Page 1

A publication of the . . . improving patient outcomes

Expert Perspective


any organizations struggle with the implementation of known best practices and quality improvement interventions. Much of the difficulty in implementing effective strategies stems from a lack of understanding organizational context. An intervention that is shown to be effective in one unit or hospital does not mean it is generalizable to other settings.

The complexity of health care delivery stresses the need to carefully examine interacting contextual variables (e.g. work setting, organizational culture) that could potentially impact implementation efforts. Laura Damschroder, MS, MPH, a researcher with the VA Center for Clinical Management Research, discusses the importance of these context variable

“A theoretical framework will enable systematic identification and understanding of drivers that predict success in different settings, guide adaptation of targeted practice changes and implementation strategies.” laura damschroder, ms, mph a n n a r b o r v e t e r a n s a f fa i r s m e d i c a l c e n t e r

and other important constructs in the Consolidated Framework for Implementation Research (CFIR). “Use of a framework to guide your research promotes generalization of findings through continued on page 2

In this issue:

Transformation through Research: Improvement Science Summit Exceeds Expectations The foundational theme of this year’s Summit was “Transformation through Research.” Beginning with Dr. Stevens, the stage was set for 1 ½ days of interactive, thought provoking presentations. “The key question to keep in mind is how do we make and sustain change in our healthcare systems. Systematic research is essential to making and sustaining change. We need a conceptual understanding of what works,” indicated Jack Needleman, PhD, ISRN Steering Council member during his moderation of the first day. The Improvement Science Summit opened the weeklong Summer Institute for Quality Improvement with gusto and a bang; setting the stage for an exciting week of interprofessional collaboration development. “The Improvement Science Summit is more than just a research methods conference,” says Kathleen R. Stevens, RN, EdD, Director of the Improvement Science Research Network. “We build research collaboratives to study the most pressing issues in healthcare improvement.”

“Knowing is not enough; we must apply. Willing is not enough; we must do.” - Goethe

2013 Improvement Science Summit


ISRN Corner: Pediatric SIG

Expert Perspective


ISRN Member Spotlight

Academic-Practice Partnerships


ISRN Expands Network Studies

To address the need for a conceptual understanding of what works, the faculty for this year’s Summit included major international leaders in healthcare system improvement representing major continued on page 2

Nearly 50 poster abstracts were accepted for presentation at the 2013 Summit.


Expert Perspective - Ken Shine



ISRN Corner: Doctoral Ed SIG


ISRN Member Spotlight



Expert Perspective

2013 Summit Exceeds Expectations

continued from page 1

continued from page 1

organizations that are blazing the trail to improvement patient outcomes. “We were so privileged to have individuals from the likes of Laura Damschroder, Lisa Simpson, Joe Schmelz, and Alex Young as presenters for this year’s Summit,” says Frank Puga, Research Scientist for the ISRN. “The entire faculty gave such useful and helpful information through their presentations, attendees are able to take what was learned at this Summit and adapt it to their local institutions. In particular, the individual processes of regulatory oversight of improvement research”

use of theory. Specifically, a theoretical framework will enable systematic identification and understanding of drivers that predict success in different settings, guide adaption of targeted practice changes and implementation strategies, and more quickly and confidently build the scientific knowledgebase.” says Damschroder. As many clinical sites struggle with implementing demonstrated interventions from one setting to the next, CFIR provides an opportunity to systematically evaluate the implementation process and promote effective strategies that generalize across units and/or hospitals. Additionally, CFIR helps raise the rigor of improvement research by relying on clearly defined theoretical constructs that pave the way for quantitative measures to evaluate implementation. “The Seattle Implementation Research Collaborative (SIRC) is currently working on mapping published instruments using the CFIR and other complementary frameworks. In addition, new measures are being developed and tested by several researchers including Bryan Weiner as well as our own group. Our online CFIR Wiki site has the latest information about these and other efforts and will continue to be updated.” Such an approach is essential to improvement research and enhances the generalizability of interventions tested in systematic investigations. As the Improvement Science Research Network begins to roll out intervention studies, CFIR will become an important framework to evaluate context as it relates to the implementation of effective strategies. 2

“Regulatory oversight continues to be an area of conflict and misunderstanding in improvement research,” says Darpan Patel, PhD, Clinical Research Project Manager for the ISRN who oversees the regulatory processes for the ISRN and the ISRN Network Studies. “Dr. Schmelz’s presentation resonated well with the audience in giving the perspective of the regulatory office’s duties as it relates to reviewing improvement studies.”

