Differentiate between quality improvement projects and quality improvement research. How can you use quality improvement in your scholarly project .
Quality in health care is defined by the Institute of Medicine (IOM) as “a direct relationship between the level of improved health services and the expected health outcomes of individuals and populations” (Roussel, 2023, p. 35). Quality improvement projects and quality improvement research both require processes that identify a problem. They both also plan and execute a(n) intervention(s) that will change or make improvements to the problem. Lastly, they both evaluate the change or solution to the problem (Roussel, 2023). Both quality improvement projects and research are based upon data and use humans in at least some aspects of their processes. Quality improvement projects and research should both be led by the six aims of quality care as defined by the IOM. These aims include that care should be safe, timely, efficient, effective, equitable, and patient-centered (Roussel, 2023). Strategies to improve quality are essential to quality improvement projects that involve safety, improvement, and innovation. According to Roussel (2023), quality improvement projects can be unique to the organization or unit, but all successful projects must have four key principles:
- Quality improvement work as systems and processes
- Focus on patients
- Focus on being part of the team
- Focus on the use of the data
One difference between quality improvement projects and quality improvement research is that quality improvement projects may require approval from an institutional review board (IRB) if they include human subjects or individually identifiable data as defined by the federal regulations for research. Humans should not be put at risk nor unique identifiable data be exposed in quality improvement research (Roussel, 2023). Research is defined by the federal government as “a systematic investigation, including research development, testing, and evaluation designed to develop or contribute to generalizable knowledge” (Roussel, 2023, p. 43). Determining if activities are deliberately created to contribute to generalized knowledge is one feature that distinguishes quality improvement research from quality improvement projects. To be generalizable knowledge means that the results of research can be applied to populations or circumstances outside of the original population studied (Roussel, 2023). IRB approval is necessary in quality improvement research when the research is planned to go beyond the unit, department, or services.
The scholarly project is meant to improve patient or organizational outcomes. Quality improvement research can help build a foundation for the scholarly project. The research can help address items pertaining to the scholarly project such as financial impacts, background data, goals, and even strengths and/or weaknesses of the project. The scholarly project is a form of quality improvement by aiming to better patient or organizational outcomes.
Roussel, L. (2023). Quality improvement projects and quality improvement research: Advancing translational science. In J.L. Harris, L.A. Roussel, C. Dearman & P.L. Thomas (Eds.), Project planning, implementation, and evaluation (4th edition, pp. 33-51). Jones & Bartlett Learning, LLC.
According to Roussel (2023), both quality improvement projects and quality improvement research involve the identification of an opportunity for improvement and the utilization of a type of improvement methodology such as plan, do, check, act (PDCA). Both improvement initiatives include the use of data and often include human subjects. Quality improvement research, however, requires Institutional Review Board (IRB) review and approval but quality improvement projects do not. Because of the similarities of the two initiatives, it is important for the team doing the project to look for a few distinguishing characteristics to determine if it is research. Research projects are intended to be generalizable beyond the situation being studied while an improvement project is meant only for the immediate situation (e.g., unit, department, or institution). Another identifying characteristic that will help identify the initiative as a research project is that it uses systematic investigation to compare two or more interventions or processes and evaluates which is more effective. When systematic investigation will contribute to generalizable knowledge, IRB review is required.
Quality improvement projects, like my scholarly project, start with the identification of a problem and then utilize a quality methodology such as the Model for Improvement (MFI) which is foundational to processes such as define-measure-analyze-improve-control (DMAIC) (Roussel, 2023). My scholarly project will focus on interventions that promote retention of novice bedside nurses on the same unit for more than one year. Because the answer to this question is complex and there is not a clearly defined standard, improvement methodology such as DMAIC or PDCA process will be essential to this work. Planning what intervention to try based on institutional data such as employee engagement survey data, implementing the change, reviewing the change, and then adapting, adopting, or abandoning the intervention will be an important part of the project. A team from Baylor health did a quality improvement project related to controllable first year nurse and controllable first to third year nurse retention in 2008-2009 and using the PDCA model implemented three sequential interventions which resulted in a >10% improvement in the retention rate for first year nurses and a >6% improvement in the retention rate for first to third year nurses showing the value of using quality improvement methodology when seeking to improve new nurse retention (Murff & DeFer, 2010).
Murff, M., & DeFer, T. (2010). Improving controllable nursing retention. Nurse Leader, 8(3), 53–57. https://doi.org./10.1016/j.mnl.2009.08.005Links to an external site.
