gaining recognition as a formal field of study in the early to mid-20th century. The establishment of nursing research as a distinct field continued to evolve over several decades.
The late 19th to early 20th centuries saw a significant shift toward professionalism in nursing. For example, the National League for Nursing was established in 1893 and advocated for scientific principles in nursing education and practice. The nursing process began to emerge as a formal framework for EBP in the 1950s and 1960s. The introduction of the clinical nurse specialist role also occurred in the 1950s, reflecting a shift toward specialization and expertise within nursing. The mid-20th century saw the establishment and growth of nursing research journals, providing a platform for disseminating evidence. Then, during the 1970s and 1980s, there was an increased emphasis on developing evidence-based guidelines to standardize care. Systematic reviews and meta-analyses gained prevalence during this period.
The 1980s were also notable for the implementation of quality assurance (QA) programs. Hospitals began to implement QA programs to establish accountability to the community for appropriate, quality care and the associated costs. Eventually, The Joint Commission, formerly known as The Joint Commission on Accreditation of Healthcare Organizations, required QA programs for reimbursement of services and accreditation. The Joint Commission then developed a model that included objective, measurable indicators to monitor, evaluate, and communicate patient care.
By the 1990s, health-care providers had recognized the difficulty of using criteria from regulatory agencies to measure quality of care. These criteria measured minimal expectations but did not identify problematic causes or processes for improvement. The resulting movement, named Continuous Quality Improvement, seemed a more effective mechanism to improve the quality of health care. Whereas QA focuses on incidents and errors, Continuous Quality Improvement focuses on the interrelated processes that affect patient outcomes and satisfaction. Consequently, The Joint Commission revised its standards to affirm patients’ right to age-specific care that respects their dignity and their cultural, spiritual, and psychosocial values.
Nurses can be involved in QI in a variety of ways, including incorporating EBP into patient care guidelines. Because bedside nurses are involved in direct patient care, they are instrumental in analyzing the latest data and refining processes accordingly. Practicing EBP in this manner is a way to minimize the theory–practice gap. The theory–practice gap in nursing refers to the divide between theoretical knowledge acquired in academic settings and the practical application of that knowledge in real-world clinical settings. This gap can create challenges for nursing professionals as they attempt to translate theoretical understanding into effective patient care. Theoretical knowledge is essential for informed decision-making and EBP, but the ability to seamlessly apply that knowledge at the bedside is crucial for delivering quality patient care.
Nursing Research
Inquiry that is systematically designed to provide knowledge for important issues relevant to the nursing profession is considered nursing research. It is designed to generate evidence to help nurses make evidence-based decisions that improve the care and quality of life for their patients. Nursing research not only provides the data that inform EBP, it can also help in a variety of problem-solving situations. For example, by eliminating actions that do not achieve desired outcomes, nurses can help to contain the costs of care.
Approaches to Nursing Research
Many research opportunities and roles exist for nurses. As clinicians, nurses should remain informed about current issues and trends in their specialized area of clinical practice. Some nurses go further, using the best available clinical evidence to initiate QI projects in their practice. Other nurses become members of interprofessional teams to confront complex health problems, or they work as independent nurse-scientists and formulate a line of scientific inquiry. Researchers may conduct clinical studies to generate knowledge related to the guidance of clinical practice. They may work as a team, combining clinical, theoretical, and methodological skills to conduct collaborative studies. Regardless of one’s role, common goals of nursing research are to better understand factors that affect health and illness; to discover innovative methods to detect, diagnose, treat, and prevent disease; and to justify changes to ineffective practices.
Research does not have to be complex or long term. Consider a floor nurse who asks patients to complete a simple, anonymous survey about their satisfaction with their hospital experience. Patients’ responses can identify problems and point hospital staff toward potential solutions. Through these and other methods, each nurse can be a part of expanding the scope of nursing knowledge through the research they conduct, read, and disseminate.
