ISRN Network News May 2014

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A publication of the . . . improving patient outcomes

Exper t Perspective: Structural Equation Modeling

5th Annual Improvement Science Summit Professor/Research in the School of Nursing at the University of Texas Health Science Center San Antonio and the Improvement Science Research Network. “That’s a reason why we’ve expanded the program to two full days.”

Rex Kline, PhD Professor W ay n e S tat e U n i v e r s i t y Concordia Universit y S u m m i t P r e s e n tat i o n : SEM, SCM, a n d S tat i s t i c s R e f o r m i n Improvement Research


tructural equation modeling (SEM) is a linear and cross sectional multivariate analysis used to determine whether a scientific model is valid, meaning that it accurately explains the phenomenon or set of interacting constructs. By testing causal relationships among latent and observed variables, scientists are able to capture precise measures of these latent variables, a variable that cannot be directly measured. Research in improvement science relies on the ability to accurately and precisely test these latent variables. For example, to understand how an individual’s perception of teamwork influences patient safety, the latent variables teamwork and patient safety need to be measured, or operationalized, through observable variables. continued on page 2

In this issue:

2014 Improvement Science Summit “Building Evidence to Impact Outcomes” This year marks the 5th anniversary for the Improvement Science Summit and the ISRN is more excited than ever to welcome nearly 300 individuals to San Antonio, TX, August 5-6, 2014. Again this year, the conference will be held at the Grand Hyatt Riverwalk in the heart of San Antonio’s downtown riverwalk area. To celebrate the 5th anniversary of the Summit, the program has been expanded to 2 full days with the theme of“Building Evidence to Impact Outcome.” “Whenever you think about building evidence in the healthcare field, you need first to begin by understanding the theories. That is why a major focus for this year’s conference is the theory of improvement,” says ISRN Summit Co-Chair Darpan Patel, PhD, Assistant

Dr. Jack Needleman, Steering Council member of the Improvement Science Research Network will preside over the two day conference. Opening the conference, Dr. Kathleen Stevens, Director of the ISRN will set the stage for the two day conference by establishing the need to conduct improvement research that is rapid, relevant and rigorous; the 3R’s for improvement. Next, Dr. Donald Goldmann, Chief Medical and Scientific Officer for the Institute for Healthcare Improvement will speak to the theme of the Summit and present national trends in healthcare improvement and the impact it can have on patient outcomes. Other noted speakers include Mary DixonWoods, PhD (University of Leicester, UK), Debra Barksdale, PhD (University of North Carolina; Patient Centered Outcomes Research Institute), Margo Edmunds, PhD (AcademyHealth), Victoria Jordan, PhD (UT MD Anderson Cancer Center), John Overtveit, PhD (The Karolinska Instituetet), Wilson Pace, MD (University of Colorado, Denver), Anita Tucker, DBA (Harvard Business continued on page 2

Improvement Science Summit


National Call for Principal Investigators

3 ISRN Resources for DNP Research


Expert Perspective: SEM


New Network Study: CAPTURE Falls



Expert Perspective: Don Goldman


Improvement Interventions: Naming Parts 5 Member Spotlights

Network Study Pipeline


SEM: A guide to research results that matter continued from page 1

Improvement Science Summit: Building Evidence to Impact Outcomes continued from page 1

