|Year : 2016 | Volume
| Issue : 3 | Page : 2-5
From ideas to institute for the design of environments aligned for patient safety (IDEA4PS): The reality of research and the keys to making it work
Susan D Moffatt-Bruce1, Timothy Huerta2
1 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
2 Departments of Family Medicine and Bioinformatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
|Date of Web Publication||19-Aug-2016|
Susan D Moffatt-Bruce
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Moffatt-Bruce SD, Huerta T. From ideas to institute for the design of environments aligned for patient safety (IDEA4PS): The reality of research and the keys to making it work. Int J Acad Med 2016;2, Suppl S1:2-5
|How to cite this URL:|
Moffatt-Bruce SD, Huerta T. From ideas to institute for the design of environments aligned for patient safety (IDEA4PS): The reality of research and the keys to making it work. Int J Acad Med [serial online] 2016 [cited 2020 Jan 19];2, Suppl S1:2-5. Available from: http://www.ijam-web.org/text.asp?2016/2/3/2/188741
| The Big Picture of Research|| |
When starting to develop a research program, the first important order of business is to define what research actually is. Research is not quality improvement; one is not a synonymous with the other. Quality means improving your outcomes, reducing the causes of variation, aligning to best practice, and success is standardization. Quality improvement is about figuring out what works for you as a practitioner, a hospital, or even a healthcare system. Research on the other hand implies improving (or at least attempting to) the outcomes of others, identifying the causes of variation, and building and informing best practice, with the ultimate success being innovation. Research is generalizable and therefore inherently fundable. Research has rules and these rules are very important. First, you cannot build research on bad process. Before a health system can research a process or an idea, they need to have their shop in order. Second, the best research is what you are already planning to do. Do not recreate the wheel. Invest research time in what is important to the institution as well as the patients and providers. Third, remember that research is a bit about opportunity and a lot about relationships. Reach out and get to know who is doing research in your local environment or even nationally and who might want to partner. Finally, there are what you say and what you do. If you are keen to do research, you will have to spend time and commit. The grants do not materialize on their own. They take time, tedious attention to detail, and continuous improvement of submissions.
| The Anatomy of a Grant|| |
Understanding the research funding process can increase your success. While you may not always be aiming to be funded by a national entity, keeping in mind what the five key aspects of federally funded grants are will help align your research grant. The first question asked is what is the potential for the proposed activity to advance knowledge and understanding within its own field or across different fields, referred to as intellectual merit, and what will be the benefit to society or advancing desired societal outcomes which are referred to as then broader impacts? Second, to what extent does the proposed research activities suggest and explore creative, original, or potentially transformative concepts? Third, is the plan for carrying out the proposed activities well-reasoned, well-organized, and based on a sound rationale? Does the plan incorporate a mechanism to assess success that is reasonable and practical? Fourth, how well qualified is an individual, team, or organization to conduct the proposed activities. In many instances, the principle investigator may be junior; however, if there is evidence of mentorship and support, the grant may very well be funded. Finally, are there adequate resources available to the investigator and team, either at the home organization or through collaborations, to carry out the proposed activities? A proven and successful institutional track record is very important when applying for multi-year grants, especially when junior or less experienced investigators are involved. Ultimately, passion for your research idea and project wins the day, but only if the science is sound and detailed. Fundable research is something that reviewers find compelling, innovative, and doable.
| The Ingredients to Success|| |
There are five ingredients to success in research: (1) Right infrastructure, (2) right people, (3) right time, (4) right energy, and (5) right leadership and vision. There are some basic infrastructure items that are needed for any research program to be successful and include good grants management, administrative support to submit grants and develop budgets, and dedicated time for providers to actually have time to develop grant ideas and respond to calls for submissions. Success is predicated on having people committed to both doing things right and doing the right things. Team science no longer tolerates silos. Team science is about coming together as equal partners, not siloed experts. Timing is everything and the right time may not always be convenient. Innovation requires that you are at the cutting edge, not the bleeding edge, and not the flat of the knife. The right energy is a key in a research group. The feeling that you are in it together is required seasoning for success. The hours and the challenges can often be exhausting; having a team to depend on makes the work so much more enjoyable. Further, the right leadership and vision is paramount for success. Success should be considered as both bottom-up and top-down, and effective leaders can manage that tension. There has to be investment from junior staff and faculty, and with sound leadership, they know that their efforts will be rewarded.