Qualitative Research
A method called qualitative research focuses on personal experiences obtained through observation and interaction with patients. Table 1.3 describes common designs for qualitative research.
| Design | Goal | Process |
|---|---|---|
| Phenomenology | To describe a phenomenon as an individual experiences it | Researchers interview people familiar with the specific phenomenon being studied, then draw conclusions based on the data. |
| Grounded theory | To understand how people are influenced by their interactions with other people and groups (Noble & Mitchell, 2016) | After interviewing each patient and their family members, researchers use the data to develop a theory about what they observed (Noble & Mitchell 2016). |
| Ethnography | To understand the influences of culture on individuals | Researchers interview members of the culture being studied, then synthesize the data into a description of that culture’s unique characteristics and influences. |
| Narrative inquiry | To understand how an individual interprets specific events in their history | Researchers consider the content and structure of the narratives that each individual shares, then analyze each narrative for themes. |
Quantitative Research
A method called quantitative research uses deduction and generalization from empirical evidence to draw conclusions. Objective data gathered by the senses from observations or experiments is known as empirical evidence. It is generally depicted by numbers in charts and tables for statistical purposes. Examples include identifying percentages, averages, and the mean of data. Researchers then determine whether the evidence supports or refutes the theory in question and to what extent conclusions can be generalized to a larger population.
Quantitative research can be experimental or nonexperimental. Experimental studies have an active intervention that affects the study participants, whose response to the intervention is measured. Experimental designs require a control to establish a correlational relationship between variables or make justified predictions. The experiments are usually double blinded, meaning information that may influence the participant or the experimenter is withheld until after the experiment is complete. This prevents biases either from the participant’s expectations or the observer’s assumption, which may influence the results. For example, researchers studying a new medication would not know which of the participants receives the medication and which receives a placebo; the participants would also be unaware.
Experimental designs include true experimental design and quasi-experimental design. In a true experimental design, the experiment is conducted in a controlled environment to study relationships, usually among two groups who receive different treatments through a randomly assigned process. Pharmacology research is a classic example that demonstrates whether a medication has a desired effect on the participant. A quasi-experimental design is similar to a true experimental design except it does not include random assignments.
A nonexperimental study offers no new intervention; instead, researchers closely observe study participants to analyze their behavior, or they analyze existing data to find patterns. Nonexperimental designs include descriptive studies and correlation studies.
Descriptive studies involve observing people or phenomena to provide a detailed depiction. In these studies, the observer describes the observed phenomenon, notes the frequency of its occurrence, and categorizes the gathered information. Essentially, descriptive studies aim to offer a comprehensive account of the characteristics and occurrences related to the individuals or events under observation. For example, one might observe and document the care practices in a hospital’s critical care unit. The observer would detail the various nursing interventions performed (e.g., medication administration, wound care), note the frequency of each intervention, and categorize the information. In this descriptive study, the aim is to provide a comprehensive snapshot of the care activities in the critical care unit, shedding light on the common practices and their occurrence patterns.
Correlational studies focus on exploring the relationship between two variables. In these studies, researchers measure the identified variables, analyze the obtained data, and present their findings in statistical form. For example, a correlational study might investigate the relationship between the frequency of patient education sessions (variable A) and the level of patient adherence to a prescribed treatment plan (variable B). By measuring both variables and using statistical analyses, researchers can explore whether there is a correlation between the amount of education provided and the extent to which patients adhere to their recommended treatments. The results may help health-care professionals understand the potential impact of education on patient adherence.
Overview of the Nursing Research Process
The nursing research process is a systematic and organized approach nurse researchers follow to investigate and explore various aspects of nursing practice, patient care, and health-care outcomes. It involves a series of steps that guide the research process, from identifying a research problem to disseminating the findings. Here is a general description of the nursing research process:
- Identify the research problem: The first step is to identify a research problem or question that requires investigation. This can be derived from gaps in knowledge, clinical observations, or the need to improve patient outcomes.
- Review existing literature: Once the research problem is identified, a comprehensive review of existing literature is conducted. This helps the nurse researcher to understand what is already known about the topic and identify the research gaps that need to be addressed.
