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The Joanna Briggs Institute clinical fellowship program: a gateway opportunity for evidence-based quality improvement and organizational culture change


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There are many benefits to the uptake of EBHC, not just in terms of practice improvement, but also in understanding individual and organisational barriers and facilitators and the process of change itself. However, a lack of autonomy in the strategic and cultural domains of healthcare organization and delivery, is problematic. The JBI Evidence Based Clinical Fellowship Program (EBCFP) overcomes this, by providing foundational knowledge on change management, leadership, implementation, and evaluation. A constructionist approach enables participants to situate and ground their learning in their own clinical experience, expertise, and interests, all of which facilitate the translation of research into practice. The Joanna Briggs Institute best evidence programs, tools, and resources bridge the evidence to practice gap, and enable organizations to up-skill and equip their clinical staff with specific skills, knowledge and resources. As such, the JBI programs can be considered gateway programs for practice change. An organisational culture of Best Practice requires investment in nurses and other front-line staff as clinical leaders, as innovators, and as drivers of healthcare quality. Organizational as well as individual benefits of the JBI EBCFP include increased capacity for clinical leadership through clinicians and carers who are equipped for practice with the knowledge, skills and resources to lead evidence-based practice change, and to facilitate an organizational culture of improvement.
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The Joanna Briggs Institute clinical fellowship
program: a gateway opportunity for
evidence-based quality improvement
and organizational culture change
Practising health professionals trained and prepared for
best practice lead the provision of high quality, evidence-
based healthcare (EBHC), as many researchers have con-
sistently demonstrated.
Nurses in particular have a
high level of knowledge and acceptance of EBHC, high
uptake of EBHC principals in undergraduate and post-
graduate nursing programs, and increasing integration of
evidence in nurse-led quality improvement initiatives.
There have been many benefits to the uptake of EBHC, not
just in terms of practice improvement, but also in under-
standing individual and organizational barriers and facil-
itators and indeed the process of change itself.
10– 13
However, nurses are not always professionally enabled
to contribute to EBHC initiatives.
While EBHC has
supported nurses to make substantive contributions to
professional nursing knowledge and practice, there are
still gaps. A lack of autonomy in the strategic and cultural
domains of healthcare organization and delivery is prob-
Without mechanismsto address these systemic,
organizational issues, the promise and potential contribu-
tion of nursing will not be fully realized.
The Joanna Briggs Institute (JBI) was established as an
international research institute in 1996 with a vision for a
world in which the best available evidence is used to
inform policy and practice to improve health in commu-
nities globally.
While many associate JBI with system-
atic reviews of the best available evidence, that is only
one element of their work. JBI is also involved with
knowledge transfer and knowledge implementation as
the JBI Model (Fig. 1) illustrates.
The JBI Evidence-Based Clinical Fellowship Program
(EBCFP) focuses on implementation and was designed
for busy healthcare practitioners, managers, and admin-
istrators, who have an interest in implementing best
practice, but may not have familiarity with the suite of
skills needed to lead and sustain practice change.
The program is delivered over 6 months; participants
attend an intensive 1-week workshop that provides
foundational knowledge on change management,
leadership, implementation, and evaluation. Following
the workshop, participants return to their clinical insti-
tution, where they conduct a rapid cycle small test of
change following a Model of EBHC.
After they have
collected baseline data, and implemented their change
based on best practice, participants return for a second
intensive residency, in which they work in small groups
to analyse and evaluate their data and work on dissemi-
nation. This constructionist approach enables partici-
pants to situate and ground their learning in their
own clinical experience, expertise, and interests, all of
which facilitate the translation of research into practice.
Programs such as the EBCFP are designed to help
improve the safety and quality of care provided in health
facilities; and facilitate the development of clinical auton-
omy in the strategic and cultural domains of healthcare
organization and delivery. This is a complex process that
crosses systems, resources, infrastructure, and policy and
process requirements, and requires situated contextual
know-how and operational leadership necessary for
patient and family care. Instituting a change based on
best practice needs to utilize a programmatic, standard-
ized approach that promotes the use of systems and
infrastructure to address issues of policy or practice at
the organizational level. This in turn, contributes to the
promotion of key indicators (such as hand hygiene or
surgical patient management) aligned with national or
international accreditation and benchmark standards.
