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Change with the Practice Care of Vascular Access Devices at Home

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Change with the Practice Care of Vascular Access Devices at Home

Instructions for the

MAP-IT Project Charter Worksheet

 

General Directions

 

Section 1:  Project Overview

 

1.2  Problem Statement

 

  • Describe who is affected by the problem, how extensive the problem is, causes and health outcomes of the problem, and the barriers that exist in solving the problem. All external evidence should be supported by citation of sources.
  • Use a broad to narrow approach.  ​For example, when describing it broadly, you may want to present national, regional or state data on the problem, if available. ​Then move to a more narrow discussion of the problem – e.g., at the city, organizational or unit level.  ​
  • Use primary (not secondary) sources ​when presenting the data. ​For example, if the data is reported to have come from the World Health Organization or the Centers for Disease Control, then the references should have come directly from these sources, and not from a review article in a journal.​
  • Reference all external data with sources. Include internal data if available.

 

Write two paragraphs single-spaced. In the first paragraph focus on external evidence from the literature supporting the significance of the problem. The 2nd paragraph needs to describe why this is a problem in this particular population, setting or context. It should focus on internal evidence from the organization. Include references below the paragraphs.

​ 

1.3 Purpose Statement 

 

A clear statement of the purpose should describe the practice change that it is to be implemented and not the goals. Include in the statement the population or context in which the practice change will be implemented. For example, “The purpose of this quality improvement project is …. ​ 

 

  • …to implement and evaluate the effectiveness of a childhood obesity screening program for a pediatric dental clinic​.
  • …to implement and evaluate a health policy toolkit to support Pennsylvania’s nurse practitioner full practice authority bill.
  • … to implement an algorithm for the postoperative administration of albumin and/or crystalloid solution use in a cardiac surgery ICU.

 

1.4 Project goals: The project short- and long-term goals should be written as SMART goals .

SMART goals are:

  • S=Specific
  • M=Measurable
  • A=Achievable
  • R=Relevant
  • T=Time specific

 

By (month)______ (day)____ (year)____ the ___________(state who, e.g., RNs, physicians) that work in ___________(setting) will change _________________(structures) and/or ______________(processes) in order to improve __________________ outcomes.

 

You will need to include at least one short- and long-term goal. You can write as many SMART goals as your project dictates.

 

The short-term goal is the goal that will be achieved during implementation of the project in NDNP 812. For example, short term goals might be:

 

By September 15, [year], 100% of the nurses in labor and delivery will be trained in the protocol of placing healthy newborn infants skin-to-skin within 5 minutes of birth to improve maternal-infant bonding and breastfeeding outcomes.

 

By December 1, [year], the nursing staff in labor and delivery will place 100% of healthy newborn infants skin-to-skin within 5 minutes of birth to improve maternal-infant bonding and breastfeeding outcomes.

 

The mid-term goal is the goal that you project will be achieved by 6 months to a year. For example, a mid-term goal might be:

           

By July 1, [year], the nursing staff in labor and delivery will place 100% of healthy newborn infants both vaginally and surgically skin-to-skin within 5 minutes of birth to improve maternal-infant bonding and breastfeeding outcomes.

 

The long-term goal is the outcome goal that the process improvements are meant to affect and should occur because of the implementation changes implemented during the project. It may include organizational, community, and/or system level changes to be achieved. These could include changes in patient outcomes or changes in a state or national policy. For example, it might be:

 

By June 1, [year], 100% of the infants born to women who stated they wanted to breastfeed their infants will be exclusively breastfeeding when discharged from the hospital to improve long-term breastfeeding outcomes.

 

The DNP project goals should be set at 100%. There are several reasons for this approach:

 

  • It is impossible to know how many of the clinicians will make the desired changes during the DNP implementation period. It may be possible to have all of the clinicians change their practice.
  • It is important to strive for the best outcomes for all patients by working to implement the evidence-based changes for all patient, not just for 80 percent, 90 percent, or another arbitrary number.
  • Goals are different than benchmarks. You can set interim benchmarks to help track interim progress toward the ultimate goal. Each context is unique. It is impossible to know how long it will take to reach the 100% mark.
  • If the goal is set too low then people stop trying when they reach the goal, rather than continuing to strive to ensure all patients receive the evidence-based care.
  • Often the patients who are in the last 10-20% are the most vulnerable patients who need evidence-based care the most. It is important to set the expectation early on in the project that the work is not done until all patients get the care that will lead to the best outcomes.

