Text-based Document. Addressing National Research Priorities in Improvement Science. Authors Stevens, Kathleen R. Downloaded 17-Jul :38:21

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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Presentation Text-based Document Addressing National Research Priorities in Improvement Science Authors Stevens, Kathleen R. Downloaded 17-Jul :38:21 Link to item

2 Symposium Addressing National Research Priorities in Improvement Science November 19, Creating a National Research Agenda for Improvement Science 2. National Network Study of Operational Failures in Frontline Nursing 3. Best Practices in Team Science within a Healthcare Improvement Research Network 4. Human Subjects Review of a Multi-site Quality Improvement Study Conducted through a National Research Network Presenters Kathleen R. Stevens, RN, EdD, ANEF, FAAN Frank Puga, PhD Darpan I. Patel, PhD 2013

3 Creating a National Research Agenda for Improvement Science Presented by Kathleen R. Stevens, RN, EdD, ANEF, FAAN University of Texas Health Science Center San Antonio Supported by NIH/NINR 1RC2NR RC2NR S1 3RC2NR S2 RWJF INQRI grant ID: UL1RR025767

4 Mission: To advance the scientific foundation for quality improvement, safety, and efficiency through transdisciplinary research addressing healthcare systems, patient-centeredness, and integration of evidence into practice Core Business: To conduct improvement research studies.

5 Setting the Stage The Need for Improvement We ve seen the reports To Err is Human Crossing the Quality Chasm McGlynn, et al., The quality of health care delivered to adults in the United States, NEJM, AHRQ Quality Reports, care remains suboptimal

6 So why is it 150 years after Semmelweis hand washing still an issue Central line infections we know how to prevent them Early return to hospitals patients not adequately prepared for discharge

7 Catalysts Improving our work is our work. Future of Nursing calls for nurses to lead and manage collaborative efforts with other members of the health care team to conduct research and to redesign and improve practice environments and health systems. (IOM, 2011) Lead with evidence of what works

8 Strategies for Implementing EBP require an evidence base of their own (Shojania & Grimshaw. 2005)

9 Setting the Stage: Need for Improvement Science Patient safety and quality improvement are clearly-stated national priorities. Improvement science still nascent, particularly in multidisciplinary care processes within the hospital setting. Small tests of improvement strategies are insufficient large samples are needed Discovering what works in improvement strategies requires rigorous evaluation approaches = improvement science

10 Definitions IMPROVEMENT SCIENCE rigorous, multisite, transdisciplinary research that Focuses on healthcare improvement (QI, safety) Determines improvement strategies that work Evaluates improvement strategies in healthcare, systems, and safety (ISRN, 2010) 9

11 Challenges of Terminology Healthcare Delivery Science Translational Science Knowledge Translation Evidence- Based Practice/CER Dissemination and Implementation Science GOAL: Shorten time between discovery and full implementation 10

12 1 New Resource: A Unique Research Laboratory

13 How Do We Know An Improvement Strategy Works? What work environment details prevent medication errors? Orange vests What impact does improved team performance have on patient safety? TeamSTEPPS training

14 R & D Strategies for the Improvement Science Research Network Create a shared vision for the work to be done (research priorities) Assure academic-practice partnership for relevancy Provide cyber infrastructure hub for interprofessional improvement and implementation research Launch landmark multi-site research studies Provide essential support though the ISRN Coordinating Center

15 Shared Vision: Stakeholder Informed Research Priorities A systematic approach to create the research agenda. Purpose: To identify views about national priorities for improvement science and build agreement for action in a national improvement research and development network in the USA.