| The Opportunity for Synergy|| |
While research is not quality improvement, there are many opportunities within hospitals and health systems to work together. The concept of the learning healthcare system is one which embraces and encourages interaction of research and operations, and if the right people find synergy, they can be incredibly rewarding and even successful in managing the tension that healthcare is facing currently. The concept is that once a quality improvement activity allows an institution to improve and attain the metrics set forth for success, further innovation or new and better practices can be researched. This kind of research requires both discipline and expertise. By combining forces and creating synergies, clinical research can inform institutional quality/safety operations. The implementation of newly acquired knowledge can then re-inform the research in a positive feedback cycle. It is a continuous process that ultimately results in a “learning healthcare system” that can positively affect not only the original study site but also be translated across multiple other institutions and settings.
| Institute for the Design of Environments Aligned for Patient Safety (Idea4ps): A case Study|| |
In the spring of 2015, the Quality and Operations Department and a highly successful group of Health Service Researchers (with a firmly established track record) in the College of Medicine came together to respond to a call from the Agency for Healthcare Quality and Research (AHRQ) entitled, “Patient Safety Learning Laboratories: Innovative Design and Development to Improve Healthcare Delivery Systems“ (P30) (RFA-HS-15-001). The request for applications (RFA) spoke to a recognized scarcity of programmatic activity that actually engaged in new design and systems engineering effort and that was focused on more than singular patient safety concerns. Furthermore, the RFA highlighted the fact that successful learning laboratories would further enable multiple “develop-test-revise” iterations of promising design features and subsystems of the sort that could normally be found in large-scale engineering projects. AHRQ asked specifically for two to four closely related projects that focus on well-known, especially costly, patient safety harms in a given clinical area, and for which new and innovative design approaches were needed. We therefore came together as a group to answer this call and build upon processes and programs we had already implemented within our academic healthcare system. We proposed a research approach to identify and explore how feedback of information could be used to inform the development of robust practices that lead to improved patient safety across the care continuum and that would ultimately improve clinical practice by designing, testing, and exploring the type and kind of information flows that result in adaptation of the health care work environment. The proposal consisted of three main projects:
Project 1: Telemetry and alarms
Research focusing on the manner in which telemetry/alarm information is provided to clinicians, focusing specifically on issues such as the “signal-to-noise ratio” problem experienced by many clinical units. This, in turn, would result in an improvement in both patient safety and care quality.
Project 2: Surveillance
Research focusing specifically on major patient safety events, including hospital-acquired infections, to allow for real-time recognition and problem-solving. This is also referred to as “digital hot spotting.“
Project 3: Crew resource management and inpatient “information flows“
Research exploring the impact of new “information flows” coming from electronic inpatient records to both patients and providers. This project also focuses on examining how the crew resource management approach could be used to escalate concerns.
These three projects were supported by three “research cores” which included an administrative core, a data analytics core, and finally and perhaps most uniquely, a human factors core. The submission required hours of work and time that no one initially had. However, after a tremendous group effort, a 561-page document (an encyclopedia-size paper copy) ultimately was delivered to AHRQ. On September 15, 2015, less than 4 months after the initial submission, we were informed of our success. Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS) was funded for 4 years to maximum amount, and now actively engaging 23 investigators from more than 8 departments at our university [Figure 1].
|Figure 1: The Institute for the Design of Environments Aligned for Patient Safety is a 4-year interprofessional research program that leverages 23 investigators from multiple departments across the Ohio State University|
Click here to view
We see the IDEA4PS success as the beginning. It is now our responsibility to leverage the expertise and skills learned from the IDEA4PS experience and build capacity within the medical center and across the health sciences campus to sustain and expand the overall effort. The IDEA4PS is a testament to the fact that with the right infrastructure, right people, right time and energy, and ultimately the right vision and leadership, research success is possible.
| References|| |
Moffatt-Bruce S, Hefner JL, McAlearney AS. Facing the tension between quality measures and patient satisfaction. Am J Med Qual 2015;30:489-90.
Hefner JL, McAlearney AS, Mansfield J, Knupp AM, Moffatt-Bruce SD. A Falls wheel in a large academic medical center: An intervention to reduce patient falls with harm. J Healthc Qual 2015;37:374-80.