NBPRU REISS Project
Evidence-Informed Nursing Service Delivery Models
´Examininig the emergence of Evidence-informed Nursing Service Delivery Models´
Doris Grinspun, RN, MSN, PhD(c), O. Ont
Nancy Edwards, RN, PhD
The aim of the REISS program of research are to examine the emergence of Evidence-informed Nursing Service Delivery Models (ENSDM) and their uptake within the health care system.
An ENSDM is defined as a transformative model for health services delivery that crosses health care sectors, involves multiple strategies, engages decision-makers (organizational, regional) in supporting implementation and is primarily delivered by or involves the work of nurses. ENSDMs entail the proactive use of evidence-informed implementation strategies both within and between organizations, to enhance the rapid uptake of nursing clinical practice guidelines by practitioners and organizations.
Definition of an ENSDM:
A transformative model for health services delivery that crosses health care sectors, involves multiple strategies, engages decision-makers (organizational, regional) in supporting implementation and is primarily delivered by or involves the work of nurses.
It entails the proactive use of evidence-informed implementation strategies both within and between organizations to enhance the rapid uptake of nursing clinical practice guidelines by practitioners and organizations.
Our primary funder for our research program is the Canadian Health Services Research Foundation. It is being conducted by a team of 21 researcher and decision-maker investigators from across Canada. Team members have diverse backgrounds and bring together the academic settings, health service organizations, the business community, training centers, professional associations, nursing unions, civil society and governments. We tap into a mix of competencies and connections to support knowledge exchange activities.
The program objectives are to understand how an evidence-informed change model develops in the health care system; to describe how ENSDMs diffuse across the health care system and what they cost; and to examine factors that support, sustain and impede intra-and inter-organizational systems change.
The research platform is the ongoing RNAO Nursing Best Practice Guidelines (BPG) initiative, which began in Ontario in 1999 and has expanded to several other provinces in Canada and abroad. The BPG initiative is funded by the Ontario Ministry of Health and Long-term Care (MOHLTC) on a multi-year basis. Twenty-nine BPGs have been developed in the past five years and additional ones are in progress. The REISS program will further our understanding of how these guidelines are best translated into improved practice and evidence-informed service delivery models.
Research Program
We are conducting five studies, to examine the features of a health systems change model, aiming to increase the uptake of nursing guidelines across service delivery units within an organization, between organizations within the same sector and between organizations operating in different sectors. Specifically we are focusing on:
Doris Grinspun and Tazim Virani from the RNAO with Nancy Edwards and Barbara Davies from the University of Ottawa.
RNAO and the University of Ottawa have partnered in the multi-year REISS project.
- Best Practice Champion Project: This study, co-lead by Jennifer Skelly and Jenny Ploeg, is exploring the network of nursing champions. This project is underway and preliminary findings will be available by the end of year 1 the program.
- Organizational Factors that Contribute to the emergence of Evidence-informed Nursing Service Delivery Models (ENSDMs): This project, co-lead by Whitney Berta and Tazim Virani, focuses on the uptake of guidelines among those organizations formally versus informally involved in the RNAO initiative. This project will be completed in year 2 and 3 of the program.
- Expanded Health Systems Diffusion Facilitating factors: This study, co-lead by Barb Davies and Judith Ritchie, looks at the expanded uptake of guidelines between organizations and across sectors. This project is underway and should be completed in year 2 of the program.
- Feedback and Systems Change: The role of timely feedback on clinical outcomes in stimulating guideline uptake within organizations is the focus of this project co-lead by Nancy Edwards and Doris Grinspun. We anticipate completing this project in year 3 of the program.
- Economic Analysis: Each of these sub-studies will provide cost data that will be used to derive empirical estimates for costing. Project study #5 is being co-lead by Angela Downey, David Sharp and Sheila Block. This project is intertwined with each study and it will be completed in year 4 of the program.