- Formulate research objectives or questions: Based on the identified research problem, clear and specific research objectives or research questions are developed. These objectives or questions guide the direction of the study.
- Design the study: The next step is to design the research study. This involves making decisions about the research design, sample size, data collection methods, and ethical considerations. The research design can be experimental, observational, qualitative, or quantitative, depending on the nature of the research question.
- Obtain ethical approval: Before conducting the study, ethical approval must be obtained from the appropriate research ethics committee or institutional review board. This ensures that the study is conducted ethically and protects the rights and welfare of participants.
- Collect data: Once the study design and ethical approval are in place, data collection can happen. Depending on the design, researchers may collect data through interviews, surveys, observations, medical records review, or other appropriate methods.
- Analyze data: The collected data are then analyzed using appropriate statistical or qualitative analysis techniques. This helps researchers draw conclusions and answer the research objectives or questions in the next step.
- Interpret and draw conclusions: The analyzed data are interpreted, and conclusions are drawn on the basis of the findings. The nurse researcher examines the results in the context of the existing literature and evaluates their implications for nursing practice, patient care, or policy.
- Communicate findings: The next step is to disseminate the research findings to the wider nursing and health-care communities. This can be done through academic publications, conferences, presentations, or other appropriate means. Sharing the findings contributes to the advancement of nursing knowledge and informs EBP.
- Evaluate and apply findings: Finally, the impact of the research findings is evaluated and considered for potential application in nursing practice. This may involve integrating the findings into clinical guidelines, protocols, or policies to improve patient outcomes and enhance nursing practice.
Throughout the nursing research process, it is important for nurse researchers to adhere to ethical principles, maintain the privacy and confidentiality of participants, and ensure the validity and reliability of the study findings. Collaboration with other health-care professionals and stakeholders is also important to enhance the relevance and impact of the research.
Phases of the Research Process
Nursing research is conducted in five phases (Brunt & Morris, 2023):
- Conceptual phase
- Design and planning phase
- Empirical phase
- Analytic phase
- Dissemination phase
Phase 1: Conceptual
The conceptual phase in nursing research involves the identification and development of research ideas, hypotheses, and theoretical frameworks. It sets the foundation for the entire research process. At the start of a research project, researchers typically formulate a research question or hypothesis. They use skills such as creativity, deductive reasoning, insight, as well as a solid grounding in previous research on the topic of interest. Table 1.4 lists important issues that nursing researchers consider when developing a research question:
| Considerations | Examples |
|---|---|
| Substantive issues | Is the research question significant? |
| Clinical issues | Could the findings be useful in clinical practice? |
| Methodological issues | How can the study be designed to yield high-quality evidence? |
| Practical issues | Are adequate resources available to do the study? |
| Ethical issues | Can this question be addressed without committing ethical transgressions? |
To organize the goals of a research project, nursing researchers often use PICOT, an acronym that reminds researchers of five key elements of an effective question. Table 1.5 lists these five elements and gives examples relevant to nursing research. The PICOT question is versatile, allowing assessment across different clinical domains like intervention, diagnosis, etiology, prevention, prognosis or prediction, quality of life, or therapy. When in the research phase, it’s crucial to craft the PICOT question effectively, aiming for an evidence-based recommendation that enhances patient care and outcomes as the result.
| PICOT Format | Examples |
|---|---|
| P = Population or Problem | Who are the patients to be studied? What characteristics are we focusing on (e.g., age, race, gender, disease, health status)? What problem is being addressed (e.g., mortality, morbidity, compliance, satisfaction)? |
| I = Intervention | What specific intervention (e.g., therapy, medication, educational approach) will be implemented? |
| C = Comparison | What alternative(s) will we compare the intervention to (e.g., placebo, no intervention, different medication)? |
| O = Outcome | What will be measured and how? What is the identified goal (e.g., fewer symptoms, increased satisfaction, reduced mortality)? |
| T = Time Frame | How long will the intervention be implemented and data collected? |
Phase 2: Design and Planning
During this phase of a study, researchers brainstorm and determine which method they will use for their study. From a broad perspective, research methods are the techniques researchers use to gather and analyze information relevant to a research question or topic. The goal of this process is to limit errors that could contaminate conclusions or invalidate findings. An example of an error that could contaminate or invalidate nursing research is selection bias. This occurs when there is a systematic difference between the characteristics of the group that is selected for the study and the larger population from which it is drawn.