The achievement of such key indicators is by neces-
sity a multidisciplinary endeavour. Graham et al.
argue that embarking on a trajectory for a
substantive strategic goal requires a whole of organiza-
tion investment. It involves a mission driven investment
that recognizes the value of nurses and their contribu-
tion to clinical leadership and policy and practice
improvement. Graham advocates for the use of a process
similar to that described in the knowledge to action
model for leveraging change processes based upon a
call to action that includes a situational analysis and total
International Journal of Evidence-Based Healthcare ß2020 University of Adelaide, Joanna Briggs Institute 1
©2020 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
organizational engagement for implementation of
The need for a roadmap and steps in planning
aligns well with the work of Steele-Moses,
who also
advocate for a gap analysis to inform the scope of work,
effective planning, inclusivity of top down support for
clinical practice transformation, and adequate resourcing
of the planning phase.
Adequate resourcing includes
finance, staff time, integration with relevant committees,
and regular high-level program activity review.
JBI Clinical Fellows work with other clinicians, admin-
istrators and managers as required to scope the problem
and develop a plan for implementing best practice to
address the compliance gaps found in the baseline audit.
The implementation phase is a facilitated project that
starts with the identification of potential barriers to best
practice, moves to solution building where strategies to
overcome the barriers are developed, and the resources
needed to implement are identified. As per the JBI
Model, the facilitation of change is step two in the
implementation of best practice and is where most of
the fellowship time is allocated. Implementation contin-
ues through an evaluation cycle that provides
Figure 1. The Joanna Briggs Institute model of evidence-based healthcare.
2International Journal of Evidence-Based Healthcare ß2020 University of Adelaide, Joanna Briggs Institute
©2020 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
measurable data on care processes and patient out-
comes that were identified as important during the
context analysis.
The JBI suite of best evidence programs, tools, and
resources facilitate the implementation of change based
on best practice, and surveys consistently demonstrate
that clinicians possess both the knowledge and motiva-
tion to participate and indeed lead such programs of
work. By bridging the evidence to practice gap, and
enabling organizations to up-skill and equip their clinical
staff with specific skills, knowledge and resources, the JBI
programs can be considered gateway programs for
practice change.
Investing in nurses and the practising professions as
clinical leaders, innovators, and drivers of healthcare
quality is well supported by high-quality systematic
reviews. Creating a collective organizational culture of
improvement, as well as the tangible individual benefits
of the JBI EBCFP include honing important project man-
agement skills, instilling a sense of empowerment and
mastery, and increasing capacity for clinical leadership
by the clinicians and carers who are equipped with the
knowledge, skills and resources to lead evidence-based
practice change. Investing in staff for EBHC is something
we can all support.
Conflicts of interest
The authors report no conflicts of interest.
Craig Lockwood PhD,
Daphne Stannard PhD, RN,
Zoe Jordan PhD
and Kylie Porritt PhD, RN
Joanna Briggs Institute, University of Adelaide, Adelaide,
South Australia, Australia,
Adult Medical/Surgical & EBP/
Nursing Research, San Francisco State University,
San Francisco, California, USA
Dr Craig Lockwood, PhD, Director
Implementation Science, Joanna Briggs Institute, Floor 3,
55 King William Road, Norwich Centre, North Adelaide,
Adelaide 5006, SA, Australia.
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4International Journal of Evidence-Based Healthcare ß2020 University of Adelaide, Joanna Briggs Institute
©2020 University of Adelaide, Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.
... Trata-se de um projeto de implementação que utilizou o método do JBI de implementação de evidências (10)(11) , com o uso das ferramentas: Practical Application of Clinical Evidence System -(PACES), ferramenta on-line para registro dos processos de auditoria (de base e de seguimento); e Getting Research Into Practice (GRiP), para registrar as barreiras identificadas durante o processo de implementação. Também, foram utilizadas estratégias para superar tais barreiras e melhorar o grau de conformidade com os critérios auditados (11) . ...