The poster sessions for the Improvement Science Summit brought together nearly 50 abstracts of improvement projects surpassing the number of presentations from last year. “It is so exciting to see the great work that is being done across the country to improve patient care,” says Dr. Stevens, ISRN Director. If you missed this years Summit, some presentations are available online in the Member Center of the ISRN website. Next year’s Improvement Science Summit and the weeklong Summer Institutes on Quality Improvement is already in development and is slated for August 4-8, 2014 at the Grand Hyatt Riverwalk in San Antonio, TX. Visit www.ISRN. net/events for more information.

A highlight for this year’s Summit was the interactive student roundtable program. Vivian Low, ISRN Steering Council member, moderated the sessions. “The feedback from the students was great!” she said. “Many students felt that the content of the Summit was so rich and intense, that this interactive session with the presenters gave them a better foundational understanding on the topics presented. This session is valuable for them as they begin developing a career path.”

Building Successful Research Collaboratives for Healthcare Improvement This 62-page book is an evidence-based guide on best practices for research collaboration in investigative teams. Transdisciplinary collaboration is essential in improvement science because the study of improvement in complex adaptive systems goes beyond the realm of a single investigator. The topics presented in this guide are drawn from the Science of Team Science, extended to collaborative research. Evidence shows that team-based science generates better results, including increased innovation and advances in knowledge. To order a copy of the evidence-based guide visit

Fall 2013 •


Academic-Practice Partnerships: A Backbone for Improvement The 2010 Institute of Medicine’s Future of Nursing Report generated a sense of urgency to strengthen nursing practice and directed attention to the future of nursing education. The goals outlined in this report, including the increase in the number of baccalaureateprepared nurses and implementation of nurse residency programs, require the collaboration between academic and practice leaders. Recognizing this need, the American Association of Colleges of Nursing (AACN) partnered with the American Organization of Nurse Executives (AONE) to form the AACN-AONE Task Force on Academic-Practice Partnerships (Beal, 2011). Effective partnerships can lead to increased student and staff satisfaction and performance, enhanced research productivity, and improved patient outcomes (Beal, 2011). However, until recently, there has been little insight into best practices for building and maintaining academic-practice partnerships. To help guide institutions in this process, the AACN-AONE Task Force for Academic-Practice Partnerships identified eight principles that underlie the foundation of successful partnerships. Among these principles are mutual respect, mutual benefit, ongoing communication, and shared vision and knowledge. (Beal, 2012)

The ISRN strongly supports collaboration between clinical and academic settings to advance nursing practice. The ISRN research collaboratives are based on some of the same principles identified by the AACN-AONE task force and can pave the way for future academic-practice partnerships. Clinically-based ISRN research associates who participate in these research collaboratives work closely with the academically-based ISRN Coordinating Center, which provides expert guidance in conducting research with the rigor needed to ensure the scientific process. The ISRN Coordinating Center helps guide sites in all stages of research implementation, from the IRB application process to data collection and analysis. The Coordinating Center and study sites share the same vision and goals (shared mental model) as they work together to answer specific research questions, such as identifying operational failures encountered by frontline nurses in the STAR-2 network study. In a recent report published by the ISRN Coordinating Center, the academic-practice partnership formed as part of the ISRN Network Studies provides the much needed support for local clinicians to successfully implement a scientifically rigorous protocol. Visit the website for more information on these academic-practice partnerships in action.