For example, imagine a study in which researchers want to investigate the effectiveness of a new nursing intervention for managing pain in postoperative patients. If the researchers only include patients who voluntarily agree to participate in the study, there might be a bias toward individuals who are more willing or motivated to try new interventions. This selection bias could lead to overestimating the effectiveness of the intervention because the sample may not be representative of the entire population of postoperative patients. Addressing and minimizing such biases are crucial in the methodological planning phase of nursing research to ensure that the study’s findings accurately reflect the broader population and can be applied more reliably to real-world clinical settings.
Phase 3: Empirical
During the next phase, researchers collect data. Collectively, the pieces of gathered information are referred to as a data set. Quantitative data include numbers and other objectively measurable information; qualitative data consist of subjective descriptions of observations or experiences. The empirical phase is often the most time-consuming part of the investigation; it is conducted in accordance with the data collection plan (where, when, and how the data will be collected) that was determined during the planning phase.
Phase 4: Analytic
The analytic phase must be done in a processed, orderly manner to enable researchers to discern and validate relevant patterns and relationships in the data. After researchers have analyzed the data, they determine how the study’s findings can best be used in clinical practice. This is when the researchers come full circle to answer the research question from phase 1. However, research is not complete until the results are disseminated in the final phase.
Phase 5: Dissemination
In the final phase of a study, the researchers communicate their findings so others can use the information in their clinical practice. This phase also allows other researchers to try to replicate the study to see if they obtain similar results. Researchers typically communicate by publishing a research report so others can easily access it. The most common types of research reports are theses and dissertations, books, presentations, and journal articles.
Many studies do not have a direct impact on clinical practice; ideally, however, the concluding step of research is to plan for its application to the clinical setting. Even when researchers are unable to implement such a plan, they can still contribute to the process by developing recommendations on how practicing nurses might someday implement the findings. Of course, many studies produce inconclusive results or even data that contradict the hypothesis. These findings are useful, too! They can help guide future researchers to identify flaws in the study or to develop better hypotheses that are supported by data.
Roles and Responsibilities in Nursing Research
Nursing researchers strive to promote participant safety and well-being during a study. They develop plans to ensure the study runs smoothly while keeping the participants fully informed. Researchers also rely on clinical nurses to put their findings into action. The efforts, successes, and failures of practicing nurses often lay the groundwork for future research. Working in tandem, researchers and clinicians continue to close the gap between theory and knowledge-based practice.
Ethics and the Research Process
Researchers often face ethical dilemmas when designing studies. Institutional review boards exist to ensure that studies are designed ethically, with the welfare of participants foremost in mind. The three major ethical principles incorporated into most research guidelines are beneficence, justice, and respect for human dignity. Recall that beneficence is the principle of doing good while also protecting the participants from physical and psychological harm and exploitation (nonmaleficence). Justice includes the right to fair and equitable treatment and to privacy. Privacy may be maintained through anonymity, wherein the researchers do not know each participant’s identity, or through formal confidentiality procedures that safeguard the information provided by the participants.
Respect for human dignity ensures the participants’ right to autonomy, also known as self-determination, which means they have the freedom to control their own activities, including their choice to participate in the study. To ensure this, at the beginning of the study, the researchers provide each participant with a full disclosure that completely describes the study, including the risks and possible benefits. Each participant also signs an informed consent indicating they have a thorough understanding of the study and agree to voluntary and informed participation.
Once all data have been collected, researchers sometimes offer debriefing sessions for the participants. This process provides the participants an opportunity to learn about the study, ask questions, and voice any complaints.