... Para adotar as melhores evidências do CT de pessoas com IC, é necessário promover a adoção, pelos profissionais de saúde, de estratégias de ensino-aprendizagem para fomentar o desenvolvimento de conhecimentos, atitudes e habilidades dos pacientes e cuidadores para monitorar, reconhecer e manejar os sintomas da IC de forma adequada (7)(8)(9)(12)(13)(14) . Além disso, é preciso contribuir para a utilização pelos enfermeiros das melhores evidências cientificas aplicadas à prática clínica (10,14) . ...
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Objectives: Assess the compliance of the implementation of better evidence in the transitional care of the person with heart failure from the hospital to the home. Methods: Evidence implementation project according to the JBI methodology in a cardiology hospital in São Paulo. Six criteria were audited before and after implementing strategies to increase compliance with best practices. 14 nurses and 22 patients participated in the audits. Results: In the baseline audit, compliance was null with five of the six criteria. Strategies: training of nurses; reformulation of the hospital discharge form and guidance on self-care in care contexts; and making telephone contact on the 7th, 14th and 21st days after discharge. In the follow-up audit, there was 100% compliance with five of the six criteria. Conclusion: The project made it possible to increase the compliance of transitional care practices in people with heart failure with the recommendations based on the best evidence.
... Fundamental to this approach is two short course programs offered by JBI: the JBI Comprehensive Systematic Review Training Program (JBI-CSRTP) which teaches systematic review methods, 8 and the JBI Evidence-based Clinical Fellowship Program (JBI-EBCFP). 9 The JBI-EBCFP is focused on evidence implementation, with the objective of improving health processes and outcomes on a health topic within the respective clinical setting, ensuring 'that this process is one that is cognizant of local culture and context, that builds capacity and supports and reinforces existing infrastructure in a sustainable fashion.' 10(p.69) One of the key components of the JBI-EBCFP is the collaboration between the two communities of clinical health settings and academic researchers, through an active facilitation role. ...
... Training programs, such as the JBI-EBCFP, which contribute to a collaborative partnership closing the gap between research and clinical practice will continue to be important within the international implementation landscape. 9,16 The JBI model of evidence-based healthcare 10 has provided a fundamental framework to assist in actioning components of the model in a flexible and contextually appropriate manner. For implementers of evidence, such as health professionals, the importance of a pragmatic and user-friendly approach cannot be overemphasized. ...
Background: Across healthcare there are acknowledged gaps in the translation of evidence into clinical practice. Undertaking a structured implementation program may assist clinicians to achieve this in their clinical practice setting. Aims/methods: The current study descriptively evaluates and analyzes the impact of JBI's (formerly known as the Joanna Briggs Institute) Evidence-based Clinical Fellowship program, since its inception in 2005. Results: Since its inception the JBI Evidence-based Clinical Fellowship Program has trained over 560 Clinical Fellows. The program consists of two 1-week intensive training workshops at JBI, collaborating with a JBI Research Fellow facilitator, with each participant then conducting a workplace evidence implementation project over the intervening 6 months in their own clinical setting. A 'train-the-trainer' program was established to provide accredited trainers to run the program through established JBI Collaborating Entities. Conclusion: Implementation of research evidence into the clinical setting is challenging for health professionals. A pragmatic approach adopted through the JBI Evidence-based Clinical Fellowship Program ensures that the Clinical Fellow remains central as the program leader, but has direction and support from their team of various stakeholders, and ongoing collaboration with a JBI facilitator. This ensures increased capacity for engagement and ongoing sustainability of future implementation programs.
... The JBI Evidence Implementation Program (formerly known as the Clinical Fellowship Program) is a six-month, evidence-based, facilitated implementation program (comprising two 5-day face-to-face intensive training workshops and an evidence implementation project undertaken in the workplace). 26,27 The program is grounded in the clinical audit and feedback process where context analysis, facilitation, and evaluation are key components. This approach has been found to be successful, with >600 healthcare professionals from over 34 countries having successfully implemented and changed practice following this process. ...
In this paper, we provide an overview of JBI's approach to evidence implementation and describe the supporting process model that aligns with this approach. The central tenets of JBI's approach to implementing evidence into practice include the use of evidence-based audit and feedback, identification of the context in which evidence is being implemented, facilitation of any change, and an evaluation process. A pragmatic and practical seven-phased approach is outlined to assist with the 'planning' and 'doing' of getting evidence into practice, focusing on clinicians as change agents for implementing evidence in clinical and policy settings. Further research and development is required to formally evaluate the robustness of the approach to better understand the complex nature of evidence implementation.
