News
March 27, 2008
Transforming Health Quality: A Chat with INQRI Program Officer Lori Melichar
The Interdisciplinary Nursing Quality Research Initiative (INQRI) supports teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. Lori Melichar serves as INQRI's senior program officer. The Foundation will announce the third round of grantees in June 2008.
Type of Publication: Stories & Articles
Q. What are some examples of the gaps in what we know about the effect of nursing on the quality of patient care?
A. We know that nurses play a pivotal role in providing quality health care in hospitals and other settings. However, nurses are not reimbursed for their care, and there are not good measures of what nurses do. In many cases hospital administrators and others don't understand nurses' specific contributions. As a result, we think there is an underinvestment in the hospital nursing workforce. If hospital administrators, policy-makers and insurers (in general, those who have decision-making abilities that influence the resources available to nursing) really understood how much and how nurses contribute to quality, they would make investments in the nursing workforce. Those investments, in turn, would help us reduce the nursing shortage.
Some of the projects that INQRI funds help us to quantify how much nurses contribute to quality by developing and testing nursing quality measures. To fill the gaps in understanding how nurses contribute to quality, several INQRI projects are looking at the processes involved in patient care and are measuring such things as care coordination by nurses.
Q. Why is the interdisciplinary element of INQRI so important?
A. We like to talk about our projects as being both rigorous and relevant. It is hard to conduct relevant research about nursing without nurses' input. But there are a lot of questions related to nursing that can benefit from the methods and analytical skills of people from other disciplines. Interdisciplinary collaboration ensures that the work is rigorous as well as relevant.
Additionally, most research about nursing is published in nursing journals. We think that the evidence that INQRI grantees develop can have much more impact if it is more broadly published in the journals of other disciplines. For example, if an economist publishes research about the nursing profession in the American Economic Review, other economists who may not have thought much about the profession may become intrigued by the challenges of nursing and conduct research on nursing.
Q. In awarding INQRI grants, you look for projects that will produce evidence for nursing professionals, as well as for hospital administrators, policy-makers and other health care decision-makers, to understand what drives nursing care. How do you engage such diverse interest groups in nursing issues?
A. We engage with interest groups through the grant application process, which is rather unique. INQRI brief proposals first are reviewed by stakeholders—including insurers, hospital administrators and chief nursing officers—the very people the research seeks to influence. First and foremost, we are interested in whether this research has the potential to inform the stakeholders and to change nursing practice. Then, for the full proposals, we ask the researchers to explain how they are going to go about their project; and we have researchers review these proposals.
But our engagement of these diverse interest groups does not end there. We invite some 15 or 20 stakeholders to a meeting with the grantees before their projects start and ask the stakeholders to offer suggestions about how they might make their project even better. This process highlights real opportunities and ways that the researchers can be gearing their work to impact the field.
Q. What are the biggest challenges to conducting research related to the quality of nursing care?
A. The biggest challenge to conducting research about nursing quality was that there were not good quality measures that we could use to understand how various investments in nursing might impact quality. That is why the first round of funding focused on building the tools and developing the measures that could then be used by subsequent INQRI grantees.
Q. What are some of the ways nurses contribute to high quality care by eliminating waste and maximizing value?
A. In trying to capture how nursing contributes to quality, we spent the first two rounds of grants looking at nurses' impact on patient outcomes. Now we also are looking at how nurses contribute to the cost side of the equation and the potential for nurses to greatly enhance the efficiency of care delivered in a variety of settings.
We have not yet announced the grantees for this third round. We expect, however, that the more we understand the role that nurses play in complicated processes such as medication administration, care coordination and communication within hospitals—how they do what they do—the more we will understand how they can contribute to improving the efficiency of these processes.
Q. Why is nursing-led innovation so important to all of health care?
A. The nurse is present in all health care settings. The nurse knows the most about everything that goes into care for a particular patient. He or she interacts with the majority of the providers and has a direct connection to the setting in which the care is delivered. Because of their role at the bedside, nurses have a unique perspective on the needs of patients. They are able to identify opportunities to improve the patient's care-whether preventing something bad from happening or identifying how care could be delivered in a slightly different way that might be more in line with the patient's own preferences for care.
Q. How is the INQRI program different than other RWJF research initiatives?
A. One of the challenges of research is that it typically happens very slowly. INQRI was designed to have a quick and relevant impact. Unlike a lot of programs where we fund researchers and then do what we can to promote their findings, we have informed INQRI grantees that while publication in peer-reviewed journals is important, we are more interested in spreading the information that they uncover as soon as it is available. We want to streamline and fast-track their research to decision-makers. We think these grantees can have an effect as early as two months after their projects are complete. That makes this program very exciting and important to the goals of RWJF—which is to have an impact on the big problems in health and health care in our lifetime.
Publication:
Publication Date:
March 27, 2008
Type of Publication:
Stories & Articles
Program Areas:
Quality/Equality
Related Topics:
Health Care Services & Quality
Benchmarks & Best Practices
Facilities
Hospitals
Patient Safety and Outcomes
Performance Standards and Measurement
Quality
Treatment Facilities
Providers & Provider Education
Nurses & Nursing
Copyright 2008 The Robert Wood Johnson Foundation http://www.rwjf.org
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care.
