Conducting the Project

At the conclusion of this module, participants will be able to:

• Identify the practice problem.
• Select the practice intervention based on evidence.
• Develop a timeline for project completion.
• Identify the role of conceptual and theoretical framework in practice improvement.
• Match methodology with data characteristics. 

Overview of conducting the project-Despite similarities, practice projects offer a unique set of advantages and challenges when compared to original research. In some cases, the solution is so desperately needed, the practice champion or investigator may enjoy an expedited timeline and attainment of site authorization. The downside to implementation when the solution is greatly needed is the possibility that the site hastily rolls out portions of the project leading to a loss of design integrity and investigator control. 

• Identifying the problem-The problem must always begin with a real practice issue. One big mistake project champions make is to choose something to investigate and implement solely based on their own interest.
  1. What are the practice challenges?
  2. What did the needs assessment show?
  3. Who tracks quality at the organization, and what issues are they seeing?
  4. Are industry trends being incorporated into practice?
  5. What information did the stakeholder needs assessment produce?

• Offering the background-Once a practice problem has been identified, it is important to present the project problem in the light of rationale for selection. This sometimes gets muddied with a heavy explanation of historical information. While the history and evolution of a problem is important, practice improvement demands specific detail for the immediate practice setting and what is known about the problem along with a need for solution. Original research may require a lengthier discussion of the global problem and longstanding history. 
  1. Does the background explain how the problem was identified?
  2. Are organization or industry metrics discussed as indicators for the need?
  3. Were stakeholder and client perspectives addressed?
  4. Is the scope of the problem history localized and specific?
• Solutions based on evidence- Innovation is important in any practice improvement project, however, the investigator must derive their localized solution from known evidence in literature. Practice improvement projects offer an interventional action in response to discovery. There must always be an actionable element to practice improvement. Without intervention, information gathering activities cannot be categorized as improvement within the practical realm. Some may struggle with this, especially as it pertains to program evaluation. When this is the case, the following questions may help support the needed interventional step to support practice improvement:

1. What information are you collecting?
2. What do you hope to do with that information?
   • Can the answer to this question become your intervention?
   • What is the ideal outcome of the intervention?
   • Can you measure this impact on practice?

• Theoretical and Conceptual Framework-Theoretical and conceptual framework must be selected in concert with the goals of the organization and in alignment with the project activities. Various profession-specific theories may be used to support underlying concepts. Models become especially important in practice improvement to support the action item in the form of an intervention. Examples of models and theories commonly used in practice improvement
  1. Lewin’s change theory
  2. Iowa model
  3. PDSA- Plan, do, study, act 
  4. ACE model for evidence-based practice
  5. Lean

• Methodology and Design-Methodology and design are important in practice improvement, though some scholars may feel these are more appropriate terms for research rather than practice improvement. While this issue is debated, there are practical uses for these concepts in practice improvement
  • Methodology is one of three:
    • Quantitative- Produces data that can be quantified in its original form. 
      • Is your measurement a number?
      • Most common method for practice improvement due to industry need for quantification. The investigator should always seek guidance when considering this methodology as some academic and professional settings may restrict its use.
    • Qualitative- Free text data such as comments left by participants. This data must be coded and categorized into themes. It is not common for practice improvement to be solely qualitative. 
    • Mixed Methods- Mixed methods are tempting for many project champions as they may think: Why not gather the additional data? Mixed method should only be used in practice improvement when practice metrics depend on the information or there is robust rationale to support it use. The investigator should always seek guidance when considering this methodology as some academic and professional settings may restrict its use.
  • Implementation- Implementation may be carried out by the investigator or other members of the project team. In many cases, professionals in the practice setting are trained to carry out certain project activities as part of the roll out. Implementation may be short and concluded in one day or take years to conclude. Most practice improvement projects will not be extremely lengthy as prolonged periods of time may lessen the necessity and relevance of the results.
  • Project conclusion- Following the conclusion of the project, data analysis and construction of the final work begins. Results may be compiled in several ways:

1. Dissertation
2. Final manuscript
3. Presentation

• • 4. Report

Suggested readings

Manchester, J., Gray-Miceli, D. L., Metcalf, J. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Facilitating Lewin’s change model with collaborative evaluation in promoting evidence based practices of health professionals. Evaluation and Program Planning, 47, 82–90. https://doi-org.lopes.idm.oclc.org/10.1016/j.evalprogplan.2014.08.007

Olisemeke, B., Chen, Y., Hemming, K., & Girling, A. (2014). The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review. Journal of Digital Imaging, 27(6), 751–778. https://doi-org.lopes.idm.oclc.org/10.1007/s10278-014-9706-z

Ungvarsky, J. (2018). PDSA cycle. Salem Press Encyclopedia of Health. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=119214266&site=eds-live&scope=site

Frye, A. W., & Hemmer, P. A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. MEDICAL TEACHER, (5), e288. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN310764886&site=eds-live&scope=site 

Reference List

Agency for Healthcare Research and Quality. (2001). Translating research into practice (TRIP II). Retrieved from http://archive.ahrq.gov/research/findings/factsheets/translating/tripfac/trip2fac.pdf 

Zaccagnini, M. & White, K. (2017). The Doctor of Nursing practice essentials: A new model for advanced practice nursing. Burlington, MA: Jones and Bartlett