16 Research Priorities in Improvement Science: setting the national agenda Improvement Research Priorities Stakeholders RAND Delphi Survey

17 PRIORITIES Available: 16

18 STRUCTURE The ISRN includes: Mission Priorities Network Associates Steering Council Coordinating Center (Base: Academic Center for Evidence-Based Practice, University of Texas Health Science Center San Antonio) Network Studies and Collaboratives Technology infrastructure Website:

19 1 New Resource: A Unique Research Laboratory

20 19 ISRN Members

21 20 ISRN Steering Council

22 21 ISRN Coordinating Center Team

23 2 New Resource: A Unique Research Laboratory

24 Definition Collaboratory Center without walls in which researchers can work together regardless of physical location. (Wulf, 1993) spans distance supports rich human interaction oriented to a common research area access to data sources and tools RESOURCE: Olson, Zimmerman, & Bos,

25 Why a Collaboratory for Improvement Science Complex scientific problems beyond the realm of single discipline or single scientist Evidence that collaboration increases quality of research Information and communication technologies-now cost-effective and reliable 24

26 2 New Resource: A Unique Research Laboratory

27 26 FUNDED: NINR/NIH $3.2 million AIM: Accelerate interprofessional improvement science in a systems context across multiple hospital sites. Create a large-scale research collaboratory to conduct improvement research studies. Coordinating Center (ACE/UTHSC) Cyberinfrastructure (virtual collaboration) Research Partners Reflects many CTSA Principles

28 Structuring the Improvement Science Collaboratory Practice Based Research Networks 25 years of AHRQ development ISRN is registered PBRN with AHRQ Science of Team Science Research Collaboratives Collaboration on the Internet Evidence-Based Assessment and Development 27

29 Improvement Science Research Network Study Guidelines Network Studies are landmark studies conducted across multiple settings Key Features include: Research Collaborative Rigorous design Science of team science for virtual collaboration Co-led by scientists and clinicians Network PIs; Site PIs Coordinating Center support

30 STUDY 2: Impact of Cognitive Load, Interruptions and Distractions on Procedural Failures and Medication Administration Errors

31 30 STUDY 1: Small Troubles, Adaptive Responses (STAR-2): Frontline Nurse Engagement in Quality Improvement

32 3 New Resource: How well does it work?

33 National Network Study of Operational Failures in Frontline Nursing Small Troubles, Adaptive Responses (STAR-2): Frontline Nurse Engagement in Quality Improvement Presenting Kathleen R. Stevens, RN, EdD, ANEF, FAAN University of Texas Health Science Center at San Antonio

34 Small Troubles, Adaptive Responses (STAR-2): Frontline Nurse Engagement in Quality Improvement BACKGROUND In frontline nursing, workarounds are a response to first order operational failures exposing patients to errors and creating inefficiencies in care. (Hassmiller) Endemic shortages of nursing staff and difficult working conditions present substantial barriers on the path to improvement. (Tucker)

35 Study Background Failures occur about one per hour per nurse on hospital units and 95% of problems are managed through workarounds. (Observational, Tucker) Detection of first order operational failures provides opportunities to fix problems and contributes to organizational learning. Frontline engagement produces better solutions

36 Network Study of Operational Failures 1. Detect 2. Eliminate

37 DETECT Aims of STAR-2 Describe first-order operational failures (defects) Investigate relationships among Detection of first-order operational failures Organizational context, and Outcomes related to quality improvement Results will guide redesign to decrease defects

38 Does the ISRN work? Conduct in the ISRN research laboratory Multisite, cross-sectional, multivariate research 55 sites applied 14 sites, 41 med/surg units, ~840 RNs 4 Pediatric Hospitals Analyze data using descriptive, multivariate, and path analysis methods

