As part of strategic planning to build an infrastructure for the Improvement Science Research Network (ISRN), an early target was to establish consensus on high-priority research, development, and evaluation needs to guide the scientific field. Because the Improvement Science Research Network proposes to promote a national program of research to advance what is known about improvement strategies, it was deemed essential to circumscribe priority research studies and topic areas as a place to begin. Such priorities will serve as a common rallying point to focus resources and attract improvement scientists and scholars into a collaborative around these common research goals. The great need for improvement science carries with it an opportunity for a myriad of priorities to be defined. These priorities are meant to highlight the most important and urgent gaps in improvement knowledge as identified by clinical and academic scholars, leaders, and change agents in acute healthcare settings.
These ISRN Research Priorities are intended to define the most urgent research studies needed to determine effective strategies in quality improvement and patient safety at this point in time. By networking to conduct improvement studies on these first targets, the ISRN will be able to intensify research efforts and quickly produce seminal research-based knowledge.
The priorities inform decisions about the scope of future work and the dissemination of ISRN-sponsored knowledge in each of the major dimensions shown below. At the same time, the ISRN maintains the flexibility to respond to emerging needs and to consider the merits of individual projects that may contribute to other worthwhile goals.
Process of Development
The ISRN priority-setting process was informed by a number of sources. These include environmental scans of major concerns in healthcare, reviews of professional and scientific literature, research priorities for quality and patient safety established by other entities (e.g., World Health Organization), a targeted stakeholder survey, and a RAND Delphi process with the ISRN Steering Council, members of which represented a wide array of stakeholders. Multiple points of information and multiple iterations of consensus building were used to assure that the Research Priorities merit high attention.
Development was accomplished through four major phases: multiple iterations of survey development; administration of the online survey to stakeholders; RAND Delphi technique with Steering Council members; and refinement through Steering Council discussion.
Stakeholder opinions were sought through an online structured survey. The survey was developed, pilot tested with various groups of stakeholders, and revised over an 8-month period (June 2009- February 2010) and through three revisions. The final survey included 33 improvement topics organized into nine dimensions of quality and safety. The online survey was preceded by an advance email invitation, followed by the invitation and survey link, and a reminder, each sent at 1-week intervals. During a 5-week period (February-March 2010), the survey was distributed to 2,777 stakeholders identified through a variety of methods, including identifying interprofessional groups and organized associations of health scientists, healthcare clinical leaders, and thought leaders in improvement and patient safety. Data were gathered from 560 respondents, reflecting a 20 percent response rate.
Responses were analyzed using descriptive statistics and were presented to the ISRN Steering Council at their meeting on March 25, 2010 in Houston, Texas. A RAND Delphi approach was used during facilitated consensus formation discussion at this meeting.
Results of the Steering Council’s multiple iterations were captured by the ISRN Coordinating Team and vetted again during the April 2010 Steering Council meeting. Through these processes, consensus on the ISRN Research Priorities was established and framed, as presented below.
Research Priority Statements
The following research priorities were adopted for the ISRN as the best thinking to date about the direction that should be taken in improvement science. (The order of topics does not reflect order of priority.)
Our Research Priorities are organized into four broad categories or domains. While it is acknowledged that, within each of these four areas, investigators could pose questions to investigate structure, process, outcome, and knowledge, the four clusters provide one way to emphasize various perspectives on quality and safety. To further circumscribe each research domain, priority topics and examples of improvement strategies were added:
- Coordination and transitions of care
- High-performing clinical systems and microsystems approaches to improvement
- Evidence-based quality improvement and best practice
- Learning organizations and culture of quality and safety