Problems as an Inspiration for Practice Improvement

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

• • Relate practice problems to opportunity in the practice setting.
  • Describe reflective practice and its role in innovation and practice improvement.
  • Differentiate between passive and active participation in practice improvement.
  • Apply techniques for practice project identification.
  • Assess problems as a source for practice improvement.

Practice Problems as a driving force for change and quality - Practice problems are defined and identified by investigators, stakeholders, and innovators in an effort to improve practice.  Problems have an innately bad connotation, though they can be purposed for great good. Without problems, advancement is slow-moving. Great skill emerges from the ability of the professional to see problems in a new light. Opportunity often results from the manifestation of practice problems, and offers the potential for allocation of time, resources, and stakeholder engagement in practice innovation. Emergence of talent is an added benefit for organizations as the need to solve practice issues lends itself to the rise of innovators. Finally, problems can be very unifying. As teams come together and a culmination of resources toward a common goal comes to fruition, cohesiveness and a common vision may be found. The takeaway is this: Practice problems can be powerfully constructive. Not only do they offer the aforementioned benefits, but they allow professionals to stretch critical thinking skills and apply specialized abilities to enhance care even beyond the issue at hand.

Identification of practice problems- Identification of problems can also be done purposefully or passively. Sometimes problems emerge with force and urgency, and others emerge gradually over time. For instance, workarounds may be developed gradually for an antiquated health record system until finally regulations mandate overhaul making more sustained electronic health record necessary. 

• Origin of the problem- It is always important to identify and articulate the background of the problem to the audience. This gives them a foundation of understanding, and can also lay the groundwork for buy-in. 
• Presentation of the problem- Accuracy in presentation facilitates alignment and facilitates answerable clinical questions. The problem should be specific and detailed, leaving no question about what problem is being targeted. 
• How problems are identified
  • Active
    1. Surveying clients or employees to evaluate need
    2. Collaborative leadership groups
    3. Stakeholder contributions to proposed innovations
    4. Program evaluation
    5. Metrics analysis and prediction of need
  • Passive
    1. In response to practice error(s)
    2. Developed to fulfill an identified regulatory deficiency
    3. Mitigation of identified risk or escalation

Passive and active participation in practice improvement- Regardless of whether the action is purposeful or not, professionals constantly engage in practice improvement or problem generation, which we have identified as an element of practice improvement. The role of each individual may be productive or antagonistic. Most importantly, the individual involvement in practice improvement may be passive or active. For example, some may solve problems in their individual practice without intent to share results or support overall practice changes. The inaction may not be intentional, nevertheless, progress is limited.

Reflective practice- Reflective practice is utilized as a technique to examine one’s previous experiences while assessing actions, thoughts, and behaviors. In doing so, paradigms and assumptions are considered in determining whether the development of practice improvement goals is constructive. 

• Personal inquiry during reflective practice is a powerful way to reveal a clear vision and direction for practice improvement. 
• View problems as great opportunities that unlock the door for furtherance of excellence rather than simply mitigation of an undesirable circumstance or outcome.
• When professionals engage in reflective practice, they may be more likely to purpose their micro-level innovations toward macro-level solutions.

Suggested readings

Hedges, C., Wolak, E., Smith-Miller, C. A., & Brown, T. (2018). The path to a quieter unit: Get staff engaged in evidence-based practice and quality-improvement projects. American Nurse Today, 13(9), 40–46. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131761860&site=eds-live&scope=site

Hewitt-Taylor, J. (2012). Identifying, analysing and solving problems in practice. Nursing Standard, 26(40), 35–41. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104465463&site=eds-live&scope=site

Lucas, C. (2018). Reflective Practice: More than I expected: Reflections on being observed and reviewed as a pharmacy teacher. Currents in Pharmacy Teaching and Learning, 10, 803–806. https://doi-org.lopes.idm.oclc.org/10.1016/j.cptl.2018.03.005 

Reference

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 

Weinstein, S. (2014). B is for balance: 12 steps toward a more balanced life at home and at work. Indianapolis, MN: Sigma Theta Tau International.

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