Improvement Science Research Network
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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. In October, 2009, 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 (Principal Investigator/Director, Kathleen R. Stevens, EdD, MS, RN, ANEF, FAAN). The ISRN's goal is to fill a national gap in improvement science through a sustained 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 (NIH Clinical and Translational Science Award) at 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, network study principal investigators, and centralized support. Built upon lessons 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?
While Improvement Science is an emerging field, it 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 processes and outcomes. "Improvement Science" is proposed as the most inclusive term in this list and is proposed as a specialty within health services research.
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 upon, 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 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.
The ISRN framework and the Stevens Star Model of Knowledge Transformation (Stevens, 2015) 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. To date this effort resulted in development of a simplified model of interventions to promote and integrate evidence into health practices, systems, and policies (Colquhoun, et al., 2013) and a review of classification schemes for these interventions (Lokker, C., et al., 2015).
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 discovery and dissemination efforts toward 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.
The ISRN is affiliated with the PBRN Resource Center of the Institute for Integration of Medicine and Science, University of Texas Health Science Center San Antonio. Through this alignment, ISRN addresses "Translational Science 3" (T3) phases of moving knowledge into practice. A PBRN is a community of clinicians and academicians united by a shared commitment to expand the science base of a given topic, answer research questions generated by network members, and better understand health issues in the clinical setting.
The interprofessional ISRN is a membership organization advised by the ISRN Steering Council. The Steering Council is composed of twelve healthcare experts, leaders, and stakeholders from both private and public agencies and facilities. Steering Council members represent a variety of backgrounds and contribute knowledge and guidance in areas such as patient safety, improvement and implementation research methods, clinical and organizational excellence criteria, systems engineering, healthcare informatics, quality measures, and team performance. The collective expertise of this multidisciplinary group reflects advanced knowledge of healthcare improvement science and aligns the ISRN's research and activities with stakeholder priorities.
ISRN activities are supported by a coordinating team housed in the School of Nursing at the School of Nursing of the University of Texas Health Science Center San Antonio.
The Improvement Science Research Network Web Event series expands capacity for conducting improvement studies through discussions of issues in the field of improvement science, provides updates regarding the ISRN activities, introduces new tools and research paradigms, and sets the stage for 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 R. Stevens, EdD, MS, RN, ANEF, FAAN, this introductory session showcased the activities of the ISRN as a catalyst for change. The discussion included definition of Improvement Science, exploration of the overlapping paradigms of Improvement Science, translational science, and implementation science and explanation of the need and context for improvement research. Furthermore, the discussion enumerated the challenges facing Improvement Science and health care improvement in general, including a lack of evidence-based research methodologies; limited facility access to national Improvement Science experts; need for the on-site training in research methodologies; and lack of adequate collegial and technological infrastructure to support a national agenda of Improvement Science research priorities. It defined Improvement Science, explored the overlapping paradigms of Improvement Science, translational science, 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. The event showcased solutions available to meet these challenges, including the ISRN. The ISRN web seminars continue to add to the discussion of improvement science research methods, study opportunities, and ISRN research results. Recordings are accessible on the ISRN website.
The ISRN is a member-driven network. Membership in the ISRN is open to all who are healthcare researchers, academic and clinical scientists, clinicians, clinical leaders, administrators, and those with a specific interest in patient safety and improvement research. Membership in the ISRN includes multiple benefits such as:
- Opportunities to participate in multi-site collaborations on patient safety and quality improvement research initiatives
- Venues for dissemination of improvement research
- Access to members-only ISRN online resources
- Leverage of a national test bed for evaluating improvement strategies
- Training resources
- 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
Agency for Healthcare Research and Quality (AHRQ)(2006). Fact Sheet: AHRQ support for primary care practice-based research networks (PBRNs). Rockville, MD: The Agency. Retrieved from nttp:/www.ahrq.gov/research/pbrn/bprnfact.htm
American Nurses Association (ANA). (2007) The National Database of Nursing Quality Indicators (NDNQI). Washington, DC: ANA.
Berwick DM. (2008). The science of improvement. JAMA. 2008;299(10):1182-4.
Bietz, M.J., Abrams, S, Cooper, D.M., Stevens, K.R., Puga, F., Patel, D.I, ... Olson, J,S. (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.,... 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. (2008). Publication guidelines for improvement studies in health care: evolution of the SQUIRE project. Annals of Internal Medicine. 149(9,670-677.
Dolor, R.J., Smith, P.C., Neale, A.V. & Agency for Health Care Research and Quality Practice-Based Research Network (2008). Institutional review board training for community practices: advice from the Agency for Healthcare Research and Quality Practice-Based Research Network listserv. Journal of the American Board of Family Medicine, 21(4):345-352.
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Newhouse, R., Bobay, K, Dykes, P.C., Stevens, K.R., & Titler, M. (2013). Methodology issues in implementation science. Medical Care, 51(4 Suppl. 2), S32-S40.
Patel, D.I., Stevens, K.R., & Puga, F. (2013). Variations in Institutional Review Board approval in the implementation of an improvement science research study. Nursing Research and Practice. Article ID 548591, 6 pages. (open access)
Puga, F, Stevens, K.R. & Patel, D. I. (2013). Adoption of best practices in team science within in a healthcare improvement research network. Nursing Research and Practice. Article ID 814360, 7 pages. (open access)
Sorra, J.S. and Nieva, V.F. (2004). Hospital survey on patient safety culture (Publication No. 04-0041). Rockville, MD: Agency for Healthcare Research and Quality.
Stevens, K.R. & Ovretveit, J. (2013). Improvement research priorities: USA survey and expert consensus. Nursing Research and Practice, 2013 (Article ID 695729), 1-8.(open access)
Stevens, K.R., Puga, F, Patel, D.I. (2012). An Evidence-Based Research Collaborative Guide. San Antonio, TX: Academic Center for Evidence-Based Practice, University of Texas Health Science Center at San Antonio.
Stevens, K,R. (2012). Stevens Star Model of EBP: Knowledge transformation. Center for Advancing Clinical Excellence. The University of Texas Health Science Center at San Antonio.
Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 8(2), 4. (open access)
Stevens, K. R. (2011). National Institute of Nursing Research has widened the Flue Highway of translation research [Letter]. Research & Theory for Nursing Practice: An International Journal. 25(3), 157-159.
Vincent, D., Hastings-Tolsma, M. & Stevens, K.R. (2013). Dissemination and implementation research: Intersection between nursing science and health care delivery. Nursing Research and Practice, Article ID 802767.
- National Institute of Nursing Research
- Agency for Healthcare Research and Quality
- University of Texas Health Science Center San Antonio
- Academic Center for Advanced Clinical Excellence
- Improvement Science Research Network
- AHRQ Innovations Exchange
- Institute for Healthcare Improvement
- American Nurses Association
- ACE STAR Model of Knowledge Transformation