39 STAR-2 Research Collaborative Study Teams from 14 sites Deaconess Hospital, Evansville, Indiana Site PI: Ellen Wathen, PhD, RN-BC Research Coordinator: Claire Bennett, BSN, RN University South Alabama Medical Center, Mobile, Alabama Site PI: Lisa Mestas, MSN, RN Site PI: Linda Roussel, DSN, RN, NEA-BC Research Coordinator: Ellen Buckner, DSN, RN, CEA Research Coordinator: Valorie Dearmon, DNP, RN, NEA-BC Baptist Memorial Hospital DeSoto, Southaven, Mississippi Site PI: Mary Townsend-Gervis, BSN, MSN Research Coordinator: Lauren Yates, RN Research Coordinator: Diana Baker, Ed.D., APRN-BC, NEA-BC Huntington Memorial Hospital, Pasadena, California Site PI: Linda Searle Leach, RN, PhD Research Coordinator: LuLu Rosales, RN, MSN Loma Linda University Medical Center, Loma Linda, California Site PI: Ellen D'Errico, PhD, RN NEA-BC Research Coordinator: Patricia Radovich, MS Ochsner Medical Center, New Orleans, Louisiana Site PI: Karen Rice, DNS, APRN, ACNS-BC, ANP Research Coordinator: Rachael Ballas- RN Research Coordinator: Shelley Thibeau- MSN, RN-C The Reading Hospital and Medical Center, West Reading, Pennsylvania Site PI: Vicki Smith, MS, RN Research Coordinator: Debra Stavarski, MSN, RN Palmetto Health Richland, Columbia, South Carolina Site PI: Janice Withycombe, PhD, RN Research Coordinator: Marie Frick-, RN Research Coordinator: Christine Walukewicz, RN, MN Colorado Children s Hospital, Aurora, Colorado Site PI: Anne Marie Kotzer, PhD, RN, CPN Research Coordinator: Joleen Fischer, BSN, RN, CPN Research Coordinator: Jessica Perdue, BSN, RN, CPN Research Coordinator: Nicki Shonka, BSN, RN, CPN Children s National Medical Center, Washington, D.C. Site PI: Eileen Engh, MSN, RN-BC, CPN Research Coordinator: Andrea Colevas, MSN, RN,CPN Research Coordinator: Catherine Williams, RN, BSN, MS, NE-BC Research Coordinator: Sharon Bostic, MBA, BSN, RN Nationwide Children s Hospital, Columbus, Ohio Site PI: Nancy Ryan Wegner, PhD., RN Research Coordinator: Carol Risch, RN, MSN Maine Medical Center, Portland, Maine Site PI: Marthe Riehle, RN, MSN, MBA, NEA-BC Research Coordinator: Denise Dende, MFA Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio Site PI: Heather Tubbs-Cooley, PhD, RN Research Coordinator: Carolyn Smith, MSN, RN Doctor s Hospital - Baptist Health South Florida, Miami, Florida Site PI: Carolyn Lindgren, PhD, RN Research Coordinator: Cheryl Brown, BSN, RN

40 STAR-2 and STAR-2+ Research Collaborative

41 Virtual Collaboration Tools Using the ISRN Collaboratory, STAR-2 was designed to capture a national sample in order to obtain a larger database of operational failures and interacting systemslevel variables. Fidelity of the protocol is assured through the ISRN s Coordinating Center. Using ISRN s unique infrastructure, STAR-2 is able to capture a large, national sample through multiple study sites that are associates in this virtual research network.

42 Protocol Implementation Kit

43 Data Collection-Plan Identical across all sites Supported though Coordinating Center Data aggregated via electronic database Collected 10 shifts over 20 days Analysis Aggregate Site-Specific report

44 Survey Packet

45

46 Evidence-Based Field Guide for Collaboration

47 Results: Small Troubles 14 hospitals completed 716 RNs engaged 85% of enrollment for 14 sites 3,902 pocket cards submitted 5.53 cards per RN 24,014 operational failures reported 6,420 Equipment/Supplies Most reported operational failure 4,396 Information/Communication- Second most operational reported failure 3,648 Other- Third most reported operational failure 6.15 failures per 12 hour shift

48 Average Number of Operational Failures Per 12 hr Shift Operational Failures Per 12 hr Shift (N=2,930 Shifts) Equipment Layout Information Staffing Medication Other