Live the ISRN Mission: Collaborate with the ISRN Be a part of improvement research that is leading the way for healthcare redesign and better outcomes for patients. Engagement of ISRN members will be essential for Network Studies. If you are interested in collaborating, contact the ISRN at

ISRN Corner: Pediatric Special Interest Group Contributed by Linda Riley, Children’s Healthcare of Atlanta

The first meeting of the Improvement Science Research Network’s Pediatric Special Interest Group (SIG) was held at a breakfast meeting during the 2013 Improvement Science Summit. This SIG was created to provide a forum for individuals who are interested in participation in quality improvement studies with a pediatric focus. At present, literature reviews of best practices for pediatric patients often find fewer sources of evidence developed in the context of pediatrics than in adults. Formation of this SIG was proposed for three purposes, (1) to take advantage of the ISRN’s unique infrastructure and resources for multisite collaboration, (2) to contribute to the scientific basis for practice, (3) to emphasize the complex needs encountered in pediatric healthcare and (4) to use ISRN’s state of the art technology for improved communication.

Fall 2013 •

On July 9, a group of 10 enthusiastic members met to discuss common interests and to begin to define goals and priorities for the Pediatric SIG. Attendees included nurses, respiratory therapists, nurse scientists, graduate students and academic faculty. “Our discussion emphasized the unique issues encountered in pediatrics and the need to represent children within ISRN’s ongoing studies in order to contribute to the scientific basis for practice,” said group facilitator, Linda Riley, Director of Nursing Research and Evidence Based Practice at Children’s Healthcare of Atlanta. A lively exchange exploring how the SIG priorities and goals align with ISRN’s research priorities and the benefits of collaboration engaged all participants. There was enthusiasm for multisite studies to maximize success for members with wide variation in research experience and available resources across the group. To recruit more members for the SIG, participants suggested advertising the SIG and encouraging participation by multiple disciplines who deliver care for children. Suggestions included creating a blog on the ISRN website to promote ongoing discussion about pediatric issues and advertising the SIG at national conferences or in specialty journals to recruit members from free standing pediatric hospitals and other healthcare organizations. To join the ISRN Pediatric SIG, contact the ISRN at 3

ISRN Member Spotlight TeamSTEPPS Workshop An Organizational Intervention for Team Performance Improvement

Michael Parchman, MPH, MD New ISRN Steering Council Member Research Network, a PBRN, and directed the PBRN Resource Center in the Community Engagement Program at the Institute for the Integration of Medicine and Science.

May 8-9, 2014 UT Health Science Center San Antonio, TX

One of his research interests is using complexity science to explore teamwork to achieve highquality health care. “Traditional statistical and research methods assume linear and repeatable patterns. However, complex adaptive systems, like health care organizations, do not behave in that way. A different approach to inquiry is required, informed by the assumptions provided to us by Complexity science, especially for people with chronic illnesses.”

Join the Academic Center for Evidence-Based Practice for this 2 day workshop where expert Master Trainers will present TeamSTEPPS® strategies related to team structure, leadership, situation monitoring, mutual support, and communication to improve team-related knowledge, skills, and outcomes.

M i c h a e l L. P a r c h m a n , MD, MPH D i r e c to r , M a c C a l l C e n t e r f o r H e a lt h C a r e I n n o vat i o n S r . I n v e s t i g ato r , G r o u p H e a lt h Research Institute

For details and registration, visit the ISRN web site

Not a Member? Join Us Today! Learn more about the benefits of membership and Join Us today. To recieve the newsletter in your inbox, subscribe to the ISRN mailing list by sending an email with “subscribe” in the body of the message.

Archived Web Seminar Avoiding Workarounds through Systems Design Presented by ISRN Steering Council member and Harvard Business School Associate Professor Anita Tucker This web seminar explores the impact of systems engineering on healthcare delivery. For details, access to this and other events, visit the ISRN web site 4

Dr. Michael L. Parchman is a recognized scholar in chronic illness care research, a family practitioner, and a health services researcher. He is the Director of the MacColl Center for Health Care Innovation Group Health Research Institute (GHRI) in Seattle, Washington and former director of the Agency for Healthcare Research and Quality’s Practice-Based Research Network (PBRN) Initiative and senior advisor for primary care. But he is no stranger to the ISRN or the UT Health Science Center San Antonio (UTHSCSA). At UTHSCSA he was the Mario E. Ramirez Endowed Distinguished Professor of Family and Community Medicine. He was also the director of the South Texas Ambulatory