 

1.5 Population/Setting Affected by Practice Change: 

 

Describe the population and context where you will be implementing your DNP Project. The description should include specific numbers of clinicians and patients who will be affected by your DNP project. For example, if you planned on implementing a depression screening tool in an out-patient clinic, you would specify the number of out-patients expected to receive the screening in the clinic each month during the project implementation period). That will allow reviewers to understand the scope of the project.

 

1.6  Middle Range or Practice Theory:

Describe how your selected middle-range or practice theory serves in the understanding the problem, the most effective evidence to implement, the place to target that evidence to bring about the practice change, and or the evaluation of the implementation. This description should be one paragraph in length, no more than 250 words.

Section 2:  Mobilize

 

2.1 Team Members

 

Complete Table 1 adding individuals based on the characteristics of your project. Teams will vary based on the goals of your project.

 

The Clinical Site Representative (CSR) needs to be someone with the power and authority to approve the project and help you achieve buy-in from the administrative sponsor(s). Administrative Sponsors are those individuals who have power and authority above the Clinical Site Representative (e.g., directors of nursing, medical directors), and need to be informed about the project to ensure that support for the work and resources will be made available.

 

The Change Champions are individuals from each group you are trying to change. For example, if the goal is to change a specific RN practice then you will need an RN Change Champion from both the night and day shift. If the change affects other professional groups  (e.g., physicians, nurse practitioners, administrative assistants, pharmacists) then you will need to identify a Change Champion from each of these groups. The Change Champions work with you and the CSR to plan how to implement the changes.

 

Section 3:  Assess

 

3.1a Fishbone Diagram

 

Review the video in the overview on Root Cause Analysis in DNP Quality Improvement. Use the Fishbone Diagram template to create the diagram for your project. Adjust the categories, the causes, and sub-causes based on the specific problem being evaluated. Submit the completed Fishbone diagram as a separate document.

 

3.1b Process Map Showing Current State

 

Process mapping is another tool that you can use to assess which processes you want to improve during your project Process Maps help you clarify what the current processes are and which processes need to be changed. Process maps also help the CSR and Change Champions think about what changes are most critical and which processes are in and out of scope of the QI project.

 

Figure 1 is the current process for mailing a letter. A process map is an easy way for people to quickly see what the current process is, and what might be changed. The conversations that take place when developing a process map also help support teamwork and ensure shared understanding of what is in and out of the scope of the project. Replace the example below with your project process map using the symbols provided, or simply write out the steps.

 

 

                                             Figure 1. Example of a process map

                                               

Another example of a process map for the course is located under Course Model in Blackboard.

 

If the practice change you are implementing is new, develop a process map displaying the current workflow pattern or steps that will need to be modified to incorporate the new practice change.

 

3.1c  Structure, Process and Outcome Measures to be Assessed Prior to Implementation

 

By definition quality improvement (QI) includes the collection and analysis of data. Structure, process, and outcome measures are the three major types of data collected by QI leaders.

Structure includes all of the factors that affect the context in which care is delivered. This includes the physical facility, equipment, and human resources, as well as organizational characteristics such as staff training and payment methods. Changes in structure might include a modification of the electronic health record, updating a policy or procedure, ensuring necessary equipment is available, and/or education of staff about the practice change. Structure is often easy to observe and measure and it may be the upstream cause of problems identified in process. The following are examples of structure measures:

  • whether or not a change in the Electronic Health Record took place (yes or no)
  • whether a policy was approved by the administration (yes or no)
  • the number of staff educated on the implementation out of the number of staff who take care of this population (numerator/denominator).

Process includes all the acts of healthcare delivery (e.g., screening, diagnosis, treatment, preventive care, and patient education). A process change is a change in clinical practice that helps resolve or modify the practice problem. The following are examples of process measures:

  • the number of patients screened out of the number of patients who should have been screened
  • the number of patients who received the flu vaccine out of those who were seen and should have received it

Outcomes contains all the effects of healthcare on patients or populations, including changes to health status, behavior, or knowledge as well as patient satisfaction and health-related quality of life. Changes in outcomes include specific improvements in population health. The following are examples of outcome measures:

  • the number of patient falls out of the number of patients who are being cared for on an inpatient unit
  • the number of patients with a urinary tract infection out of the number of patients who have a catheter (CAUTI rate)

Based on priorities, complete Table 3 and describe the structure, process and outcome measures that you plan to assess prior to implementation and those that you will continue to assess during implementation.