... PRISMA checklist was used to present the results of this analysis [36]. Using the Joanna Briggs Institute (JBI) tool to assess the quality of the articles [37]. JBI tools contain a total of eight questions, such as; Q1: Where were the criteria for inclusion in the sample clearly defined, Q2: ...
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Background COVID-19 has significantly impacted humans worldwide in recent times. Weather variables have a remarkable effect on COVID-19 spread all over the universe. Objectives The aim of this study was to find the correlation between weather variables with COVID-19 cases and COVID-19 deaths. Methods Five electronic databases such as PubMed, Science Direct, Scopus, Ovid (Medline), and Ovid (Embase) were searched to conduct the literature survey from January 01, 2020, to February 03, 2022. Both fixed-effects and random-effects models were used to calculate pooled correlation and 95% confidence interval (CI) for both effect measures. Included studies heterogeneity was measured by Cochrane chi-square test statistic Q, I2 and τ2. Funnel plot was used to measure publication bias. A Sensitivity analysis was also carried out. Results Total 38 studies were analyzed in this study. The result of this analysis showed a significantly negative impact on COVID-19 fixed effect incidence and weather variables such as temperature (r = -0.113***), relative humidity (r = -0.019***), precipitation (r = -0.143***), air pressure (r = -0.073*), and sunlight (r = -0.277***) and also found positive impact on wind speed (r = 0.076***) and dew point (r = 0.115***). From this analysis, significant negative impact was also found for COVID-19 fixed effect death and weather variables such as temperature (r = -0.094***), wind speed (r = -0.048**), rainfall (r = -0.158***), sunlight (r = -0.271***) and positive impact for relative humidity (r = 0.059***). Conclusion This meta-analysis disclosed significant correlations between weather and COVID-19 cases and deaths. The findings of this analysis would help policymakers and the health professionals to reduce the cases and fatality rate depending on weather forecast techniques and fight this pandemic using restricted assets.
... We assessed the quality of the articles selected in this study by using the Joanna Briggs Institute (JBI) tool 29 . The checklist contained eight questions such as (a) were the criteria for inclusion in the sample clearly defined, (b) were the study subjects and the setting described in detail, (c) was the exposure measured in a valid and reliable way, were objective, (d) standard criteria used for measurement of the condition, (e) were confounding factors identified, (f) were strategies to deal with confounding factors stated, (g) were the outcomes measured in a valid and reliable way and (h) was appropriate statistical analysis used. ...
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This study presents a systematic review and meta-analysis over the findings of significance of correlations between weather parameters (temperature, humidity, rainfall, ultra violet radiation, wind speed) and COVID-19. The meta-analysis was performed by using ‘meta’ package in R studio. We found significant correlation between temperature (0.11 [95% CI, 0.01-0.22], 0.22 [95% CI, 0.16-0.28] for fixed effect death rate and incidence, respectively), humidity (0.14 [95% CI, 0.07-0.20] for fixed effect incidence) and wind speed (0.58 [95% CI, 0.49- 0.66] for fixed effect incidence) with the death rate and incidence of COVID-19 (p<0.01). The study included 11 articles that carried extensive research work on more than 110 country-wise data set. Thus, we can show that weather can be considered as an important element regarding the correlation with COVID-19.
... The JBI approach to evidence implementation was followed [11], including the use of the Practical Application of Clinical Evidence System (PACES) software [11] and Getting Research into Practice (GRiP) framework for promoting evidence based health care following attendance at an evidence implementation training programme, funded through a competitive scholarship [12][13][14]. This approach involves three phases of activity: ...