Application of Nursing Research and EBP in Practice
EBP and nursing research have similarities, but they are not the same. The main difference between the two is their purpose. The purpose of research in nursing is to evaluate current knowledge and theories to formulate better nursing practices for improved patient outcomes. The purpose of EBP in nursing is to use the evidence from research to make informed decisions regarding patient care and outcomes. EBP is vital to providing the highest quality of patient care and safety. As defined by Melnyk and Fineout-Overholt (2023), EBP typically includes seven steps:
- encouraging a spirit of inquiry or curiosity
- asking questions
- searching for evidence
- appraising the evidence
- integrating the evidence into practice
- evaluating outcomes of the practice change
- sharing the results
Examples of Nursing Research
Nurses are firsthand observers while providing patient care, enabling them to directly assess and document processes and ideas that could be improved through further investigation. The topics nurses may choose to research are endless; they are the drivers of evidence-based knowledge to promote improved patient outcomes. Here are just a few examples of the countless possible topics for nursing research:
- adapting nursing in a digital era
- causes and prevalence of stress in nurses
- ethics related to artificial hydration and nutrition
- personalized diets for older adults to promote healthy aging
- strategies for raising awareness of cancer-causing air pollution
- the opioid crisis and its social impacts
Regardless of the topic, the process begins with developing a question (often using the PICOT format), choosing the design for your research, and setting clear goals (Riva et al., 2012).
Examples of EBP in Nursing
EBP is intended to promote positive outcomes through shared decision-making, but another essential goal is to prevent complications. These achievements, in turn, help reduce health-care costs, improve patient satisfaction (which further improves reimbursement rates), and reduce the demand for health-care resources, enabling organizations to reallocate resources to other areas where they will be more effective. Table 1.6 lists some examples of EBP in nursing.
| Example | Outcome |
|---|---|
| Elevating the head of a patient’s bed between 30° and 45° | Supports the airway and reduces the risk of aspiration |
| Turning and repositioning a patient every 2 hours | Helps to maintain clean, dry skin and prevent skin breakdown |
| Wearing personal protective equipment as necessary, using proper hand hygiene, and maintaining a clean environment | Prevents hospital-acquired infections and reduces the spread of other infections |
| Administering oxygen when treating chronic obstructive pulmonary disease | Improves the survival rate by reducing the risk of hypoxia (a deficiency of oxygen reaching the body tissues) and organ failure |
Quality Improvement
The framework used to improve patient care and outcomes in a systematic manner is called quality improvement. This is accomplished with standardized processes and structures to reduce variation and achieve predictable results to improve patient outcomes. Processes might include standard protocols for operating procedures, education, and training. Structures might include up-to-date technology and a culture of quality that ensures everyone is working together to deliver quality health care for patients. A QI mindset encourages providers to become leaders in researching and delivering positive changes and improvements in every component of the health-care system.
The QI process involves a collaborative effort from various stakeholders within a health-care setting, including health-care professionals such as physicians, nurses, administrators, and support staff. Nurses play a crucial role in the QI process, contributing their frontline experience and expertise in patient care. They actively participate in identifying areas for improvement, implementing changes, and monitoring outcomes. Nurses are instrumental in ensuring that quality standards are met, patient safety is prioritized, and EBPs are integrated into daily care.
Models for QI
When undertaking a QI project, it is important to use a model that will guide the project and provide feedback related to progress. Two common QI models used in nursing originated in the manufacturing industry: the Six Sigma model and the Lean Model. The Six Sigma model was created by Motorola. Its main goals are to decrease variation and defects in products (Earlam, 2016). The Lean model was created by Toyota. Its main goals are to eliminate waste and improve efficiency so tall work adds value (John’s Hopkins Nursing Center for Nursing Inquiry, 2022).
A third QI model was developed specifically for health care by Associates for Process Improvement in partnership with the Institute for Healthcare Improvement (IHI). The resulting Model for Improvement was created by expanding the plan-do-study-act (PDSA) cycle. The PDSA cycle is a continuous process that works to improve quality by following the steps of the scientific process: making a hypothesis (plan), testing the hypothesis (do), examining the results (study), and reporting the results (act).