Keep in mind that the baseline (current state) assessment, which is a part of your gap analysis (comparison of current state to desired state) will help you refine your SMART goals and your implementation plans. Information about structure and process can be obtained from medical records, interviews with patients, Clinical Site Representative, practitioners and staff, or direct observations of the clinical setting. Interviews and observations will help you answer the question – Why is this change needed here?

3.2 Structure, Process, and Outcome Measures to be Assessed During Implementation

 

Complete Table 4 to identify the structure, process, and outcome measures you will be collect during implementation of your DNP Project. Whenever possible use tested and validated measures that have been endorsed by the National Quality Forum or other organizations such as the Centers for Medicaid and Medicare or regulatory agencies like the Joint Commission. Sometimes you can also identify validated measures based on the research that is published about the structure and process changes you plan to implement.

 

Some QI projects would benefit from the use of balancing measures. For example, if you are working to reduce cesarean births you also need to make sure you have balancing measures to ensure that you are not introducing unintended negative outcomes for the mothers and infants by pushing the cesarean birth rate too low.

 

Section 4:  Plan

 

4.1. Outline in Table 5 the types of quality improvement strategies and tactics you will utilize during the implementation of your DNP project.

 

Planning is a key component to success. Implementation leaders will be more effective if their implementation plan includes multiple types of strategies and tactics. The most effective approach is to tailor the implementation strategies and tactics to mitigate the barriers and enhance the facilitators that are specific to each implementation effort.

 

Too often leaders default to only one strategy, education. According to Roger’s (2003) research, education is the first stage when disseminating an innovation. However, leaders need to utilize other strategies and tactics to complete the other four stages outlined by Rogers (persuasion, decision, implementation, and confirmation or continuation).

 

Dr. Debra Bingham drew upon her own research and the work of the Expert Recommendations for Implementing Change (ERIC) project to develop a list of possible implementation strategies and tactics (Bingham & Main, 2010; Powell et al., 2015). These lists were then re-organized to attempt to make it easier for implementation leaders to think beyond education.

 

There are multiple ways to organize the list of possible implementation strategies and tactics. Dr. Bingham divided these lists into five major types of strategies that fit within the first five letters of the alphabet:

 

A = Accountability

B = Buy-In for the right outcomes or incentives

C = Collaboration, Communication, and Changes in structures

D = Data

E = Education

 

Subsequently different tactics were identified for each type of major strategy. The list of possible tactics is not exhaustive or mutually exclusive. In other words, some tactics may fit under more than one strategy. In addition, there is more evidence available about some tactics than others. Since implementation is context specific, it is challenging to have one list that meets the needs of every implementation effort. Instead, this list can prompt leaders to be creative and selective in which tactics they utilize and when they should utilize each one. If one tactic is not working, then leaders need to review the list and utilize additional tactics.

 

This list is not meant to be exhaustive, rather to help stimulate your own list of change ideas. Add to this list and outline your change ideas. Thinking ahead, insert a date when you think you will utilize the tactics that you plan to use to ensure implementation success.

 

Be creative. For example, for the tactic titled “tests”,  you might set up a jeopardy like game. You also need to be aware of budget constraints. As a student you may not have the access to an online education portal where you can create the education so you may choose to create binders that have all of the PowerPoint slides and handouts that everyone can refer to while sitting at the desk or in the break room. You can also be creative by coming up with a clever name for your project, etc. Have your QI team help you make the implementation launch a great success by making it a lot of fun!

 

Keep in mind that adults do not like to be embarrassed. So come up with tactics that help everyone succeed. Avoid blaming and shaming and making people defensive. Be respective, open, honest, and collaborative. The success of your DNP Project depends on how willing people are to work with you. You do not have the ability to dictate that they make changes. You are in the position to persuade and support their efforts to improve outcomes.