Primarily used as a confirmatory School), and Rex Kline, PhD (Wayne State Again this year, the Summit Student Program technique, SEM is bound by a set of University). will highlight the success and impact of four primary assumptions that allow student led projects in improvement research. for correct interpretation of results. Students will have the opportunity to “Whenever you think about building First, all variables used in the model participate in interprofessional roundtable evidence in the healthcare field, you must be normally distributed, except discussions with Summit experts and will need first to begin by understanding for exogenous variables (i.e., variables have a special section at within the poster the theories. That is why a major focus that are independent of the model) presentations. This roundtable discussion on this year’s Summit is the theories of and large samples. Second, missing is open to all undergraduate and graduate data must be completely random Improvement” students and provides an opportunity for meaning that there is no relationship them to interact with experts in the field of “We are so excited to be able to bring this between the cause of the missing Improvement Science. This is a great occasion caliber of presenters to the Improvement data and the respondent’s potential for students to meet other students, build Science Summit,” says Dr. Stevens. “We have response. Third, there must be a large collaborations, and learn from work that the ‘who’s-who’ of theory, evaluation and sample size in order to have enough others are doing. The student roundtable power to test the variables in a model. methodology in improvement science at the with Summit experts will be held the podium. The most important thing about the A good rule of thumb for sample size afternoon of August 5th. Summit are the research collaboratives that is at least 5 responses per parameter are developed.” The 2014 Improvement Science Summit estimate. Lastly the correct model – “Building Evidence to Impact Outcomes” specification must be implemented This year, two new network studies will be provides an excellent opportunity to in the model. If the relationship launched and will be actively recruiting study enhance one’s capacity to conduct is linear, then the model must be sites to participate. One study will focus rigorous improvement studies. Through testing a linear relationship. on falls reduction using an evidence-based the presentation of theories, designs and implementation project called CAPTURE evaluation methods, individuals will be able To learn more about SEM, be sure Falls (PI: Katherine Jones, PhD, University to take what is absorbed at this conference to attend the Improvement Science of Nebraska Medical Center). The second and directly apply it to improving the quality Summit where Dr. Rex Kline will study will investigate the impact of the work and safety of care provided to patients. present on the use of SEM in environment on stress and fatigue in the improvement research. Dr. Rex Kline workforce. (PI: Frank Puga, PhD, UTHSCSA For an overview with detailed descriptions of is an associate professor at Concordia each session and to register, visit https://isrn. School of Nursing). University and conducts research in net/2014SummerInstitute. structural equation modeling, among other interests. He will be one of the speakers at the 2014 Improvement Improvement Science Summit: Highlighted Speakers Science Summit and will focus his talk on the principles of structural equation modeling in healthcare improvement. Dr. Kline is the author of several books, including but not limited to, “Beyond significance testing: Statistical reform in the behavioral sciences” and “Becoming a behavioral science researcher: A guide to producing V i c t o r i a J o rd a n , P h D M a r y D i x o n -W o o ds , P h D M a r g o E d m u n ds , P h D D e b r a B a rksd a l e , P h D research that matter” and his talk D i r e c to r , Q u a l i t y A s s o c i at e P r o f e s s o r Professor Vice President should prove to be informative and M e a s u r e m e n t , UT help guide improvement science UNC, C h a p e l H i l l University of Leicester A c a d e m y H e a lt h MD A n d e r s o n research. In order to facilitate his S u m m i t P r e s e n tat i o n : S u m m i t P r e s e n tat i o n : talk, below is a brief description S u m m i t P r e s e n tat i o n : S u m m i t P r e s e n tat i o n : A d va n c e s M a d e i n A n a ly t i c a l M e t h o d s a n d P at i e n t C e n t e r e d T h e R o l e o f T h e o r y of structural equation modeling EDM for Producing Q uality Measures in I m p r o v e m e n t R e s e a r c h : a n d E x p l a n at i o n i n and the necessary assumptions. K nowledge about Q uality Improvement I n s i g h t s f r o m PCORI. I m p r o v e m e n t R e s e a r c h To register for the Improvement Improvement Science Summit, visit https://isrn. net/2014SummerInstitute. Spring 2014 • 2

Expert Perspective: Donald Goldmann

Chief Medical and Scientific Officer, Institute for Healthcare Improvement

This topic has high relevance to the ISRN’s The 2014 Improvement Science Summit research priorities and stresses need for rigorous, program will cover a range of topics relevant rapid, and relevant improvement research. For to quality improvement, patient safety, health more information on the 2014 Improvement services research, and delivery system science. Science Summit, please visit www.ISRN. Attendees will have the opportunity to hear net/2014SummerInstitute. presentations on theories, study designs, analytical methods, and applications of research Don Goldmann’s 7 Rules for Engaging in the field of Improvement Science. The keynote presentation for this year’s Improvement Clinicians in Quality Improvement Science Summit will set the stage for all these 1. Emphasize improvement, not assurance topics from the perspective of a national leader 2. Avoid “mystical” language in the field. Donald Goldmann, M.D., Chief Medical and Scientific Officer with the Institute for Healthcare Improvement, has built a career on health services and quality improvement research. At the 2014 Improvement Science Summit he will be speaking to the conference’s theme, “Building Evidence to Impact Outcomes.”