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Background To further reduce malaria burden, identification of areas with highest burden for targeted interventions needs to occur. Routine health information has the potential to indicate where and when clinical malaria occurs the most. Developing countries mostly use paper-based data systems however they are error-prone as they require manual aggregation, tallying and transferring of data. Piloting was done using electronic data capture (EDC) with a cheap and user friendly software in rural Malawian primary healthcare setting to improve the quality of health records. Methods Audit and feedback tools from the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research into Practice) were used in four primary healthcare facilities. Using this approach, the best available evidence for a malaria information system (MIS) was identified. Baseline audit of the existing MIS was conducted in the facilities based on available best practice for MIS; this included ensuring data consistency and completeness in MIS by sampling 25 random records of malaria positive cases. Implementation of an adapted evidence-based EDC system using tablets on an OpenDataKit platform was done. An end line audit following implementation was then conducted. Users had interviews on experiences and challenges concerning EDC at the beginning and end of the survey. Results The existing MIS was paper-based, occupied huge storage space, had some data losses due to torn out papers and were illegible in some facilities. The existing MIS did not have documentation of necessary parameters, such as malaria deaths and treatment within 14 days. Training manuals and modules were absent. One health centre solely had data completeness and consistency at 100% of the malaria-positive sampled records. Data completeness and consistency rose to 100% with readily available records containing information on recent malaria treatment. Interview findings at the end of the survey showed that EDC was acceptable among users and they agreed that the tablets and the OpenDataKit were easy to use, improved productivity and quality of care. Conclusions Improvement of data quality and use in the Malawian rural facilities was achieved through the introduction of EDC using OpenDataKit. Health workers in the facilities showed satisfaction with the use of EDC.
The study has its main objective to empirically analyze the role of culture in organizations. As leadership is considered one of the most important factors towards motivation and then organizational performance, however it may not work without integrity. And when we talk about integrity, in organizations for leadership integrity, it takes a lot of time to be established and maintained. Similarly, when leadership integrity may be established, it is postulated that teams can work better and perform more efficiently. To test the proposition, after developing theoretical framework, data were collected from respondents. To analyze the data, SPSS software was employed and results were generated accordingly. Findings of the study show that both hypotheses got accepted and hence recommendations for future researchers and practitioner, this study can be really useful. Keywords: Organizational culture, Motivation, Performance, Leadership integrity.
In this paper we describe and discuss evidence-implementation as a venture in global human collaboration within the framework of “people, process, evidence and technology” as a roadmap for navigating implementation. At its core implementation is not a technological, or theoretical process, it is a human process. That health professionals central to implementation activities may not have had formal training in implementation, highlights the need for processes and programs that can be integrated within health care organisation structures . Audit with feedback is an accessible implementation approach that includes the capacity to embed theory, frameworks and bottom-up change processes to improve the quality of care. In this third paper in the JBI series, we discuss how four overarching principals necessary for sustainability (Culture, Capacity, Communication and Collaboration) are combined with evidence, technology and resources for evidence-based practice change. This approach has been successfully used across hundreds of evidence implementation projects around the globe for over 15 years. We present healthcare practitioner-led evidence-based practice improvement as sustainable and achievable in collaborative environments such as the global JBI network as a primary interest of the practicing professions and provide an overview of the JBI approach to evidence implementation.
Background: Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change. Local problem: An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation. Methods: Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation. Interventions: LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition. Results: The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change. Conclusions: Lean Six Sigma can increase the effectiveness of an EBQI program.
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Background: In 2005, Pearson et al. presented a developmental framework of evidence-based practice that sought to situate healthcare evidence and its role and use within the complexity of practice settings globally. A decade later, it was deemed timely to re-examine the Model and its component parts to determine whether they remain relevant and a true and accurate reflection of where the evidence-based movement is today. Methods: A two-phase process was employed for this project. Phase 1 involved a citation analysis, conducted using the index citation of the original source article on the Joanna Briggs Institute (JBI) Model by Pearson et al. The databases searched were Web of Science and Google Scholar from year of publication (2005) to July 2015. Duplicates and articles in languages other than English were removed, and all results were imported and combined in an Excel spreadsheet for review, coding and interpretation. Phase 2 (model revision) occurred in two parts. Part 1 involved revision of the Model by an internal working group. This revised version of the Model was then subjected to a process of focus group discussion (Part 2) that engaged staff of the Joanna Briggs Collaboration during the 2015 annual general meeting. These data were recorded then transcribed for review and consideration. Results: The citation analysis revealed that the Model was primarily utilized to conceptualize evidence and evidence-based healthcare, but that language used in relation to concepts within the Model was variable. Equally, the working group and focus group feedback confirmed that there was a need to ensure the language utilized in the Model was internationally appropriate and in line with current international trends. This feedback and analysis informed the revised version of the JBI Model. Conclusion: Based on the citation analysis, working group and focus group feedback the new JBI Model for Evidence Based Healthcare attempts to utilize more internationally appropriate language to detail the intricacies of the relationships between systems and individuals across different settings and the need for contextual localization to enable policy makers and practitioners to make evidence-based decisions at the point of care.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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BACKGROUND: The Magnet model proposes an accreditation for hospitals having demonstrated a healthy work environment and, as a result, positive staff and patient outcomes. Yet there are conflicting findings surrounding the actual impact of Magnet's organizational model on these outcomes, as well as a wide range of designs influencing the quality of these results.