 

Table 1. Bingham’s ABCDE’s Implementation Strategies and Tactics

 

Strategies and Tactics

 

Definitions

Dates

 

Accountability

 

Conduct cyclical small tests of change*

 

Implement changes in a cyclical fashion using small tests of change before taking changes system-wide. Tests of change benefit from systematic measurement, and results of the tests of changes are studied for insights on how to do better. This process continues serially over time, and refinement is added with each cycle

 

Change accreditation or membership requirements*

 

Strive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation

 

Create or change credentialing and/or licensure standards*

 

Create an organization that certifies clinicians in the innovation or encourages an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward the innovation

 

Obtain formal commitments*

Obtain written commitments from key partners that state what they will do to implement the innovation

 

Obtain and use patients/consumers and family feedback*

Develop strategies to increase patient/consumer and family feedback on the implementation effort

 

Place innovation on fee for service lists/formularies*

Work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable)

 

Provide performance reviews

Hold discussions between an employer and employee in order to give feedback about how current behavior does or does not meet expectations of job performance

 

Provide clinical supervision*

Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation

 

Revise professional roles*

Shift and revise roles among professionals who provide care, and redesign job characteristics

 

 

Buy-In (Incentives/Disincentives)

 

Access new funding*

Access new or existing money to facilitate the implementation

 

Alter incentive/allowance structures*

Work to incentivize the adoption and implementation of the clinical innovation. Examples from DB: professional recognition, a bonus, a certificate of achievement, a thank you letter that cc’s their manager and can be put into their employee file, pizza party when the group achieve pre-determined milestones

 

Alter patient/consumer fees*

Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments

 

Develop disincentives*

Provide financial disincentives for failure to implement or use the clinical innovations

 

Increase demand*

Attempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation

 

Change liability laws*

Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation

 

Make billing easier*

Make it easier to bill for the clinical innovation

 

Use other payment schemes*

Introduce payment approaches (in a catch-all category)

 

Use capitated payments*

Pay providers or care systems a set amount per patient/consumer for delivering clinical care

 

Collaboration, Communication, and Changes in Structures

Collaboration

Intervene with patients/consumers to enhance uptake and adherence*

Develop strategies with patients to encourage and problem solve around adherence

 

Identify early adopters*

 

Identify early adopters at the local site to learn from their experiences with the practice innovation

 

Identify and prepare champions*

 

Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization

 

Involve executive boards*

Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes

 

Involve patients/consumers and family members*

Engage or include patients/consumers and families in the implementation effort

 

Build a coalition (Peer Support and Peer Pressure)*

Recruit and cultivate relationships with partners in the implementation effort

 

Conduct local consensus discussions*

Include local providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate

 

Develop academic partnerships*

Partner with a university or academic unit for the purposes of shared training and bringing research skills to an implementation project

 

Communication

Meetings

Schedule group discussions, e.g., staff meetings, workgroup/advisory board meetings. Find a routine time, e.g., every Wed. at 10am, to meet to discuss your progress toward the goal(s).

 

One-to-one discussions

Set up a discussion between a change leader and someone else whom they are seeking to influence to change

 

Academic detailing discussions

Schedule a review and discussion of academic research by one leader meeting with one clinician at a time

 

Remind clinicians*

Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation. Examples from DB: checklists to help them perform specific tasks, order sets, pop-ups on the computer, emails to individuals or groups, newsletters.

 

Share information in a public and transparent manner

Post a collection of data or other information that is organized and displayed on a poster board or a bulletin board that is visible to all. Develop electronic dashboards

 

Provide ongoing consultation*

Provide ongoing consultation with one or more experts in the strategies used to support implementing the innovation

 

Arrange disciplinary discussions*

Arrange a discussion that is held by someone in the position to give employee feedback and a formal review of performance in order to outline how current behavior does not meet required expectations of job performance

 

Capture and share local knowledge*

 

Capture local knowledge from implementation sites on how implementers and clinicians made something work in their setting and then share it with other sites

 

Centralize technical assistance*

 

Develop and use a centralized system to deliver technical assistance focused on implementation issues

 

Develop a formal implementation blueprint*

 

Develop a formal implementation blueprint that includes all goals and strategies.

The blueprint should include the following: 1) aim/purpose of the implementation; 2) scope of the change (e.g., what organizational units are affected); 3) timeframe and milestones; and 4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time

 

Mandate change*

 

Have leadership declare the priority of the innovation and their determination to have it implemented

 

Model and simulate change*

Model or simulate the change that will be implemented prior to implementation

 

Organize clinician implementation team meetings*

Develop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another’s learning

 

Promote adaptability*

 

Identify the ways a clinical innovation can be tailored to meet local needs and clarify which elements of the innovation must be maintained to preserve fidelity

 

Promote network weaving*

 

Identify and build on existing high-quality working relationships and networks within and outside the organization, organizational units, teams, etc. to promote information sharing, collaborative problem-solving, and a shared vision/goal

related to implementing the innovation

 

Use mass media*

 

Use media to reach large numbers of people to spread the word about the clinical innovation

 

Involve executive boards*

Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes

 

 

Use advisory boards and workgroups*

Create and engage a formal group of multiple kinds of stakeholders to provide input and advice on implementation efforts and to elicit recommendations for improvements. Comment from DB: Include patient advocates on the workgroups/advisory boards.

