Dear Editor:
Professor Alan Pearson's editorial1 is embraced by the community of improvement science researchers. Professor Pearson accurately describes the focus of improvement science as the identification measurement of improvement strategies within health systems. The Improvement Science Research Network (ISRN) is the only National Institutes of Health supported improvement research network. I would like to elaborate on his statements to further inform the readers about the ISRN, how it came about and the primary focus of the work ahead.
Although improving the quality and safety of patient care rose to a top level priority more than a decade ago, too little progress has been made in building the scientific basis for improvement, particularly in acute care settings. While some groundbreaking research has been done, such efforts often have been confined to localised sites or are of insufficient scientific rigor. The nature of the research affords few opportunities to broadly test findings, collect data from multiple populations or share what has been learned across multiple sites. People who work in healthcare tend to work in silos, says Suzanne Beyea, associate professor of Family and Community Medicine at Dartmouth Medical School and ISRN Steering Council member. She further states, 'We tend to just stay within our organizations, within our fields, within our perspectives. This makes it challenging to offer the best quality of care to patients or even to know what constitutes the best quality of care.'2 Partnerships have not always come easily. The ISRN will forge research collaboratives among academic and clinical researchers with the goal of conducting multisite, interprofessional, rigorous improvement research. The research collaboratives make it possible to build on evidence-based practice, focus on testing improvement strategies and ultimately improve care processes and patient outcomes. To facilitate these ambitions, the ISRN's collaborative will be supported by a coordinating centre hub which will include a web environment for the conduct of research and capacity-building, a technical support line, a collection of resources to use in creating a strong cadre of scientists in the field (e.g. a compendium of research instruments and bibliographies organised around key concepts in improvement science) and communication venues such as newsletters, online interaction and web casts.
The ISRN fills a national gap in improvement science by creating a central structure upon which to build a sustainable, comprehensive network for testing improvement approaches in acute care settings. The infrastructure is rapidly expanding globally and across ambulatory and wellness settings. The technological infrastructure will make it easier for clinical and academic researchers to collaborate and collect, process, analyse and disseminate results of large scale studies.
The ISRN's primary mission is to accelerate interprofessional improvement science in a systems context across multiple hospital sites. To speed research in priority areas, the ISRN published improvement research priority topics that reflect stakeholder opinion and expert guidance.3 The full report is presented on the ISRN website (http://www.ISRN.net). Key topics include the following:
* Coordination and transitions of care
* High-performing clinical systems and microsystem approaches to improvement
* Evidence-based quality improvement and best practice
* Learning organisations and culture of quality and safety
The work of ISRN is guided by these priorities, along with a framework of team science, to build a robust and large body of scientific findings that guide improved patient care within various systems.
By developing an evidence base for healthcare improvement parallel to the evidence base for clinical treatment and care, the ISRN will identify the most effective tools, methodologies and research designs that will lead to improvements in health outcomes, patient safety and health care delivery. In essence, improvement science will enhance diffusion of innovation by building evidence about strategies that most improve healthcare delivery.
The ISRN will provide trouble-free methods for investigators to design, implement and share research results by coordinating and facilitating interprofessional multisite research on and about improvement. Collaboration among clinical and academic researchers and among multiple sites allows researchers to gather larger samples under rigorous standards to yield powerful and generalisable conclusions. These partnerships can synthesise and synergise the work of translational science, transformational science, implementation science and potentiate the improvement science evidence base.
Participants in the inaugural Improvement Science Summit (San Antonio, Texas, July 2010) entitled 'The Way Forward', learned about best practices in networking to advance research. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, spoke on 'The Promise of Improvement Science', stating that such research is key to transforming our healthcare processes.4 Professor Pearson provided a vital discussion during the Summit on 'Networking for Improvement Science: Lessons From Cochrane Collaboration and Joanna Briggs Institute', in which he declared that 'more international collaboration in improvement science is both desirable - because good health care is one of the few truly universal aspirations.'5
The inaugural summit launched the ISRN's national research network which is designed to transform patient care and improve patient outcomes. Three large-scale, networked, multisite studies emerged from the Summit participants, and are currently underway. These studies focus on three topics: engaging frontline nursing staff in quality improvement, examining the impact of disruptions on medication administration errors, and investigating team performance and patient safety. A synopsis of these studies can be perused at our website. The second year Improvement Science Summit is scheduled for 28-29 June 2011 in San Antonio, in tandem with the annual Summer Institute on Evidence-Based Practice.
Future improvement studies will necessarily focus on strategies to build safer work cultures, engage frontline staff in improvement, find effective ways to diffuse evidence-based practice in and across institutions, and determine the combinations and permutations of best practices that create the environment for improvement of the system. Because ISRN infrastructure can support large, rigorous multisite studies, rapid determination and wide dissemination of the most effective strategies will be enhanced.
'In healthcare, we must not only do our work, but also improve our work. This requires the evidence base we will build through the Improvement Science Research Network' (Stevens, 2010).3 We share Professor Pearson's hope that the volume of improvement science reports will rise rapidly under the wings of healthcare transformation.
Acknowledgements
Funding for the ISRN was provided by a $3.1 million grant from the National Institute of Nursing Research of the National Institutes of Health, with funds from the American Recovery and Reinvestment Act of 2009 Award Number RC2NR011946 National Institute for Nursing Research. Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN, professor and director, Academic Center for Evidence-Based Practice, the University of Texas Health Science Center at San Antonio is the Principal Investigator.
[horizontal ellipsis] to the best of our knowledge,
Academic Center for Evidence-Based Practice, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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