D o n a l d G o l d m a n n , MD

3. Relate improvement work to what matters to clinicians

Chief Medical

4. Accommodate clinician’s workdload and schedule


5. Be upfront about fiscal agenda 6. Provide relevant data



Scientific Officer

H e a lt h c a r e I m p r o v e m e n t

S u m m i t P r e s e n tat i o n : Building Evidence

to I m pa c t

O u tc o m e s

7. Highlight the academic case for quality improvement

Dr. Goldmann’s presentation will focus on national trends in healthcare improvement and the impact of care delivery on patient outcomes.

“No longer can quality improvers get by with claims that cannot be supported by credible data.” Donald Goldmann

National Call for Principal Investigators The ISRN is interested in collaborating on research studies which contribute to the mission of the ISRN and target one or more of the four stakeholder research priorities. The Improvement Science Research Network (ISRN) invites clinical scholars and academic scientists to develop improvement research studies that advance the Network’s purpose. Many have launched significant improvement and patient safety research studies in a myriad of clinical settings. The ISRN will enable these scientists to establish standards of scientific rigor and will ultimately improve patient outcomes and healthcare delivery processes nationwide through its Network Studies. These guidelines represent conventions for ISRN-endorsed studies and should be used as guidance on how to develop and implement multi-site quality improvement studies. 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. In order to be eligible for consideration, applications must be submitted as an email attachment to the ISRN Coordinating Center. A transdisciplinary team of experts will evaluate the applications. Study PIs will be notified of their status.

A. Coordination and Transitions of Care Priority Topics: Evaluate strategies and methods to assure coordination and continuity of care across transitions in given clinical populations. Test and refine methods of handoffs and other strategies to assure safe, effective, and efficient transitions in given clinical populations. B. High-Performing Clinical Systems and Microsystems Approaches to Improvement Priority Topics: Determine effectiveness and efficiency of various methods and models for integrating and sustaining best practices in improving care processes and patient outcomes. Investigate strategies to engage frontline providers in improving quality and patient safety. C. Evidence-Based Quality Improvement and Best Practice Priority Topics: Evaluate strategies and impact of employing evidencebased practice in clinical care for process and outcomes improvement. Determine gaps and bridge gaps between knowledge and practice. D. Learning Organizations and Culture of Quality and Safety Priority Topics: Investigate strategies for creating organizational environments, processes that support cultures fully linked to maintaining quality, and patient safety in order to maximize patient outcomes. Determine effective approaches to developing organizational climates for change, innovation, and organizational learning.

Contact the ISRN Coordinating Center to learn more about collaborating with the ISRN. Spring 2014 •


New and Noteworthy CALL FOR ABSTRACTS Submit your abstracts to the Summer Institutes on Quality Improvement for poster and podium presentation. For more information visit https://

ISRN WEB SEMINAR Reducing Readmissions: New Frontiers in Care Transition Join the ISRN during our next web seminar presented by Dr. Suzanne Mitchell from the Boston University School of Medicine. This web seminar will explore the benefits of discharge planning and its effect on readmission rates through experiences from the funded Project RED program Date: July 2, 2014 Time: 2:00 ET

Not a Member Yet? 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.