Phase 1
The Model for Improvement is divided into two phases. Phase 1 begins by asking three pertinent questions:
- What are you trying to accomplish?
- How will you know that a change is an improvement?
- What changes can you make that will result in improvement?
These questions help structure the phase, which consists of setting aims, establishing measures, and selecting an intervention (changes).When setting aims, or goals, it helps to use the SMART format:
- Specific: Make goals straightforward, stating specifically what you want to happen.
- Measurable: Choose goals with outcomes that can be measured to assess your progress.
- Achievable: Ensure goals are attainable and not overambitious.
- Relevant: Choose goals that align with those of your organization.
- Time-bound: Set a reasonable time frame in which to attain each goal.
Establishing measures helps the team determine if a change results in a tangible improvement. There are four common types of QI metrics:
- Balancing metrics involve assessing unintended consequences or potential negative impacts of QI initiatives. Although the primary focus is on improving specific aspects of care, it’s essential to monitor for any adverse effects on other areas. Balancing metrics help prevent unintended harm and ensure a balanced approach to QI efforts.
- Outcome metrics are used to assess the results or impacts of health-care processes or interventions. Examples include patient outcomes such as mortality rates, readmission rates, complication rates, and patient satisfaction scores. Outcome metrics provide insights into the overall effectiveness of health-care practices.
- Process metrics focus on the steps or activities involved in delivering health care. They measure the efficiency, reliability, and adherence to established protocols. Examples include the time it takes to complete a specific procedure, compliance with evidence-based guidelines, and adherence to safety protocols.
- Structure metrics assess the organizational and environmental factors that can influence the delivery of healthcare. These may include the availability of resources, staffing levels, infrastructure, and the implementation of best practices. Monitoring structure metrics helps ensure the necessary components are in place to support high-quality care.
For example, suppose a hospital wants to decrease its rates of hand-borne infections. The QI team might use the structure measure of the availability of hand-sanitizer pumps, the process measure of handwashing compliance rates, the outcome measure of hospital-acquired infection rates, and the imbalance measure of skin breakdown among the staff.
The final step in phase 1 is selecting an intervention or solution. This is accomplished by determining the cause of a particular problem. QI teams do this by conducting a root cause analysis. By determining the root cause of a problem, you can more easily determine the appropriate interventions.
Phase 2
The second phase of the Model for Improvement is to test the intervention using the PDSA cycle:
- Plan: Identify stakeholders—anyone who is key to the project’s success or otherwise invested in it—and begin building the implementation team. This should include management and clinical staff as well as patients and their families. It’s also important to know which stakeholders, if any, may hinder the advancement of the project, to determine how frequently to engage with everyone. For example, a nondisclosure or identification of a conflict of interest can halt a study.
- Do: Take the necessary time to set the plan in motion, implementing the intervention while collecting and documenting data relevant to the project’s success.
- Study: Analyze the data and compare the actual results to the initial hypothesis.
- Act: Take the necessary time to act on what was learned. Did it work? Do you need to adapt changes to begin a second PDSA cycle because the first approach didn’t quite attain your goal? Or do you need to abandon the intervention because you observed no improvement or a worse outcome?
Attributes of QI
The goal of QI is to adopt a reputable model to guide a project while collecting and analyzing data and testing the effects of interventions. Implementing QI is vital to any organization that seeks to provide quality care and improve efficiency, safety, and patient outcomes. Here are some recent examples of QI by health-care organizations (Health Catalyst Editors, 2022):
- Allina Health implemented an initiative for pharmacist-led medication therapy management that reduced the cost of care and improved patient outcomes.
- Mission Health in North Carolina began using a data-driven approach to promote early sepsis identification and standardize the treatment of sepsis.
- UnityPoint Health established a prioritization and implementation approach to improve outcomes that produced the following results: (1) the deployment of interventions in sepsis alerts, order sets, and other clinical support tools resulted in variable costs being reduced; (2) the reductions in level of service resulted in patients returning home sooner; and (3) there was an increase in sepsis screenings being completed and an increase in sepsis order sets being used in the emergency department.