Background: Globally, there is an increasing incidence of inflammatory bowel disease. It is very important for patients to be involved with self-management that can optimize personal heath behavior to control the disease. Objectives: The aim of this project was to increase nursing staff knowledge of inflammatory bowel disease discharge guidance, and to improve the quality of education for discharged patients, thereby improving their self-management. Methods: A baseline audit was conducted by interviewing 30 patients in the gastroenterology ward of Huadong Hospital, Fudan University. The project utilized the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research Into Practice audit tools for promoting quality of education and self-management of patients with inflammatory bowel disease. Thirty patients were provided with written materials, which included disease education and information regarding self-management. A post-implementation audit was conducted. Results: There was improvement of education prior to discharge and dietary consultancy in the gastroenterology ward. Self-management plans utilizing written materials only were not sufficient for ensuring sustainability of the project. Conclusions: Comprehensive self-management education can make a contribution to improving awareness of the importance of self-management for patients with inflammatory bowel disease.
Background: Supporting and involving the families of pre-term infants' in the discharge process provides them with confidence in caring for their infants at home. In an effort to facilitate families' readiness for discharge, the neonatal unit (NU) of the Children's Hospital of Fudan University has implemented a best practice project. Objectives: The aim of this project was to integrate the best available evidence on facilitating families' readiness for discharge into the nursing practice of the Children's Hospital of Fudan University. Methods: The current evidence implementation project utilized the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice audit (GRiP) and feedback tools. Nine audit criteria were established on the best available evidence. The project was divided into three phases and conducted over six months in the NU. Results: Follow-up audits showed significant improvements. The most significant improvements, 95% compliance, were found in family involvement on admission, formal assessment of the family's caregiving capabilities, psychosocial readiness, resource availability and preferred teaching style. A moderate increase was noted in identification of family members involved (65%), formal assessment of their learning needs (50%) and provision of tailored education (55%). A small increase of 25% in compliance was found for evaluation of the education. Conclusion: The project led to various changes, such as early involvement of pre-term infants' families, a formal assessment of their readiness for caring for infants and a tailored education program. Further audits will need to be carried out to sustain behavior change and monitor any areas for improvements.
Background: Heart failure is a major public health concern which contributes significantly to rising healthcare costs. Comprehensive discharge planning can improve health outcomes and reduce readmission rates which, in turn, can lead to cost savings. Objectives: The aim of this project was to promote best practice in the discharge planning of heart failure patients admitted in the coronary care unit of Zhongshan Hospital. Methods: A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Five audit criteria that represent best practice recommendations for heart failure discharge planning were used. A baseline audit was conducted followed by the implementation of multiple strategies, and the project was finalized with a follow-up audit to determine change in practice. Results: Improvements in practice were observed for all five criteria. The most significant improvements were in the following: completion of a discharge checklist (from 0% to 100% compliance), comprehensive (i.e. inclusion of six topics for self-care) discharge education for patients (from 7% to 100% compliance), and conducting a telephone follow-up (from 0% to 76% compliance). The compliance rates for the two remaining criteria, completion of a structured education for patients and scheduling an outpatient clinic visit, both increased from 93% to 100%.Strategies that were implemented to achieve change in practice included development of a local discharge planning checklist, provision of training for nurses, and development of resources. Conclusions: The project demonstrated positive changes in the discharge planning practices of nurses in the coronary care unit of Zhongshan Hospital. A formalized discharge planning is currently in place and plans for sustaining practice change are underway. A continuous cycle of audit and re-audit will need to be carried out in the future to determine the impact of this evidence implementation activity on heart failure patient outcomes.