49 Discussion: Study and ISRN Frequency of operational failures occurring in med-surg units Frontline engagement, context, and quality improvement Satisfaction Rating: ISRN infrastructure is effective for conducting multisite improvement research: Enthusiasm for engagement in rigorous research Broad national representation Clinical relevance Rapid deployment & completion Scale up and spread Virtual Collaboration Regulatory-IRB

50 Using the ISRN Collaboratory, STAR-2 was designed to capture a national sample in order to obtain a larger database of operational failures and interacting systems-level variables. Fidelity of the protocol is assured through the ISRN s Coordinating Center. Using ISRN s unique infrastructure, STAR-2 is able to capture a large, national sample through multiple study sites that are associates in this virtual research network. 49

51 STUDY 3: System Factors that Facilitate Uptake of Team Performance for Patient Safety (TeamSTEPPS )

52 TeamSTEPPS

53 Note that each Network Study is open for ISRN members to become Site Investigators Study Priority Status STAR-2 B-Microsystem PHASE 2 ACTIVE: Currently building research collaborative with 12 hospitals. Phase 1 complete in 14 hospitals. 20,000+ data points gathered and analyzed. Medication Errors and Cognitive Load B-Microsystems PHASE 2 ACTIVE: Currently building research collaborative with 4 hospitals. Phase 1 near finalizing data entry. Data analysis currently underway STAR-RT B-Microsystem IN DEVELOPMENT: Project is under development by Network PI. Call for interested hospitals to participate in this study will be released 1st quarter of TeamSTEPPS Care Coordination Care Transition STAR-3 Improvement Collaborative Your 52 Study Here B-Microsystems D-Macrosystems A-Transitions and Coordination in Care A-Transitions and Coordination in Care B-Microsystems C-Uptake of Evidence- Based Practice A, B, C, or D IN DEVELOPMENT: Project is under development by Network PI. Call for interested hospitals to participate in this study will be released 1st quarter of In DEVELOPMENT: Archived Web Seminar August 2012 to activate ISRN member interest. Potential intervention identified for Network testing. IN DEVELOPMENT: Archived Web Seminar July 2012 to activate ISRN member interest. IN DEVELOPMENT: Project to test interventions for STAR-2 are currently being developed. IN DEVELOPMENT: Project is on the drawing board You are invited to design a Network Study for launch across our 200+ member network.

54 Best Practices in Team Science within a Healthcare Improvement Research Network Presented by Frank Puga, PhD University of Texas Health Science Center San Antonio

55 A Collaborative Approach Health care quality improvement is a complex process requiring partnerships between scientist and academicians. Collaboration and team science is growing as a methodology to address complex problems (Stokols et al., 2008). 54

56 A Framework for Collaborative Research The Science of Team Science (SciTS): Provides the evidence base for scientific teams. Benefits of collaboration Factors that contribute to success Systematic approach to building a research collaborative Taken from Falk-Krzesinski et al., 2010

57 Theory of Remote Scientific Collaboration Factors for Successful Virtual Collaboration Nature of the Work Common Ground Collaboration Readiness Management, Planning, and Decision Making Olson, G.M., Zimmerman, A., & Bos, N. (2008) Technology Readiness 56

58 Building ISRN Research Collaboratives Research Network Strategies: Virtual Collaboratory Readiness for Collaboration Shared Mental Model Project Support and Management 57

59 ISRN Research Infrastructure Coordinating Center Support Academic-Practice Partnerships Training meetings Capacity Building A protocol implementation kit Technical resources (e.g. centralized database) 58

60 Success Indicators Study management (# protocol deviations) Engagement (meeting participation) Readiness (timeline adherence) Virtual Readiness (quality of research infrastructure, collaborative success) 59

61 Case Study 14 hospitals engaged in an ISRN Network Study Average size: 425 beds Average Daily Census: 74.7% Site Study Team: Site Principal Investigator, Site Coordinator, and Research Associates 60