Dr. Parchman’s expertise with complexity science challenges ISRN to consider in the future is the “scale up and spread of innovations or new evidence across health systems or organization with limited resources.” This can be viewed as a “complex network perspective of social relationships that are used to influence behaviors. Such diffusion of behavior change is discussed in Albert-Laszlo Barabasi’s book, “Linked,”and in a recent article by Atul Gwande about Slow Ideas.” Contact the ISRN to have an ISRN Steering Council Member present at your organization or conference. Call us at 210-567-1480 or email us at improvementscienceresearch@ Read a profile of each of the ISRN Steering Council Members by visiting experts/index.asp

Research Resources: •

A video of Dr. Parchman’s 2012 Summit presentation is available to ISRN members at www.

Barabasi, A-L. (2002). Linked, the new science of networks: How everything is connected to everything else and what it means for business, science and everyday life. New York: Perseus Publishing.

Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L. (2013). A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care. Health Affairs, 32(2), 357-367.

Gwande, A. (2013). Slow ideas: Some innovations spread fast: How do you speed the ones that don’t. New Yorker, July 29. Available from reporting/2013/07/29/130729fa_fact_gawande Fall 2013 •


Dr. Shine’s Passion Comes Full Circle at the 2013 Summer Institute The well-being, safety and utmost care for patients are the goals that drive Kenneth I. Shine, M.D. every day. As a world-renowned cardiologist and physiologist, Dr. Shine has led key efforts to revolutionize patient safety in health care facilities across the nation.

his work ultimately proved that the quality of patient health improved tremendously with fewer incidences of pneumonia and pulmonary emboli, lower cost to the patients, and a higher rate of patients returning to work.

Dr. Shine emphasized the significance of evidenceIt was fitting that on the eve of his retirement as based practice in healthcare. executive vice chancellor for health affairs for The “In the absence of evidence, healthcare providers University of Texas System, Dr. Shine delivered tend to hold tight to ingrained notions about a poignant keynote address, “Lessons Learned appropriate treatments,” he said. “Changing from a Lifetime of Quality Improvement,” to attitudes and behaviors is very difficult, especially more than 518 fellow educators and health care when procedures and processes have been done the same way for years.” “Life is precious. Providing the best and

safest care for patients also evevates our profession and our mission”

Dr. Shine’s study was later published in the New England Journal of Medicine and led to a surge of similar analyses on patient safety and quality of providers at the 12th annual Summer Institute care. He praised the UT System institutions for on Evidence-Based Practice. The lectureship was their role in pioneering patient safety and quality sponsored by the Academic Center for Evidence- of care programs, and thanked two UT Health Based Practice (ACE) in the School of Nursing Science Center faculty in particular for their at the UT Health Science Center for health care efforts – Kathleen R. Stevens, Ed.D., RN, ANEF, providers who have dedicated their lives to his FAAN, professor and director of the Improvement shared passion of providing quality health care. Science Research Network and the ACE; and Jan E. Patterson, M.D., M.S., who has led a clinical Dr. Shine, who joined the UT System in 2003, safety and effectiveness course for faculty at the spoke at ACE’s third conference in July of 2004. university since 2008. Dr. Patterson is the UT This year, he painted a precise portrait of the transformation in healthcare quality improvement System Executive Vice Chancellor’s Health Fellow for Clinical Effectiveness. to date and inspired enthusiasm for the efforts that will need to continue and expand. Dr. Shine challenged the audience to be cognizant of the multiplicity of changes in health care – from He recounted his time as chief resident in legislative, to educational to technological – and medicine at the Massachusetts General Hospital others. in 1968 when he was struck by the fact that every heart attack patient was hospitalized for exactly 21 days. He proposed a study of those patient outcomes after decreasing their hospitalization from 21 days to 14 days. Although his proposal was met with intense opposition and resistance,

“Life is precious,” Dr. Shine said. “Providing the best and safest care for patients also elevates our profession and our mission. That is why your interest in evidence is going to be front and center now and in the future.”