Research Transfer Activities
We expect that findings will be of relevance to a range of decision-makers. We are specifically targeting four groups for knowledge translation activities:
- those directly involved provincially, nationally and internationally in nursing management, nursing education, nursing professional standards and policies, nursing education and nursing labour issues;
- the "community" of senior executives within health care service organizations who make many of the decisions regarding budgets and resource allocation;
- decision-makers involved in health care reform at provincial and federal levels, in particular those who are bringing nursing issues to the policy arena; and
- agencies responsible for monitoring patient care outcomes in the health care system (CIHI, ICES, Nursing and Health Outcomes project of MOHLTC, Nursing Health Services Research Unit at the University of Toronto, and Accreditation Groups).
Each of these groups of decision-makers will be brought together on two occasions for a summit. The first of these meetings is scheduled for the spring of 2007.
The advisory committee for this research program is comprised of interdisciplinary members representing diverse perspectives who have roles both within and outside health care at provincial, national and international levels. Our advisory meets twice a year via teleconference.
Semi-annual updates on relevant projects are sent to key stakeholders via e-mail will be posted on the project web site. We also initiate contacts with individual decision-makers to seek input on relevant issues and look at opportunities for collaboration. The rich array of individual networks of team members facilitates links to other decision-makers in both the nursing and health services communities.
The team’s system-change observatory will provide an ongoing means for trainees working with the program to build their own networks bridging research and decision-maker communities. This observatory will be a virtual network of policy makers and researchers in at least 3-4 provinces who are interested in learning from our work and adding their own queries as the work progresses. The project funding includes a postdoctoral fellow who will work with Dr. Edwards and other team members to help develop this systems-change observatory.
Capacity Development Initiatives
We are building on the strong slate of capacity development activities we already have in place including:
- Involvement with 4 CIHR- and CHSRF-funded regional training centers,
- mentoring EXTRA fellows and postdoctoral fellows,
- continuation of a summer research internship offered across Canada by Dr. Edwards as part of her nursing chair award,
- graduate student supervision and courses, and
- RNAO’s multiple initiatives for continuing education.
We aim to rapidly integrate learning from this program of research into undergraduate and graduate courses in our respective universities; to enhance the full use of data arising from our proposed projects through the identification of potential thesis projects for graduate students, the involvement of research interns and EXTRA fellows and the participation of postdoctoral fellows.
We hope that results from this study, will allow us to better understand the:
- costs involved in new service delivery models,
- the means by which successful models can be more rapidly deployed throughout the health care system,
- features of successful models, and variations in these models that better fit the contextual realities of delivering services across sectors (acute, long-term and community care) and in differing geographic environments (e.g. urban versus rural).
We anticipate that study findings will be useful for decision-makers in health care service delivery organizations, regional health authorities (LIHNs in Ontario) and government.
Co-Principal Investigators:
- Dr. Nancy Edwards RN, PhD (Researcher), University of Ottawa
- Doris Grinspun RN PhD(c) (Decision-Maker), Registered Nurses Association of Ontario (RNAO)
Research Co-Investigators:
- Angela Downey PhD CMA FCMA, University of Lethbridge
- David Sharp ACMA MA (Oxon) PhD, University of Western Ontario
- Ali Dastmalchian BA MSc PhD, University of Victoria
- Whitney Berta BSc MBA PhD, University of Toronto
- Barbara Davies RN PhD, University of Ottawa
- Kathy Higuchi RN PhD, University of Ottawa
- Jenny Ploeg RN PhD, McMaster University
- Jennifer Skelly RN PhD, McMaster University
- Ian Graham PhD, University of Ottawa
- Ariella Lang RN PhD, University of Ottawa
- Patricia Marck RN PhD, University of Alberta
- Cecile Michaud RN PhD, Université de Sherbrooke, Campus de Longueuil
Decision-Maker Co-Investigators:
- Irmajean Banjok RN PhD, RNAO
- Sheila Block BA MA(Econ), RNAO
- Judith Ritchie RN PhD, McGill University Health Centre
- Tazim Virani RN PhD(c), RNAO
- Heather McConnell RN MA(Ed), RNAO
- Ann Lynch RN MSc(A), McGill University Health Centre
- Stephanie Lappan-Gracon RN MN, RNAO
Funding Sources:
- CHSRF
- Nursing Research Fund
Co-Sponsors:
- RNAO
- University of Ottawa
- Canadian Nurses Association
- l’Hôpital Charles LeMoyne
- SCO Health Services
- Health Canada
- Office of Nursing Policy
