DNP Peers’ Posts Needing Responses
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:
1. Quality improvement work as systems and processes
1. Focus on patients
1. Focus on being part of the team
1. 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).