Roussel, L. (2023). Quality improvement projects and quality improvement research: Advancing translational science. In Harris, J. L., Roussel, L. A., Dearman, C., & Thomas, P. L. (Eds.), Project planning, implementation, and evaluation: A guide for nurses and interprofessional teams. (4th ed, pp. 33-48). Jones & Bartlett Learning.
Michelle Beaven Beebe
The Institute of Medicine defines quality care as ” safe, timely, efficient, effective, equitable, and patient-centered ” (Roussel, 2023). To achieve these aims, healthcare organizations must participate in quality improvement. The distinction between a quality improvement project and research lies in the scope (Roussel, 2023). Moreover, there may be an overlap between the two. Both activities utilize a systematic team approach, focusing on data and patients(Roussel, 2023). They may require institutional review board support for ethical or regulatory reasons (Roussel, 2023) to protect their human subjects.
Quality improvement projects are unique to the organization and align with the organization’s goals(Roussel, 2023). These systematic processes monitor, evaluate, and advance organizational performance (Roussel, 2023). They often utilize Plan-Do-Check-Act cycles or other research techniques(Roussel, 2023). The quality improvement project focuses on work within a unit, department, service line, or organization(Roussel, 2023). Applicability beyond this focus may occur but is not intended (Roussel, 2023).
Quality Improvement research is not limited to a specific locale or organization. The intent is for the generalization of the data and applicability to a broader audience (Roussel, 2023). The research aims at new knowledge relevant to sustaining quality improvement. Sometimes a quality improvement project may become a research project and require an adjustment such as IRB. An example will be if qualitative data collection beyond standard patient care is added to a project (Roussel, 2023). A second example will be if there is a comparison of treatments, interventions, or processes (Roussel, 2023).
Utilizing quality improvement is the center of the scholarly project. The scholarly project builds a bridge between knowledge and practice to achieve improved healthcare. In the scholarly project, the student identifies a phenomenon, reviews the literature and evidence-based practices, develops a plan, executes a project, and then analyzes it. This process is essentially Plan – Do – Check – Act, like a quality improvement project or research. The decision is then whether to adopt, adapt or abandon the process. The scholarly project ultimately demonstrates the scholar’s skills in quality improvement and translating this information into practice (Roussel, 2023).
Roussel, L. (2023). Quality improvement projects and quality improvement research: Advancing translational science. In J.L. Harris, L.A. Roussel, C. Dearman & P.L.Thomas (Eds.), Project planning, implementation, and evaluation: A guide for nurses and interprofessional teams (4th edition, pp. 33-51). Jones & Bartlett Learning, LLC.
Differentiating between a quality improvement (QI) project and research can be difficult because both involve defining a problem, planning, and implementing an intervention to solve the problem and improve patient care (Roussel, 2023). Cooperation in quality improvement processes is an essential component of evidence-based healthcare, therefore, participation in QI projects is a given, and additional participant consent is not required (Roussel, 2023). However, healthcare organizations do not need to participate in research; therefore, participant consent is required (Roussel, 2023).
Another characteristic of QI research is that the results from the research are intended to contribute to generalizable knowledge, which means the results of the research can be applied beyond the population or situation that is immediately studied (Roussel, 2023). Regardless of the type of QI, the foundational work for developing QI projects and research is critical to long-term organizational success (Roussel, 2023).
I plan to implement an evidence-based practice change that will improve resident care by prophylactically addressing the reasons residents fall. This QI project will be done on a small scale at one skilled nursing facility and will involve the cooperation of all staff members. The project was created based on input from stakeholders and centers on a facility’s priority to reduce resident falls.
Discussion of previous fall reduction interventions, successes and challenges with these interventions, and data identified a current practice gap that needed to be addressed. Evidence and root cause analysis supported addressing the 5 Ps (pain, potty, position, possessions, and pedals of the wheelchair) as a fall reduction measure. High-level evidence supports the use of a time-out in other healthcare facilities as a way to reduce errors. The researcher and stakeholders proposed that all staff members utilize a time-out before leaving the resident room that addresses the 5 Ps to reduce resident fall rates.
Roussel, L. (2023). Quality Improvement Projects and Quality Improvement Research: Advancing Translational Science. In Harris, J.L., Roussel, L.A., Dearman, C., & Thomas, P.L. (Eds.). Project planning, implementation, and evaluation (4thed. pp. 33-50). Jones & Barlett.