Background: Purposeful and timely rounding is a best practice intervention to routinely meet patient care needs, ensure patient safety, decrease the occurrence of patient preventable events, and proactively address problems before they occur. The Institute for Healthcare Improvement (IHI) endorsed hourly rounding as the best way to reduce call lights and fall injuries, and increase both quality of care and patient satisfaction. Nurse knowledge regarding purposeful rounding and infrastructure supporting timeliness are essential components for consistency with this patient centred practice. Objectives: The project aimed to improve patient satisfaction and safety through implementation of purposeful and timely nursing rounds. Goals for patient satisfaction scores and fall volume were set. Specific objectives were to determine current compliance with evidence-based criteria related to rounding times and protocols, improve best practice knowledge among staff nurses, and increase compliance with these criteria. Methods: For the objectives of this project the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool were used. Direct observation of staff nurses on a medical surgical unit in the United States was employed to assess timeliness and utilization of a protocol when rounding. Interventions were developed in response to baseline audit results. A follow-up audit was conducted to determine compliance with the same criteria. For the project aims, pre- and post-intervention unit-level data related to nursing-sensitive elements of patient satisfaction and safety were compared. Results: Rounding frequency at specified intervals during awake and sleeping hours nearly doubled. Use of a rounding protocol increased substantially to 64% compliance from zero. Three elements of patient satisfaction had substantive rate increases but the hospital's goals were not reached. Nurse communication and pain management scores increased modestly (5% and 11%, respectively). Responsiveness of hospital staff increased moderately (15%) with a significant sub-element increase in toileting (41%). Patient falls decreased by 50%. Conclusions: Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing nursing round interventions which serve to improve patient communication and staff responsiveness. Having a supportive infrastructure and an organized approach, encompassing all levels of staff, to meet patient needs during their hospital stay was a key factor for success. Hard-wiring of new practices related to workflow takes time as staff embrace change and understand how best practice interventions significantly improve patient outcomes.
Importance The literature suggests that hospitals with better nursing work environments provide better quality of care. Less is known about value (cost vs quality).Objectives To test whether hospitals with better nursing work environments displayed better value than those with worse nursing environments and to determine patient risk groups associated with the greatest value.Design, Setting, and Participants A retrospective matched-cohort design, comparing the outcomes and cost of patients at focal hospitals recognized nationally as having good nurse working environments and nurse-to-bed ratios of 1 or greater with patients at control group hospitals without such recognition and with nurse-to-bed ratios less than 1. This study included 25 752 elderly Medicare general surgery patients treated at focal hospitals and 62 882 patients treated at control hospitals during 2004-2006 in Illinois, New York, and Texas. The study was conducted between January 1, 2004, and November 30, 2006; this analysis was conducted from April to August 2015.Exposures Focal vs control hospitals (better vs worse nursing environment).Main Outcomes and Measures Thirty-day mortality and costs reflecting resource utilization.Results This study was conducted at 35 focal hospitals (mean nurse-to-bed ratio, 1.51) and 293 control hospitals (mean nurse-to-bed ratio, 0.69). Focal hospitals were larger and more teaching and technology intensive than control hospitals. Thirty-day mortality in focal hospitals was 4.8% vs 5.8% in control hospitals (P < .001), while the cost per patient was similar: the focal-control was −$163 (95% CI = −$542 to $215; P = .40), suggesting better value in the focal group. For the focal vs control hospitals, the greatest mortality benefit (17.3% vs 19.9%; P < .001) occurred in patients in the highest risk quintile, with a nonsignificant cost difference of $941 per patient ($53 701 vs $52 760; P = .25). The greatest difference in value between focal and control hospitals appeared in patients in the second-highest risk quintile, with mortality of 4.2% vs 5.8% (P < .001), with a nonsignificant cost difference of −$862 ($33 513 vs $34 375; P = .12).Conclusions and Relevance Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients. These results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value, but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.