DevelopmentofanIntegrationModelofEvidenceBasedPractice(EBP...
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Development of an Integration Model of EvidenceBased Practice (EBP), Process Improvement (PI) and Patient Safety. Michelle Pendleton, DNP, RN, Bill Harrington, MBA, BS, Kelly Johnson, MSN, RN, CPPS, KimTharpBarrie DNP, RN, SANE, Jill Berger, MSN, MBA, RN, NEBC Michelle Pendleton [email protected] 1951 Bishop Lane, Ste 103 Louisville KY 40218 5022725366 Contact The passing of the Affordable Care Act (ACA) spurred the movement from “volumebased” to “value based” healthcare financing. In mid2011, the Centers for Medicare and Medicaid Services (CMS) released an extensive document on Hospital ValueBased Purchasing (HVBP) Final Rule, and the InsAtute of Medicine considers paAent safety “indisAnguishable” from the delivery of quality health care (Aspen et al, 2004; Commikee on the Quality of Health Care in America, 2001). Buyers and consumers of healthcare are holding providers accountable for the quality and cost of care. As care providers work to improve the quality scores and as the quality targets related to reimbursement get progressively harder, sustaining the good results of today are not enough. Providers and organizaAons must conAnuously look to the evidence for alternaAve methods of care delivery, uAlize a consistent process improvement model for change, and incorporate conscious consideraAon for paAent safety. Introduction Through the collaboraAon and leadership of a DNP registered nurse and a PhD student in industrial engineering, Norton Healthcare (NHC), in Louisville Kentucky has embraced the journey to integrate the models of evidence based pracAce (EBP) (Johns Hopkins), conAnuous process improvement (DMAIC) and paAent safety. Combining DMAIC, paAent safety and EBP helps to ensure that decisions are based on a combinaAon of best evidence and creaAvity, potenAally miAgaAng false starts or trial and error and prevenAng “reinvenAng the wheel”. Project Description Tools for use Acknowledgements Norton Healthcare departments of Clinical Effectiveness, Institute for Nursing and Risk Management With special thanks to: Shirl Johnson Director, Clinical Effectiveness Jodi Behr Chair, Evidence Based Practice Matrix Todd Lammert System Director, Clinical Effectiveness ACer a literature search looking for current models of integraAon yielded minimal results, a comparison of the purpose, strength and opportunity of EBP and DMAIC was completed. This exercise provided a gap analysis of each methodology and idenAfied where each method could complement the other. EBP and PI Comparison Summary DMAIC (NHC implemented model) EBP (Johns Hopkins) Both DMAIC and EBP Purpose Understanding our problem/ environment Leveraging the documented leanings of others Robust way of knowing our own problems Strength •Guided process •Sustain improvement Framework to appraise fit/ appropriateness of external knowledge Ensure that decisions are based on a combina@on of best evidence and crea@vity, mi@ga@ng false starts defensible scien@fic evidence Opportunity • “a long @me to complete” •limited to internal knowledge •Rigor rela@ng to iden@fying root cause • “charter” type document to provide an overview or guiding document to complete work (scope creep) Strengths of one complement the opportuni@es of another A key component of prac@cefocused doctorate degrees such as the doctorate of nursing prac@ce (DNP) is to transform the health care delivery system by designing, evalua@ng, and con@nuously improving the context within which care is delivered. This innova@on has poten@al to shorten project cycle @me and ensure improving quality and safer pa@ent care. References American Association of Colleges of Nursing (AACN), (2004), Doctor of Nursing Practice (DNP) position statement. Retrieved from h\p://www.aacn.nche.edu/dnp/dnppositionstatement Aspden P, Corrigan J, Wolco\ J, et al., eds. (2004). Patient safety: achieving a new standard for care. Washington, DC: National Academies Press Commi\ee on the Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st century. (2001). Washington, DC: National Academy Press Federal Registrar (2011), v76, no.88 retrieved fromh\p://www.gpo.gov/fdsys/pkg/FR201105 06/pdf/201110568.pdf Johns Hopkins Evidence Based Practice Used with Permission Modelh\p://www.hopkinsmedicine.org/institute_nursing/ continuing_education/evidence_based_practice.html Integrated Project Checklist Johns Hopkins Question Development Easy to follow tools and a checklist were developed and implemented to ensure that quality and practice projects integrate the knowledge and skills for clinical and administrative leadership across services and sites. Summary of Evidence Table Synthesis is KEY Framework Components NHC PaAent Safety Campaign Practice Question Evidence Translation Johns Hopkins EBP Model NHC PI Model DMAIC Define Measure Analyze Improve Control
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Development of an Integration Model of Evidence-‐‑Based Practice (EBP), Process Improvement (PI) and Patient Safety.