 

Use an implementation advisor*

 

Seek guidance from experts in implementation

 

Visit other sites*

 

Visit sites where a similar implementation effort has been considered successful. [Observe and discuss implementation strategies and tactics that were utilized and found to be helpful.]

 

Changes in Structures

Change physical structure and equipment*

Evaluate current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation

 

Change record systems*

Change records systems to allow better assessment of implementation or clinical

outcomes

 

Change service sites*

Change the location of clinical service sites to increase access

 

Create a learning collaborative*

Facilitate the formation of groups of providers or provider organizations and foster a collaborative learning environment to improve implementation of the clinical innovation

 

Create new clinical teams*

Change who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered)

 

Develop and implement tools for quality monitoring*

Develop, test, and introduce into quality-monitoring systems the right input—the appropriate language, protocols, algorithms, standards, and measures (of processes,

patient/consumer outcomes, and implementation outcomes) that are often specific to the innovation being implemented

 

Develop resource sharing agreements

 

Develop partnerships with organizations that have resources needed to implement the innovation

 

Fund and contract for the clinical innovation*

Respond to Governments and other payers of services issue requests for proposals to deliver the innovation. Use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation

 

Start a dissemination organization*

Identify or start a separate organization that is responsible for disseminating the clinical innovation. It could be a for-profit or non-profit organization

 

Data

Assess for readiness and identify barriers and facilitators*

Assess various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort

 

Complete audits and provide feedback*

Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior. DB addition: Collect data to track progress toward achieving improvements in structure, process, and outcomes.

 

Use data sharing and benchmarking

Data collection, reporting, and analysis is performed so that clinicians, units, hospitals, states organizations, and nations can compare and contrast their structure, process, and outcomes with other like groups

 

Use public release of data

Details of care patterns and outcomes are reported in such a way that anyone can access this information

 

Provide data reports

A summary of key data

 

Conduct local needs assessment*

Collect and analyze data related to the need for the innovation

 

Develop and organize quality monitoring systems*

Develop and organize systems and procedures that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement

 

Use data experts*

Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts

 

Facilitate relay of clinical data to providers*

Provide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes use of the targeted innovation

 

Involve executive boards*

Involve existing governing structures (e.g., boards of directors, medical staff boards of governance) in the implementation effort, including the review of data on implementation processes

 

Use data warehousing techniques*

Integrate clinical records across facilities and organizations to facilitate implementation across systems

 

Purposely reexamine the implementation*

Monitor progress and adjust clinical practices and implementation strategies to continuously improve the quality of care

 

Stage implementation scale up*

Phase implementation efforts by starting with small pilots or demonstration projects and gradually move to a system wide rollout

 

Tailor strategies*

Tailor the implementation strategies to address barriers and leverage facilitators that were identified through earlier data collection

 

Education

Conduct ongoing training*

Plan for and conduct training in the clinical innovation in an ongoing way

 

Set up classes, present at conferences and grand rounds, provide webinars

Provide formal educational sessions developed on specific topics. Set up educational group sessions that are geared toward the needs of a particular group of clinicians at a hospital or facility.

 

Provide simulation training

Set up simulations for clinicians and teams to demonstrate skills and teamwork during a fabricated situation that mimics a complicated situation that they will face and need to practice how to respond

 

Present at competency fairs

Allow Clinicians to demonstrate their knowledge of a new concept or demonstrate their ability to perform a clinical skill

 

Use tests

Provide opportunities for clinicians to answer questions to show their mastery of a topic

 

Provide demonstrations

Provide opportunities for clinicians to demonstrate their ability or skill to follow a policy or procedure

 

Provide on-line education

Use the internet to provide educational content

 

Conduct educational meetings*

Hold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation

 

Inform local opinion leaders*

Inform providers identified by colleagues as opinion leaders or “educationally influential” about the clinical innovation in the hopes that they will influence colleagues to adopt it

 

Use train-the-trainer strategies*

Train designated clinicians or organizations to train others in the clinical innovation

 

Work with educational institutions*

Encourage educational institutions to train clinicians in the innovation

 

Conduct educational outreach visits*

Have a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider’s practice

 

Develop an implementation glossary*

Develop and distribute a list of terms describing the innovation, implementation, and stakeholders in the organizational change

 

Develop educational materials*

Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation

 

Distribute educational materials

 

Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically

 

Facilitation*

A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship. Example from DB: Identify and train clinicians who can be QI facilitators.