TeamSTEPPS® Master Training Workshop November 6-7, 2014 San Antonio, TX Registration for this 2 day workshop will open in September 2014. Strategies to improve team-related knowledge, skills, and outcomes using a Train-the-Trainer model will be presented. 4

Network Study Prospectus: CAPTURE Falls

Network PI: Katherine Jones, PT, PhD University of Nebraska Medical Center

The Agency for Healthcare Research and Quality (AHRQ) defines a patient fall as “a sudden, unintended, uncontrolled, downward displacement of a patient’s body to the ground or other object” and includes unassisted and assisted falls. Falls remain a common, costly, and serious adverse event in hospitals. Between 2% and 12% of patients fall at least once while hospitalized. Falls with injuries result in an average excess cost of $4,233. Regardless of injury, a fall may result in a fear of falling that limits mobility and contributes to functional decline. Consequently, falls have been designated as 1 of 11 preventable hospitalacquired conditions for which the Centers for Medicare and Medicaid does not reimburse hospitals that receive payment under the Inpatient Prospective Payment System if the condition was not present on admission.

contingency team reflects upon the factors associated with the fall to mitigate future risk. The CF toolkit uses learning domains to structure reflexivity in post-fall huddles. The four learning domains are determined by the combination of process certainty and interdependence of actors which determines sources of error, strategies for learning, and preventive interventions

We have been funded by AHRQ since August 2012 to develop, implement, and evaluate a multicomponent team-based fall risk reduction intervention—Collaboration And Proactive Teamwork Used to REduce (CAPTURE) Falls. The purpose of CAPTURE Falls (CF) is: (1) to decrease the risk of falls in 17 small rural hospitals by implementing evidence-based fall risk reduction interventions supported by a culture of safety, teamwork, and sensemaking; and (2) to develop and disseminate a fall risk reduction toolkit that complements existing tool kits by shifting the paradigm for fall risk reduction from a nursing quality indicator to one that views the structure, process, and outcomes of fall risk reduction as indicators of organizational quality.

2. There is an association between team perceptions of reflexivity and fall rates.

The core team providing care at the bedside identifies modifiable fall risk factors and reliably implements universal and targeted interventions. When a fall occurs, a

We have observed associations between organizational processes (or lack thereof ) and fall outcomes, which are reflected in the following sample hypotheses: 1.There is an association between competency training (annual and new employee) in safe transfers and mobility and the incidence of assisted falls and injurious falls.

Specific Aims 1. To determine if specific coordinating, core and contingency team processes and reflexivity are associated with the incidence of four outcomes: unassisted non-injurious falls, unassisted injurious falls, assisted non-injurious falls, assisted injurious falls. 2. To disseminate and evaluate the generalizability of the CF toolkit and its focus on multiteam system reflexivity in up to 30 hospitals of varying sizes. This study will be presented in its entirety, including study implementation, at this summer’s Improvement Science Summit. For more details about the Summit visit https://

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

Spring 2014 •

Improvement Interventions Naming the Parts Understanding how improvement strategies work requires that the “working parts” be named and classified. For example, a few of the underlying ‘parts’ of the TeamSTEPPS® performance improvement strategy are shared mental model, leadership, and closed loop communication. Because the field is new, standardizing the wide range of inconsistent terms (e.g., improvement science, implementation research, translational science, and knowledge translation) is an important first step toward building theories to guide action. The ISRN, represented by Dr. Kathleen Stevens, participates in a 12-person international invitational group that set out to develop a simplified model for describing “interventions that enhance integration of evidence into practice” (i.e., uptake of EBP), directly related to one of the ISRN Research Priorities. The goal of the group is to develop a common language and an overarching model for improvement interventions. Led by University of Ottawa’s Jeremy Grimshaw, the group reviewed multiple frameworks and models for classifying improvement interventions. The resulting white paper recently has been published in the open source journal, Implementation Science. Through 2014, the group will continue to expand opportunities for consensus input, direction, and participation in this important step in formalizing a common taxonomy for the science of improvement. Follow this work by reading their first publication: Heather Colquhoun, Jennifer Leeman, Susan Michie, Cynthia Lokker, Peter Bragge, Susanne Hempel, Ann McKibbon, Gjalt-Jorn Y. Peters, Kathleen Stevens, Michael G. Wilson, and Jeremy Grimshaw. Towards a simplified model of interventions to promote and integrate evidence into health practices, systems, and policies. Implementation Science. (An open source journal) Classification schemes and taxonomies will enable us to improve uniformity of terminology, promote communication, enhance collaboration, and facilitate evidence synthesis in the field. Reference: Colquohoun et al., (2014) Towards a simplified model of interventions to promote and integrate evidence into health practices, systems and policies. Implementation Science, 9:51