More about Dr. Ken Shine Kenneth I. Shine, M.D., retired this year after a10-year tenure as Executive Vice Chancellor of Health Affairs for The University of Texas System, where he was responsible for the six UT System health institutions, including the UT Health Science Center San Antonio, and their aggregate operating budget of almost $8.4 billion. Dr. Shine was honored with the 2011 John M. Eisenberg Patient Safety and Quality Award from the National Quality Forum and Joint Commission. He also received the Founders Award of the American College of Healthcare Quality. He was recognized for leading numerous initiatives to improve quality and safety in health care. In 1992, Dr. Shine was named President of the Institute of Medicine (IOM), a nonprofit, nonpartisan organization that helps influence national health care policy. During his 10 years as its leader, the IOM took on several crucially important issues such as food safety, tobacco use and end-of-life care, and became one of the most important forces to improve health in the nation. He also organized the IOM Health Care Quality Initiative that produced the reports “To Err is Human” and “Crossing the Quality Chasm.”

Fall 2013 •



k at h l e e n r . s t e v e n s , r n , edd , m s n , a n e f , fa a n , i s r n d i r e c to r

“Collaboratory” Conference Deemed a Success Collaboratory. A center without walls, in which the nation’s researchers can perform their research without regard to physical location, interacting with colleagues, accessing approaches, sharing data and computational resources, and building accessible databanks. (Adapted from Wulf, 1989) Virtual partners became in-person associates as they gathered at the July 2013 Improvement Science Summit to advance the science of improvement and patient safety. Many of the Summit participants previously spent hours and weeks together virtually, conducting studies in the Improvement Science Research Network “collaboratory.” The delight was apparent when these scholars, both clinical and academic, came together in San Antonio this July to share success stories, interpret results, and plan for the ‘next’ study. The conference was deemed a success. As associates noted, “Awesome program! I loved the personal touches and the opportunities to interact with presenters. The value of the Summit was worth every dollar and I will be attending again.” This fourth Summit significantly boosted the knowledge foundation for improving healthcare quality and patient safety. The Summit is the official conference of the Improvement Science Research Network, a place where likeminded people gathered to advance 5 continued on page 6


FROM THE DIRECTOR continued from page 5

improvement science through a national research network. Uniquely focused on specialty research methods, frameworks, and designs required by research in this field, presenters at this year’s Summit focused on the narrower field of implementation research to address the 2013 theme, “Transformation through Research.” The multifaceted event highlighted the progress of the network and completion of major national research projects in systems improvement. The ISRN Steering Council met in a full day retreat to assess progress and lay out our next set of goals. Change agents, clinicians, and scientists gathered together in this one-of-akind conference to build capacity for rapid, rigorous, and relevant projects to meet the Triple Aim objectives in healthcare. Experts presented a topshelf program of research methods on implementation research. Discussions explored theoretical frameworks, design and statistical approaches, navigating IRB, building investigative teams, and tips for successful grant writing in the field. Those who were involved in the ISRN’s two Network studies presented findings and new waves of the Network studies were launched. Our collective achievements in the short history of the ISRN were visible and impressive and the excitement about our work is tremendous. This issue of Network News provides a glimpse of the in-person Summit activities. Missed it? The accelerated momentum gained this summer can be continued and spread through the materials available via our website: The ISRN Coordinating Center is busily mounting presentation recordings on the website. Want to come? …or come again? Mark your calendars for August 4-8, 2014, Grand Hyatt San Antonio. 6

ISRN Expands on Impactful Network Studies The Improvement Science Research Network (ISRN) has expanded its first ISRN Network Study, “Small Troubles, Adaptive Responses (STAR-2): Frontline Nurse Engagement in Quality Improvement” as “STAR-2+”. In this study, frontline nursing staff will use specially-designed pocket cards to detect small problems (also known as operational failures) that prompt work inefficiencies and suboptimal care quality. Operational failures are frequently seen with equipment at the frontline, preventing clinicians from performing clinical tasks efficiently. Twelve sites were selected to participate in this landmark study which will advance our understanding of relationships among nursing practice environment, frontline quality improvement engagement, and outcomes in acute care clinical units. The ISRN will also conduct a second wave of the ISRN Network Study, “The Impact of Cognitive Load, Interruptions, and Distractions on Procedural Failures and Medication Administration Errors (Med Errors).” Medication administration is a high volume and high risk nursing activity. Nursing work is complex and nurses work in an interruption-driven environment and have to integrate their cognitive work with psychomotor and affective skills in order to deliver effective care. The aim of this multi-site study is to describe cognitive load, interruptions, and distractions experienced by registered nurses during medication administration and explore how these factors impact procedural failures and medication errors. With a focus on improvement strategies, the ISRN research collaboratives use interdisciplinary teams and principles grounded in the Science of Team Science and virtual collaboration to conduct quality improvement studies on a national, landmark level. The central tenet of the ISRN is that quality improvement initiatives should be based on rigorous and replicable scientific research. With that tenet as the driving force, these ISRN research collaboratives will contribute to impactful research and generalizable knowledge.