Michelle Pendleton, DNP, RN, Bill Harrington, MBA, BS, Kelly Johnson, MSN, RN, CPPS, Kim Tharp-‐‑Barrie DNP, RN, SANE, Jill Berger, MSN, MBA, RN, NE-‐‑BC
Michelle Pendleton [email protected] 1951 Bishop Lane, Ste 103 Louisville KY 40218 502-‐‑272-‐‑5366
Contact
The passing of the Affordable Care Act (ACA) spurred the movement from “volume-‐based” to “value-‐based” healthcare financing. In mid-‐2011, the Centers for Medicare and Medicaid Services (CMS) released an extensive document on Hospital Value-‐Based Purchasing (HVBP) Final Rule, and the InsAtute of Medicine considers paAent safety “indisAnguishable” from the delivery of quality health care (Aspen et al, 2004; Commikee on the Quality of Health Care in America, 2001). Buyers and consumers of healthcare are holding providers accountable for the quality and cost of care. As care providers work to improve the quality scores and as the quality targets related to reimbursement get progressively harder, sustaining the good results of today are not enough. Providers and organizaAons must conAnuously look to the evidence for alternaAve methods of care delivery, uAlize a consistent process improvement model for change, and incorporate conscious consideraAon for paAent safety.
Introduction
Through the collaboraAon and leadership of a DNP registered nurse and a PhD student in industrial engineering, Norton Healthcare (NHC), in Louisville Kentucky has embraced the journey to integrate the models of evidence based pracAce (EBP) (Johns Hopkins), conAnuous process improvement (DMAIC) and paAent safety. Combining DMAIC, paAent safety and EBP helps to ensure that decisions are based on a combinaAon of best evidence and creaAvity, potenAally miAgaAng false starts or trial and error and prevenAng “reinvenAng the wheel”.
Project Description
Tools for use
Acknowledgements Norton Healthcare departments of Clinical Effectiveness, Institute for Nursing and Risk Management With special thanks to: Shirl Johnson Director, Clinical Effectiveness Jodi Behr Chair, Evidence Based Practice Matrix Todd Lammert System Director, Clinical Effectiveness
ACer a literature search looking for current models of integraAon yielded minimal results, a comparison of the purpose, strength and opportunity of EBP and DMAIC was completed. This exercise provided a gap analysis of each methodology and idenAfied where each method could complement the other.
EBP and PI Comparison Summary
DMAIC (NHC implemented model)
EBP (Johns Hopkins) Both DMAIC and EBP
Purpose Understanding our problem/environment
Leveraging the documented leanings of others
Robust way of knowing our own problems
Strength •Guided process •Sustain improvement
Framework to appraise fit/appropriateness of external knowledge
Ensure that decisions are based on a combina@on of best evidence and crea@vity, mi@ga@ng false starts defensible scien@fic evidence
Opportunity • “a long @me to complete” •limited to internal knowledge
•Rigor rela@ng to iden@fying root cause • “charter” type document to provide an overview or guiding document to complete work (scope creep)
Strengths of one complement the opportuni@es of another
A key component of prac@ce-‐focused doctorate degrees such as the doctorate of nursing prac@ce (DNP) is to transform the health care delivery system by designing, evalua@ng, and con@nuously improving the context within which care is delivered. This innova@on has poten@al to shorten project cycle @me and ensure improving
quality and safer pa@ent care.
References American Association of Colleges of Nursing (AACN), (2004), Doctor of Nursing Practice (DNP) position statement. Retrieved from h\p://www.aacn.nche.edu/dnp/dnp-‐‑position-‐‑statement Aspden P, Corrigan J, Wolco\ J, et al., eds. (2004). Patient safety: achieving a new standard for care. Washington, DC: National Academies Press Commi\ee on the Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st century. (2001). Washington, DC: National Academy Press Federal Registrar (2011), v76, no.88 retrieved from h\p://www.gpo.gov/fdsys/pkg/FR-‐‑2011-‐‑05-‐‑ 06/pdf/2011-‐‑10568.pdf Johns Hopkins Evidence Based Practice Used with Permission Modelh\p://www.hopkinsmedicine.org/institute_nursing/continuing_education/evidence_based_practice.html
Integrated Project Checklist Johns Hopkins Question Development
Easy to follow tools and a checklist were developed and implemented to ensure that quality and practice projects integrate the knowledge and skills for clinical and administrative leadership across services and sites.
Summary of Evidence Table
Synthesis is KEY
Framework Components NHC PaAent Safety Campaign
Practice Question
Evidence Translation
Johns Hopkins EBP Model NHC PI Model DMAIC
Define
Measure
Analyze Improve
Control