The ISRN Resources: A “Natural Fit” for DNP Research ISRN members have access to an extensive library of capacity-building resources, the content of which aligns with modern undergraduate, graduate, and doctoral programs. DNP programs, in particular, are focused on the same priorities as the ISRN - delivery system improvement. Throughout their program, DNP students encounter topics such as evidence-based practice, delivery systems, and organizational culture and leadership. “With this in mind, DNP students and the Improvement Science Research Network are a natural fit. The ISRN provides the framework in which DNP students can actively garner, utilize, and extrapolate research findings into meaningful clinical practice”, says ISRN student member Erin Hennessey. DNP students can use the ISRN as a laboratory to conduct their culminating project on a multi-site level. This helps increase the generalizability of the results, thereby surpassing the impact of a project done on an individual level. Student members are also encouraged to attend the annual Improvement Science Summit, the official conference of the ISRN, in San Antonio, Texas. This year’s Summit includes a student program, including a special interest group breakfast, that allows both undergraduate and graduate students to build collaborations and learn from work that others are doing. Student Program>>

Spring 2014 •



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

Good News, Great News THE GOOD NEWS ISRN members are marching toward addressing the nation’s consensus priorities in improvement science, which are to 1) close the gap between knowledge and practice; 2) improve structure and processes in clinical care; 3) create quality-oriented organizational environments; and 4) improve continuity of care. Together, ISRN members, Steering Council members, Network PIs, and collaborators continue to determine what works in improving care. Results from the first ISRN studies will be reported at the Improvement Science Summit in August: Over 40 clinical sites joined ISRN Research Collaboratives to conduct studies on frontline engagement in quality improvement and medication safety. Site PIs report multiple benefits of the collaborative and study results point to ways of improving. THE GREAT NEWS ISRN continues to grow capacity in this unique scientific field. New ISRN Research Collaboratives will test solutions that address patient falls, and preventable readmissions; extended studies will examine interventions for medication errors, sustaining team performance, The open call for Network PIs will produce significant leadership for new research studies. continued on page 6




Network Study Pipeline Opportunities to Engage in Landmark Studies

continued from page 5

Affiliations across professional entities underscore the sharpening focus on improvement and implementation research to guide the transformation of healthcare quality and safety. For example, joint work has begun with AcademyHealth, Institute for Healthcare Improvement, and American Association of Medical Colleges. The idea of collaborative teams of doctoral students across disciplines and across multiple settings resonates with faculty in PhD and DNP programs. Imagine the power of teams of doctoral students, equipped with research methods, utilizing the ISRN national test bed to establish their career-long program of research in improvement science!

At the 2014 Improvement Science Summit attendees will have the opportunity to learn about upcoming ISRN Network Studies. On May 6 there will be a panel dedicated to two developing network studies that focus on falls reduction and stress in the nursing workforce. The falls reduction study will investigate the adoption and use of an evidencebased toolkit designed to decrease the risk of falls. The workforce stress study will examine the relationship between work environment and physiological markers stress in the nursing workforce in order build and test system-based interventions that promote adaptive responses to occupational stressors.

In addition to the presentations on these future ISRN Network Studies, Kathleen Stevens, RN, EdD, ANEF, FAAN, ISRN Director, will discuss how clinical scholars and academic scientists can lead future Network Studies. This summer the ISRN will be issuing a call for Network Principal Investigators to propose and lead research studies that advance the Network’s mission. For more background information on this call for Network Principal Investigators, see the story on page 3. More information and guidelines on proposing new studies will be available on later this year. To see the program for this year’s summit, visit

The Improvement Science Summit program is yet again the ‘best ever.’ Features include research methodology topics, ISRN Network Study results, special interest groups, and importantly, the formation of three new ISRN Network Study Collaboratives. The ISRN Steering Council will report on the 2017 Vision resulting from their retreat just prior to the Summit. With ISRN as a nexus linking the vast talent across our ISRN membership, we will continue to make headlines in achieving our mission of rapidly advancing improvement science for improved health. Stay connected and up to date with all things ISRN. Subscribe to the ISRN mailing by sending a message to ImprovementScienceResearch@


