Improvement Science Research Network

The Improvement Science Research Network (ISRN) (Principal Investigator: Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN) is a large-scale academic-practice based healthcare research network that was created to accelerate interprofessional improvement science across multiple healthcare sites. Development of the ISRN was supported by the National Institutes of Health (NIH)through funds from the American Recovery and Reinvestment Act's "Grand Opportunities" Program and began in October 2009. The ISRN aims to fill a national gap in improvement science through a sustainable research network for testing system-focused improvement strategies in healthcare.

To anchor its interprofessional focus, the ISRN is part of the Institute for Integration of Medicine and Science (Clinical and Translational Science Award) of the University of Texas Health Science Center San Antonio (UTHSCSA) and is housed in the UTHSCSA School of Nursing.

The ISRN provides a national laboratory for investigators from across broad geographical range to study improvement, healthcare delivery systems, dissemination, implementation, translation, safety, and patient outcomes.

The ISRN infrastructure supports virtual collaboration in the conduct of network studies through direct engagement of study partners and sites and network study principal investigators and centralized support. Built upon lessions learned from practice-based research networks (PBRNs), the ISRN is registered with the Agency for Healthcare Research and Quality as an active PBRN.

What is Improvement Science?

Improvement Science shares common aspects with other areas of research such as implementation science, translational science, healthcare delivery science, and knowledge translation. These fields are similar in their focus on transforming what is learned from research into common practice to improve care and outcomes. "Improvement Science" is proposed as the broadest, most encompassing term.

Need for Improvement Science Taxonomy

Because Improvement Science is a new scientific field, a common vocabulary is emerging. The influence of Improvement Science will be accelerated by the ability to measure outcomes and index knowledge; this is not possible without a specific taxonomy reflective of the science itself. An improvement science taxonomy will provide a way for subject matter experts to develop, reflect upon, characterize, and examine relationships among the components that comprise Improvement Science as a whole, rather than individual parts. The ISRN framework and the Stevens Star Model of Knowledge Transformation (Stevens, 2008) are reflected in an international effort to create common terminology of organizational interventions for implementing best (evidence-based) practices into health practices, systems and policies.

The goal is for users to have the ability to access Improvement Science knowledge and resources by using a consistent set of terms for organizing, retrieving, and delivering information for their own improvement purposes.

Research Priorities

The Improvement Science Research Network established national stakeholder consensus on research priorities that distinguish it from other practice-based research networks (Stevens & Ovretveit, 2013). These priorities highlight the most important and urgent gaps in improvement knowledge as identified by clinical and academic scholars, leaders, and change agents across major healthcare disciplines. The research priorities guide decisions about the direction of ISRN work and dissemination of ISRN-sponsored knowledge in each of the following domains of improvement science:

1. Coordination and Transitions of Care – this category emphasizes strategies for improvement to care processes in specific clinical conditions. At this time, care coordination and transitions of care are the key clinical focus. Examples of Research Issues: Team performance, medication reconciliation, discharge for prevention of early readmission, patient centered care, measurement of targeted outcomes.

2. High Performing Clinical Systems and Microsystems Approaches to Improvement – this category emphasizes structure and process in clinical care and healthcare as complex adaptive systems. Examples of Research Issues: Frontline provider engagement, factors related to uptake, adoption and implementation, sustaining improvements and improvement processes.

3. Evidence-Based Quality Improvement and Best Practice – this category emphasizes closing the gap between knowledge and practice through transforming knowledge and designating and implementing best practices. Examples of Research Issues: Develop and critically appraise clinical practice guidelines, adoption and spread of best practices, customization of best practices, institutional elements in adoption, defining best practice in absence of evidence, consumers in EBP, technology-based integration.

4. Learning Organizations and Culture of Quality and Safety – this category emphasizes human factors and other aspects of a system related to organizational culture and commitment to quality and safety. Examples of Research Issues: Unit based nursing quality teams, protecting strategy from culture, engendering values and beliefs for culture of patient safety.

Governance

The ISRN is a membership organization guided by two groups: the Coordinating Center and the ISRN Steering Council.

The Coordinating Center is housed within the Center for Advanced Clinical Excellence in the School of Nursing at the University of Texas Health Science Center, San Antonio. Founded upon a longstanding commitment to clinical and translational research, the ISRN Coordinating Center partners with the Institute for Integration of Medicine and Science (IIMS) to further reduce barriers to research and strengthen the science of quality improvement.

The Steering Council is composed of sixteen healthcare experts from both private and public organizations across the nation. Steering Council members come from a variety of backgrounds and contribute knowledge in areas such as healthcare informatics, healthcare information technology, quality measures, teamwork/TeamSTEPPS, patient safety, and implementation practice. The aggregate expertise of this multidisciplinary group reflects advanced knowledge of healthcare improvement and guides the ISRN’s research priorities and activities.