62 Data Collection Review of Regulatory documents Survey: Site Principal Investigators and Site Coordinators 61

63 Table 2. Protocol Deviations, s Received, Timeline Adjustments Collaborating Protocol s Received Timeline Meeting Site Deviations (N) (N) Adjustment Attendance (%) Site Yes 83.3% Site 2 NA 104 No 100.0% Site No 100.0% Site 4 NA 75 Yes 100.0% Site No 100.0% Site Yes 100.0% Site No 100.0% Site No 100.0% Site 9 NA 43 Yes 100.0% Site No 83.3% Site 11 NA 81 No 100.0% Site No 100.0% Site Yes 66.7% Site No 83.3% 62 NA = Not Available (Puga, Stevens, and Patel 2013)

64 Table 3. Summary on the Quality of Services offered by the ISRN Coordinating Center Quality (% responses) ISRN COORDINATING CENTER SERVICES & RESOURCES Low Medium High Total (Puga, Stevens, and Patel 2013) Focused on improvement science as the Network mission Responded quickly and effectively to Site PIs s and phone calls Provided clear description of the structure of ISRN (e.g., Network PIs; Site PIs; Network Studies) Established Network structure and processes that supported collaboration Furnished clear call for letters of intent and application for STAR-2 sites Supported Site PIs and Collaborators as full partners in the study Outlined fair guidelines for collaboration (e.g., publication credits) Provided a useful SharePoint site Engaged 63 sites in an action plan for continuing in ISRN Network studies

65 SciTS-Based Research Infrastructure Conclusions SciTS created a robust research environment that fosters transdisciplinary collaboration Fidelity of the protocol was assured across multiple sites. Time lines and deliverables were met Collaboration success was positively rated (Bietz et al., 2012) What about impact on research results? 64

66 General Conclusions Transdisciplinary models are effective in improvement research SciTS provides a strong framework Further research is needed to study the impact on dissemination and implementation of effective improvement strategies 65

67 Resources Stevens, Puga, and Patel

68 Resources 67

69 Human Subjects Review of a Multi-site Quality Improvement Study Conducted through a National Research Network Presented by Darpan I. Patel, PhD University of Texas Health Science Center San Antonio

70 69

71

72 Gap in Knowledge There is a need to figure out what works in our healthcare systems. Need to increase the quantity, quality and generalizability of improvement research. (Berwick, 2008) Initiated by the IOM report indicating a need to transform the healthcare system. (IOM 2000, 2008)

73 But what is it? Research Quality Improvement

74 Is it Research? Research a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. (45 CFR (d)) Quality Improvement

75 Is it Quality Improvement? Research Quality Improvement -systematic, data-guided activities designed to bring about immediate positive changes in the delivery of health care in particular settings. (Baily et al., 2006)

76 Regulatory Difficulties in Improving Care Michigan Keystone ICU project (Pronovost et al., 2006) Exempt from IRB review OHRP sends Determination Letter indicating it conducted non-exempt human subjects research; deemed the study should have had full board review PBRN Health Services Research Variations in review type, time to approval and consenting requirements Delays in study start up, due to regulatory processes

77 Regulatory Difficulties in Improving Care

78 Regulatory Challenges Improvement Science determine which improvement strategies work Generalizable Knowledge Informed Consent Analysis of Administrative Data HIPAA

79 Test Your Knowledge If I plan to carry out a quality improvement project and publish the results, does the intent to publish mean I have to submit my project for IRB review?

80 Regulatory Challenges Intent to Publish Does it mean I need to go through IRB? Major implications on DNP projects Need to assure that ethical standards have been addressed in the planning and implementation of the QI activity (Ogrinc, et al., 2008) ISRN Blog

81 Purpose Review the processes and variations in the IRB approvals in the implementation of a multi-site, improvement study.