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

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ISRN Steering Council Member Spotlight: Carolyn Clancy, MD Carolyn M. Clancy, MD, was appointed Director of the Agency for Healthcare Research and Quality (AHRQ) on February 5, 2003 and reappointed on October 9, 2009. Prior to her appointment, Dr. Clancy was Director of AHRQ’s Center for Outcomes and Effectiveness Research. Dr. Clancy, a general internist and health services researcher, is a graduate of Boston College and the University of Massachusetts Medical School. Following clinical training in internal medicine, Dr. Clancy was a Henry J. Kaiser Family Foundation Fellow at the University of Pennsylvania. C a r o ly n M. C l a n c y , MD a s s i s ta n t d e p u t y u n d e r s e c r ata r y f o r h e a lt h f o r q u a l i t y , s a f e t y

a n d va lu e

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h e a lt h a d m i n i s t r at i o n

Steering Council List>> Improvement Science Summit>>

Before joining AHRQ in 1990, she was also an assistant professor in the Department of Internal Medicine at the Medical College of Virginia. Dr. Clancy holds an academic appointment at George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine) and serves as Senior Associate Editor, Health Services

Research. She serves on multiple editorial boards including the Annals of Internal Medicine, Annals of Family Medicine, American Journal of Medical Quality, and Medical Care Research and Review. She is a member of the Institute of Medicine and was elected a Master of the American College of Physicians in 2004. In 2009, Dr. Clancy was awarded the 2009 William B. Graham Prize for Health Services Research. Her major research interests include improving health care quality and patient safety, and reducing disparities in care associated with patients’ race, ethnicity, gender, income, and education. As Director, she launched the first annual report to the Congress on health care disparities and health care quality. Carolyn is a member of the PCORI (Patient Centered Outcome Research Institute) Board of Directors. In 2010, Carolyn was recognized by modern Healthcare as the #7 most powerful people in Healthcare.

ISRN Member Spotlight: Rebekah Powers, Midland Memorial Hospital

Rebehak Powers,

dnp, rn-bc,

cmsrn, cspha, chts-cp, midland m e m o r i a l h o s p i ta l , m i d l a n d , t x

Dr. Powers is a site principal investigator for the ISRN’s STAR-2+ network study. To find out which Network Studies are being launched at the Improvement Science Summit see this year’s Summit Program>>

Spring 2014 •

Dr. Rebekah Powers DNP, RN-BC, CMSRN, CSPHA, CHTS-CP works at Midland Memorial Hospital in Midland, Texas as the nurse educator for inpatient surgical services. She became interested in the ISRN after attending the 2011 Summer Institute on Evidence-Based Practice (EBP), and joined the ISRN in 2013. Dr. Powers’ interests lie in improvement of nursing practice and patient safety and her DNP capstone work examined interruptions and distractions during medication administration. When the call for participants for STAR-2 + study came out it piqued an interest that fit with the development of a culture of patient safety at Midland Memorial hospital. Dr. Powers served on the Texas Board of Nursing Taxonomy of Errors, Root Cause Analysis of Practice Breakdown, (TERCAP), and American Organization of Nurse Executives Care, Innovation and Transformation (CIT) group. She is

the past chair of the shared governance Council for Nursing Research, Innovations and Improvement at Midland Memorial and has been an active member since 2009. She was the educator for the CIT initial implementation effort. Midland Memorial Hospital’s participation in the STAR-2+ research project assists nurses in medical/surgical units to identify operational failures that can lead to practice breakdowns and have the potential to cause patient harm. Through the shared governance process, staff are empowered to address the failure and implement staff driven solutions to address the failure and enhance systems processes. Future work in the field of improvement science will explore how to engage nurses in regular assessment of the work environment and how to resolve practice breakdown to prevent errors from reaching the patient. To learn more about how to engage as a member of the ISRN, visit 7


Evaluating Evidence-Based Practice Competencies According to the Institute of Medicine, Evidence-Based Practice (EBP) is a key component to healthcare quality improvement. This stresses the need for a workforce skilled in EBP and a need to track progress in EBP readiness, preparedness, and competencies. ACE has resources to help: Build your capacity and evaluate your readiness in EBP.

