Program Overview
The Difference Nurses are Making to Improve Quality and Keep Patients Safe
The Interdisciplinary Nursing Quality Research Initiative (INQRI)
The Robert Wood Johnson Foundation (RWJF) is committed to playing a leading role in enhancing health care quality for all patients. The Foundation's current goals include transforming the way care is delivered at the bedside, reducing the shortage of nurses and advancing the science to improve health care quality.
Nurses represent the single largest group of health professionals who deliver hospital care, yet little is known about what they do to ensure that care is safe, beneficial, patient-centered, timely, efficient and equitable. Although there is anecdotal evidence of how nursing care affects patient health and safety, there is limited rigorous research demonstrating causal relationships between the quality of nursing care and patient outcomes. Many policies and programs are based on the assumption that developing effective performance measurement systems will enable health care stakeholders to better understand and monitor the degree to which nursing care influences patient safety and health care quality. However, this theory has yet to be rigorously tested.
To address the gaps in what we know about nursing's effect on quality and leverage opportunities for research to identify the contributions nurses are making to save lives and keep patients safer and healthier, the RWJF created the Interdisciplinary Nursing Quality Research Initiative (INQRI). INQRI is a national effort to support research to reduce medical errors and improve patient care and to identify solutions to help health systems and health professionals ensure the best medical outcomes possible. Some INQRI projects will produce evidence that better nursing affects better quality. Other projects should help hospital administrators, policy makers and other key healthcare decision makers understand what drives better nursing care to keep patients safe and healthy and the environmental changes essential to making that happen.
As its name suggests, the program will support teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. This program is led by Mary Naylor, a nurse and health services researcher, and Mark Pauly, a health care economist, both at the University of Pennsylvania, in partnership with Lori Melichar and colleagues at the RWJF.
INTERDISCIPLINARY RESEARCH TEAMS
The INQRI program seeks applicants that will apply diverse perspectives and methodological techniques to answer questions without sacrificing the relevance and insights provided by clinicians. To accomplish these joint goals, INQRI requires interdisciplinary research teams for all projects. Though any interdisciplinary partnership is eligible for consideration, INQRI reviewers will be especially interested in seeing proposals that combine the perspectives and techniques of nursing scholars and scholars from non-clinical backgrounds.
GRANTEES
The first round of grantees began work in August 2006 and completed their work in fall 2008. Their research focuses on measurement. The nine research projects covered three major areas: (1) investigating the link between the work of nurses and the quality of care provided in hospitals; (2) producing and validating measures that capture nurses' contributions to quality care in hospitals; and (3) evaluating the impact of innovative nurse-led initiatives on patient outcomes. Twelve additional projects received INQRI grants in September 2007 and completed their work in August 2009. These teams are looking at interventions to prevent falls; evidence-based nursing and chronic disease; pediatric nursing care; nurse workforce and hospital performance; and how to improve hospital discharge.
Grants were awarded to eight additional teams in September 2008. These researchers are in the middle of their projects which assess nurses' contributions to quality while improving efficiency and will complete their work later this year. Five new teams received funding in September 2009. These researchers are addressing the value of nursing in achieving efficient, high quality patient care.
TRANSLATING THE RESEARCH
Ultimately, the expectation is that this investigator-initiated research will result in robust results that can be shared with policymakers, hospital administrators and others who determine how nursing resources will be distributed to improve the quality and outcomes of patient care. To increase the probability that the findings of studies supported by the INQRI program are placed in the hands of and used by influential decision-makers, INQRI is engaging key stakeholders on an ongoing basis to provide feedback and practical guidance to researcher teams. In addition to providing communications assistance to researchers to ensure that their work reaches a broad and diverse audience, the INQRI leadership team will produce syntheses that place the work of INQRI grantees in the context of similar research by others in the nursing and other health care fields.
CONCLUSION
For more than 30 years the Robert Wood Johnson Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. The Interdisciplinary Nursing Quality Research Initiative will continue this tradition of success and advance the science of nursing through rigorous, interdisciplinary research as it focuses on new methods to facilitate and advance efforts to improve care for patients.