82 Facilitating IRB Submissions ISRN Coordinating Center produced Protocol Implementation Kits for each site. PIKs contained IRB templates Standardized Protocol Sample IRB Application Sample Consent Form Sample Information Brochure Study promotion materials Sites were asked to sign investigator agreements to facilitate a quicker study start up

83 Methods An ad hoc review of IRB application materials and correspondences was conducted. Identified the level of review conducted and noted any changes that were made in the final approved documents. Time to submission, time to approval and time to study start was calculated.

84 Results 13 of the 14 study sites conducted independent IRB review 1 study site signed an agreement to fall under the UTHSCSA FWA. No changes to the protocol or ICF were requested.

85 Results Table 1. IRB Review Type and Requirement for Documented Consent Wave Hospital IRB Type Review Type Documented Consent 1 A Academic Expedited No 1 B Academic Expedited Yes 2 C Hospital Expedited Yes 2 D Academic Expedited Yes 2 E Hospital Full Board Yes 2 F Hospital Expedited Yes 2 G Hospital Expedited No 2 H Hospital Expedited Yes 3 I Hospital Expedited Yes 3 J Hospital Full Board Yes 3 L Hospital Expedited Yes 3 K Hospital Expedited Yes 3 M Academic Expedited Yes 3 N Hospital Expedited Yes

86 Results Table 2. Study start-up times (in business days) Days to Submission Days to Approval Days to Study Start All Hospitals 45.1 ± ± ± 10.1 Academic IRB 24.0 ± ± ± 10.2 Hospital-based IRB 54.1 ± ± ± 9.1

87 Areas of concern for the IRBs Data security Consenting Process Data Collection

88 Limitations If you ve seen one IRB you ve seen one IRB! Risk was minimal higher risk studies may result in greater variations.

89 Conclusions Lack of investigator agreements indicate IRBs wanted direct oversight of improvement research at their facilities. IRB approvals, facilitated by the ISRN Coordinating Center and the PIK, resulted in no resubmissions and quick turn around times. IRB review was seemingly streamlined and timely Working with research organizations can provide resources to clinician researchers.

90 SUMMARY Symposium Addressing National Research Priorities in Improvement Science November 19, 2013

91 Summary The Improvement Science Research Network (ISRN) aims to accelerate the development and dissemination of interprofessional improvement science in a systems context across multiple sites. Membership organization comprised of hospitals and universities wanting to engage in quality improvement research The uniqueness of the ISRN is that its focus on organizational systems makes it possible to scientifically explore the system effect(s) on the delivery of healthcare in the acute care setting. The Improvement Science Research Network (ISRN) aims to accelerate the development and dissemination of interprofessional improvement science in a systems context across multiple sites. 90

92 Summary The ISRN actively drives advancements in improvement science by: Creating an infrastructure for multidisciplinary acute care providers to collaborate on improvement science projects through ISRN membership Directing national improvement science research priorities Supporting Network members in developing theories, methods, and designs for achieving rigorous improvement science research Offering central data management and expert analysis for improvement science research studies 91

93 ISRN as a Research Laboratory The ISRN is dedicated to building a foundation for CER in improvement. ISRN provides a laboratory to greatly enhance feasibility and generalizability of research projects. Provides a robust infrastructure for national programs of research to test quality improvement interventions. Managed by a coordinating center with expertise in evidence-based practices, project implementation, project management, regulatory aspects of research, statistical analysis, and team science principles. Research Portfolio: Frontline engagement in quality improvement and detecting operational failures Impact of cognitive load, interruptions and distractions on medication administration errors Investigating the role of team performance in clinical outcomes 92