 

Make training dynamic*

Vary the information delivery methods to cater to different learning styles and work contexts, and shape the training in the innovation to be interactive

 

Prepare patients/consumers to be active participants*

Prepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or about available evidence-supported treatments

 

Provide local technical assistance*

Develop and use a system to deliver technical assistance focused on implementation issues using local personnel

 

Recruit, designate, and train for leadership*

Recruit, designate, and train leaders for the change effort

 

Shadow other experts*

 

Provide ways for key individuals to directly observe experienced people engage with or use the targeted practice changes or innovation

 

References

 

Rogers, E.M. (2003). Diffusion of Innovations (5th Ed.). New York: Simon & Schuster.

 

Bingham, D. & Main, E. (2010). Effective implementation strategies and tactics for leading change on maternity units. Journal of Perinatal and Neonatal Nursing, 24(1), 32-42.

 

*Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Procter, E.K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), 21. Retrieved from https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0209-1

 

Note:  The tactics outlined by ERIC are identified with an asterisk. The ERIC tactics were reorganized by D.Bingham into types of strategies. Examples were added where indicated. The names and descriptions developed by ERIC have not been altered.

 

 

4.2 Timeline

 

Insert the dates in the figure that are specific for your DNP project. Include dates for key milestones such as when the baseline assessment begins and ends, the go-live date, dates and specific types of implementation strategies and tactics that are utilized. Insert your key implementation tactics into the figure in the gray boxes. Fill in the timeline based on the dates you included in Table 5. Make sure you select dates in consultation with your team and that they agree that these dates are reasonable.

 

4.3 Data Collection Plan

 

Describe how often you will collect data, the methods you will use, and who will collect it. Think ahead and try to identify all potential barriers to your data collection plan. Only plan to collect data you absolutely need and have a plan to analyze. Make your data collection as practical as possible.

 

4.4 Data Analysis Plan

 

You are required, at a minimum, to demonstrate competence in using run charts to track implementation progress for your project. Many DNP students run other statistical tests depending on their types of measures. You may also choose to use statistical process control charts.

 

During the planning phase it is helpful to test out your data analysis plan using hypothetical data in a run chart. Module 3 contains a video presentation and topic on Run Charts.

Download the use the Run Chart Template in Excel (found in Module 3 under the topic on Run Charts) to test your data analysis plan and figure out how you will analyze the implementation data you plan to collect.

 

Test your data analysis plan by entering hypothetical baseline data into the Run Chart Template following these three easy steps:

 

  • Enter hypothetical dates or observation numbers indicating intervals into the green cells in the first column. (clear the sample data before you begin). Data is often collected daily, but the minimum interval between dates or observations should be weekly.
  • Enter your data values into the blue cells. Data values are determined by calculating percentages based on your measures outlined in Table 4. For example, if during week one the staff were able to screen only 30 out of 60 patients who should have been screened, then you would enter 50 indicating the 50% of the patients were screened (30/60 = 50%).
  • The median will be automatically calculated as you enter data.
  • Enter your goal for each day or week. In most cases, that would 100 for 100%

4.5 Sustainability is the process of hard-wiring or locking in the structure, process, or outcome improvements that were made during the QI implementation phase. Sustainability is how you work to ensure that your work is continued on after you.

A variety of features may contribute to sustainable change in an organization dependent upon the objectives of the DNP project. The following are some examples:

  • the engagement of senior leaders in the administration early in the planning of the project
  • the inclusion of mentors or champions from the organization to facilitate the change and continue processes
  • the integration of documentation of the practice change into the Electronic Health Record
  • the availability of financial resources for maintaining the process improvement beyond the project end
  • a clear need for the practice change to occur within the organization
  • insertion of newly developed processes as part of new staff orientation and/or organizational policies
  • establishment of an ongoing sustainability measurement plan for collection of outcomes and quality improvement activity data (e.g., structure, process, and outcome measures, frequency of chart audits, ongoing use of benchmarks and target goals)

Sections 5 & 6  (Implement and Track) will be completed in the Fall semester when you take NDNP 812.

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