ISRN Corner: Doctoral Education Special Interest Group

Contributed by Patricia Donohue-Porter, Adelphi University

7:00 AM was not too early for over 40 interested participants arriving for the first ever meeting of the Doctoral Education SIG meeting at the Improvement Science Summit. Welcomed by representatives from the ISRN Steering Council, Network Improvement Studies and the ISRN Coordinating Center, the group began an inaugural dialogue about how the ISRN can help to support doctoral studies. In nursing, educational preparation for both the PhD and DNP degrees includes the need for integrating new content areas and competencies in areas of team science, interprofessional communication, translational science and improvement in the quality of care nurses deliver. The attendees at the SIG meeting recognized this and both faculty and students alike spoke of their development needs in going forward in improvement science. Many felt that starting out in a Special Interest Group would help them learn more of the specifics of team science and, most importantly, feel connected to a national agenda for improvement. Discussion revealed how helpful it was to hear success stories of improvement science as well as learn about specific areas in improvement implementation such as sustaining change initiatives. The goal of the SIG for doctoral education is to use the knowledge developed from the ISRN research priorities and studies to improve care and to offer students an enhanced view of the ISRN as a virtual resource for dissertations and projects. Continued engagement of doctoral students with the ISRN community is our goal, taking place through individual contacts, doctoral student associations at individual schools and future webinars. If you are pursuing doctoral education in improvement science, think about joining this exciting new group, the Doctoral Education SIG! Contact the ISRN at to be added to this active group.

ISRN Steering Council Kathleen R. Stevens, RN, EdD, MSN, ANEF, FAAN, ISRN Director Carolyn M. Clancy, MD VA Headquarters Heidi King, MS, FACHE TRICARE Management Activity Vivian Low, MPH, BSN, RN-BC El Camino Hospital Gail Mallory, PhD, RN, NEA-BC Oncology Nursing Society Jack Needleman, PhD, FAAN UCLA School of Public Health John Øvretveit, BSC (HONS), MPHIL,

PhD, CPSYCHOL, CSCI, MIHM The Karolinska Institutet, Stockholm Wilson Pace, MD, FAAFP University of Colorado, Denver Michael Parchman, MD, MPH MacCall Center for Healthcare Innovation Mary Salisbury, MSN, RN The Cedar Institute, Inc. Lily Thomas, PhD, RN North Shore-Long Island Jewish Health System Anita Tucker, DBA Harvard Business School

Fall 2013 •

Call For Abstracts Summer Institutes on QUALITY IMPROVEMENT AUGUST 4-8, 2014 SAN ANTONIO, TX Clinicians, Educators and Researchers share your EBP successes. Nurses, physicians, pharmacists, managers, and health professionals are invited to submit for consideration, abstracts consistent with the theme of these national, interdisciplinary conferences.

ABSTRACT SUBMISSION DEADLINE: Monday, April 7, 2014 Transforming healthcare through quality improvement and patient safety initiatives is a national priority which focuses on advancing healthcare improvement through research. We encourage you to submit abstracts on your quality improvement projects that match research priorities set forth by the Improvement Science Research Network (ISRN). For furthur details, see Research Priorities on

TOPICS FOR SUMMIT (not limited to): A. Coordination and Transitions of Care B. High-Performing Clinical Systems and Microsystems Approaches to Improvement C. Evidence-Based Quality Improvement and Best Practice D. Learning Organizations and Culture of Quality and Safety


 Background  Purpose  Materials & Methods  Results  Conclusions  Bibliography

GUIDELINES FOR SUBMISSION: Abstracts will be accepted online only beginning November 18, 2013 For information on abstract requirements and to submit your abstract, visit our website at If you have a problem submitting your abstract, please contact us at or call (210)-567-1480

Anita Tucker, MA, DBA - New ISRN Steering Council Member Dr. Anita Tucker is an Associate Professor at the Harvard Business School, Harvard University. Her interests are operations management and organizational learning theory as they relate to an organization’s internal supply chain and a lack of integration of small-scale operational problems.