94 93 Resources

95 94 Resources

96 Resources-Bibliography Berwick, D. M. (2008). The science of improvement. JAMA, 299, 10, p Ferrer, R. L., Stevens, K. R, Sintes, A., Patel, D. I, & Puga, F. (In Review). Real-time reporting of small operational failures in nursing care. BMJ Quality and Safety. Stevens, K. R & Ovretveit, J. (2013). Improvement research priorities: USA survey and expert consensus. Nursing Research and Practice (Article ID ), 1-8. Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Nursing Issues. 8 (2), 4. Patel, D. I., Stevens, K. R., & Puga, F. (2013). Variations in institutional review board approval in the implementation of an improvement research study. Nursing Research and Practice. 2013, Article ID , 6. Puga, F., Stevens, K. R., & Patel, D. I. (2013). Adopting of best practices in team science within a healthcare improvement research network. Nursing Research and Practice. Volume 2013 (2013), Article ID , 7 pages. Retrieved from Bietz, M. J., Abrams, S., Cooper, D., Stevens, K.R., Puga, F., Patel, D. I., Olson, G. M., & Olson, J. S. (2012). Improving the odds through the Collaboration Success Wizard. Translational Behavioral Medicine, 1-7, Retrieved from z. 95

97 Resources-Bibliography Ogrinc, G., Mooney, S.E., Estrada, C., et al. (2008). The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Quality and Safety in Health Care, 17, :i13-i32 doi: /qshc Stevens, K. R, Puga, F., & Patel, D. I. (2012). An Evidence-Based Research Collaborative Guide. San Antonio, Texas: University of Texas Health Science Center San Antonio. Stevens, K. R. (2012). Delivering on the promise of EBP. Nursing Management, 43(4), Stevens, K. R. (2010). Evidence-based practice: Destination or journey? Nursing Outlook, 58(6), Stevens, K. R. (2009). Essential competencies for evidence-based practice in nursing (2nd ed.). San Antonio, TX: Academic Center for Evidence-based Practice (ACE) of the University of Texas Health Science Center San Antonio. Stevens, K. R. (2009). Companion instrument, ACE EBP Readiness inventory ( 2nd ed.) Academic Center for Evidence-based Practice (ACE). San Antonio, TX: University of Texas Health Science Center San Antonio. Available from ACESTAR@uthscsa.edu. Trochim, W. M., Marcus, S. T., Masse, L. C., Moser, R. P., & Weld, P. C. (2008). The evaluation of large research initiatives: A participatory integrative mixed-methods approach. American Journal of Evaluation, 29(1),

98 Resources-Other Improvement Science Research Network. Visit ISRN Research Agenda available at Network News. ISRN Newsletters, chronicling the development and projects of the ISRN. Building Successful Research Collaboratives for Healthcare Improvement is an evidencebased guide based on best practices for research collaboration in investigative teams. Adventures in Evidence-Based Practice: Accelerating Discoveries to Outcomes. A 38- minute streaming video highlighting knowledge transformation and improvement science. Summer Institutes on Quality Improvement: A cluster of interprofessional conferences. August 4-8, San Antonio. Improvement Science Summit. The first national research methods conference highlighting the unique and expanding designs and statistics used in improvement science, implementation research, and quality improvement projects. Summer Institute on Evidence-Based Quality Improvement. The nation s leading interprofessional conference dedicated solely to moving research into practice. 97

99 Acknowledgements FUNDING This project was supported by National Institute of Nursing Research-Grand Opportunities ARRA 1RC2NR RC2NR S1 3RC2NR S2 RWJF INQRI grant ID: National Center for Research Resource Clinical and Translational Science Award UL1RR This content is solely the responsibility of the authors and does not necessarily reflect the official views of the funding agency. PEOPLE Thanks to ISRN Coordinating Center team for their essential support. Thanks to ISRN associates that formed the ISRN and Network Study Research Collaboratives. Thanks to the ISRN Steering Council who saw the ISRN on a blank slate.

100 Contact Information Puga

101 PURPOSE: to advance cutting evidence-based nursing practice, research, and education within an interdisciplinary context. GOAL: to turn research into action, improving health care and patient outcomes through evidence-based practice, research, and education.

102 To move the world we must first move ourselves. -- Socrates