Evaluate EBP Readiness ACE Evidence-Based Practice Readiness Inventory (ACE-ERI) The ACE-ERI was developed through methodological research studies in response to a national need for assessment approaches in nursing competencies. Using the foundation for the development of the Essential Competencies in Evidence-Based Practice and the ACE Star Model of Knowledge Transformation, this self-report instrument was designed to measure EBP readiness in nurse clinicians, educators, and students. The ACE-ERI provides a score of EBP readiness and three versions of the instrument guarantees a good fit for each student and clinician level: Basic, Intermediate, and Advanced. Psychometric studies have demonstrated high reliability, strong validity, and sensitivity to detect changes pre and post interventions. Offered primarily as an online survey, the ACE-ERI has been used in hospitals and schools of nursing across the country to benchmark progress in EBP competencies.

How was the ACE-ERI developed? The survey is based on a national consensus of essential nursing EBP competencies, organized around the ACE Star Model of Knowledge Transformation as a framework.

Benefits of using the ACE-ERI Using self-efficacy as a basis, the ACE-ERI presents EBP competencies as a Likert-type scale. Scores from the survey allow educators, researchers, or hospital administrators to benchmark of EBP readiness for both students and clinicians. The high reliability and validity of the ACE-ERI assures accurate assessment of this essential skill in transforming healthcare.

ACE-ERI Pricing There is a fee associated with use of the ACE-ERI. The cost breakdown for the ACE-ERI is as follows: Survey and Protocol Use (1st 100 surveys) Database Set-up (1st 100 surveys) Analysis and Reports Cost per Survey (after 1st 100)

$250 $250 $500 $2

Prices may vary depending on your individual needs.

Interested students, educators, EBP directors, and nurse mangers may contact the ACE office to inquire about use of the instrument and to discuss pricing or email

The newly-published 62-page book, Building Successful Research Collaboratives for Healthcare Improvement is an evidence-based guide based 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 and extended to collaborative research. Evidence shows that team-based science generates better results, including increased innovation and advances in knowledge. This guide will build your investigative team’s capacity for collaboration and ensure successful work in team-based improvement research. The processes and tools in Research Collaboratives were tested by members of the Improvement Science Research Network (ISRN) during national, multi-site improvement research projects. Through this guide, you will be introduced to effective strategies for team formation, leadership, conflict management, and virtual collaboration.

Program & Schedule | Call for Abstracts | Hotel Accommodations | Registration

Summer Institutes on Quality Improvement August 5-8, 2014 | Pre-Conference August 4, 2014 Grand Hyatt Riverwalk, San Antonio, TX

At the 2014 Institutes: ◆◆ Apply evidence-based practice to improve care, safety, and patient outcomes. ◆◆ Build capacity to conduct research on improvement and implementation strategies. Take advantage of these back-to-back conferences and be part of the force that transforms care by moving research Building Evidence to Impact Outcomes. Come and make a difference. Enjoy top-notch professional development in one of America’s top five “city getaways,” San Antonio, Texas!

Offered by: Academic Center for Evidence-Based Practice (ACE) Improvement Science Research Network (ISRN) School of Nursing University of Texas Health Science Center San Antonio

Call For Abstracts Summer Institutes on QUALITY IMPROVEMENT August 5-8, 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.

ACCEPTING ABSTRACT Deadline: May 15 IMPROVEMENT SCIENCE SUMMIT ON RESEARCH METHODS August 5-6, 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: New abstract submission requirements this year: abstracts will be accepted online only. For information on abstract requirements and to submit your abstract, visit our website at

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 Nadia Khoja, MS Darpan Patel, PhD Frank Puga, PhD Publication Manager Darpan Patel, 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 hospital sites. Benefits include the following: • • • • • • • • •

Opportunities to participate in multi-site collaborations on patient safety and quality improvement research 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:

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

Follow us on Twitter @theISRN Volume 3 • No. 2 • Spring 2014

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.


Spring 2014 •