Events

Web Events

The Improvement Science Research Network Web Event series explores issues in the field of improvement science, provides updates regarding the ISRN activities, introduces new tools and research paradigms, and solicits input regarding new directions for research. The first session of the web event series, The Way Forward: An Introduction to Improvement Science, was held in June 2010. Presented by Jack Needleman, PhD, FAAN, and Kathleen Stevens, EdD, MS, RN, ANEF, FAAN, this introductory session showcased the activities of the ISRN as a catalyst for change. It defined Improvement Science, explored the overlapping paradigms of Improvement Science, translational science, and implementation science and explained the need and context for improvement science research. Furthermore, it enumerated the many challenges facing Improvement Science and health care improvement in general, including a lack of evidence-based research methodologies; limited institutional access to national Improvement Science experts; a need for on-site training in research methodologies; and the absence of a collegial and technological infrastructure to support a national agenda for Improvement Science research priorities. Finally, the event showcased the solutions available to meet these challenges, including the ISRN.

ISRN Membership

The ISRN is a member driven network. Membership in the ISRN is open to individuals who are healthcare researchers, academicians, clinicians or administrators with a specific interest in patient safety and improvement research in the acute care setting. Membership in the ISRN includes multiple benefits such as:

Opportunities to participate in multi-site collaborations on patient safety and quality improvement research initiatives
Access to members-only ISRN online resources
Leverage of a national test bed for evaluating improvement strategies
Training resources such as IRB training
Expert guidance in conducting research
Technology infrastructure for participating in multi-site studies
Access to the ISRN web portal providing secure communication, storage and sharing of documents and data
A technical support system providing access to expert guidance in conducting research and using statistics

References

Agency for Healthcare Research and Quality. Fact Sheet: AHRQ support for primary care practice-based research networks (PBRNs), 2006.

American Nurses Association (ANA). The National Database of Nursing Quality Indicators. Washington, DC: ANA, 2007

Berwick DM. (2008). The science of improvement. JAMA. 2008;299(10):1182-4.

Bietz, MJ, Abrams, S, Cooper, D, Stevens, KR, Puga, F, Patel, DI, Olson, GM, & Olson, JS. (2012). Improving the odds through the Collaboration Success Wizard. Translational Behavioral Medicine, 1-7.

Colquhoun, H, Leeman,, J, Michie, S, Lokker, C, Bragge, P, Hempel, S, McKibbon, KS, Peters, GJ, Stevens, KR, Wilson, MH, & Grimshaw, J. (2014). Towards a simplified model of interventions to promote and integrate evidence into health practices, systems, and policies. Implementation Science, 9, 51. (open access)

Davidoff F, Batalden P, Stevens D, Ogrinc G, & Mooney S. Publication guidelines for improvement studies in health care: evolution of the SQUIRE project. Ann Int Med. 2008;149(9):670-7.

Dolor RJ, Smith PC, Neale AV. Agency for Health Care Research and Quality Practice-Based Research Network. Institutional review board training for community practices: advice from the Agency for Health Care Research and Quality Practice-Based Research Network listserv. J Am Board Fam Med. 2008;21(4):345-52.

Graham DG, Spano MS, Stewart TV, Staton EW, Meers A, Pace WD. (2007). Strategies for planning and launching PBRN research studies: a project of the Academy of Family Physicians National Research Network (AAFP NRN). J Am Board Fam Med. 2007 Mar-Apr;20(2):220-8.

Newhouse RP, Petit JC, Poe S, Rocco L. (2006). The slippery slope: differentiating between quality improvement and research. J Nur Adm. 2006 Apr;36(4):211-9

Newhouse, R, Bobay, K, Dykes, PC, Stevens, KR, Titler, M. (2013). Methodology issues in implementation science. Medical Care, 51, S 32-40.

Patel, DI, Puga, F, Ferrer, RL, & Stevens, KR. (2013). Variations in institutional review board approval of a standardized, multi-site, improvement science research project. Research in Nursing and Health. Article ID 548591, 6 pages. (open access)

Puga, F, Stevens, K. & Patel, D. (2013). Adoption of best practices in team science within a healthcare improvement research network. Nursing Research and Practice. Article ID 814360, 7 pages. (open access)

Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville, MD: Agency for Healthcare Research and Quality, 2004.

Stevens, KR & Ovretveit, J. (2013). Improvement research priorities: USA survey and expert consensus. Nursing Research and Practice. Article ID 695729, 8 pages. (open access)

Stevens, KR, Puga, F, Patel, DI. (2012). An Evidence-Based Research Collaborative Guide. San Antonio, TX: University of Texas Health Science Center San Antonio.