A n i ta L. T u c k e r , MA, DBA A s s o c i at e P r o f e s s o r o f B u s i n e s s A d m i n i s t r at i o n s H a r va r d B u s i n e s s S c h o o l H a r va r d U n i v e r s i t y

Fall 2013 •

Operations management and organizational learning theory are used by Dr. Tucker to understand and improve front-line work processes that result in positive organizational learning and change. She works with healthcare organizations like Kaiser Permanente and Duke University Hospital, studying the impact of internal supply chains on patient outcomes and staff efficiency. She is also investigating a series of laboratory experiments on medication administration and nursing work systems. Dr. Tucker has received a number of awards for her research, publications and mentoships from the Academy of Management, Academy Health, Alfred P. Sloan Industry Studies, and California Management Review. Her works

in progress focuses on work-arounds, patient safety, nurse turnover, and length of stay.

Senot, C., Chandrasekaran, A. Ward, P. T., & Tucker, A. L. (2013, Sept.). “The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance.” Working Paper, No. 14-024. Harvard Business School, Harvard University. Tucker, A. L., Heisler, W. S. & Janisse, L. D. (2013, Sept.). Organizational Factors that Contribute to Operational Failures in Hospitals. Working Paper, No. 14-023. Harvard Business School, Harvard University. Tucker, A. L. (2012). Fostering organizational learning: The impact of work design on workarounds, errors, and speaking up about internal supply chain problems Working Paper, No. 13-044. Harvard Business School, Harvard University. Boston, MA. Retrieved from urn-3:HUL.InstRepos:10018988.


7703 Floyd Curl Drive, MC 7949 San Antonio, TX 78229

ISRN Mission

Network News

To advance the scientific foundation for quality improvement, safety, and efficiency through transdisciplinary research addressing healthcare systems, patient-centeredness, and integration of evidence into practice.

Executive Editor Kathleen R. Stevens, RN, EdD, MSN, ANEF, FAAN, ISRN Director

How to get Involved

Contributing Authors Braulio Amezaga, BA Ellen Hanks, MLS Tiffany Luna, BA Darpan Patel, PhD Frank Puga, PhD

Become a member of the ISRN, the first national collaboration of clinical and academic leaders devoted to accelerating improvement science in a systems context across multiple sites. Benefits include the following: • • • • • • • • •

Opportunities to participate in multi-site research collaboratives on patient safety and quality improvement initiatives; Access to members-only ISRN online resources; Leverage of a national test bed for evaluating improvement strategies; Training resources such as IRB training; Expert guidance in conducting research; Technology infrastructure for participating in multi-site studies; Access to the ISRN web portal, which provides secure communication, storage, and sharing of documents and data; A technical support system that provides access to expert guidance in conducting research and using statistics; and Recognition as an ISRN member and use of the ISRN logo on presentations and publications.


To become a member of the ISRN visit: and click on “Join Us.”

Guest Contributers Linda, Riley, RN, PhD, Child. Health of Atl Patricia Donohue-Porter , RN, PhD, Adelphi University

Contact Us 210.567.1480 M–F 8 am–5 pm CT

Follow us on Twitter @theISRN Volume 3 • No. 3 • Fall 2013

The project described was supported by Award Number 3RC2NR011946 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.


Fall 2013 •

ISRN Network News Fall 2013  

Network News is a quarterly newsletter designed to connect you to the emerging Improvement Science Research Network (ISRN)—the first nationw...

ISRN Network News Fall 2013  

Network News is a quarterly newsletter designed to connect you to the emerging Improvement Science Research Network (ISRN)—the first nationw...