Changes in System Structures and Processes in an Academic-Service Partnership: Improving Patient Outcomes

The University of Michigan Health System and School of Nursing formed a unique partnership to integrate education, practice, and scholarship with the ultimate goal of improving patient outcomes at the point of care. A partnership is characterized by open communication, cooperation, and on-going feedback that allow achievement of mutual goals. Two elements of partnership, shared structures and processes, are critical for creating an integrated learning and practice environment.  This paper describes integrated structures and processes that work synergistically to enable teams of faculty, students, and staff to focus on quality improvement and evidence-based practice. Structural changes included embedding faculty on clinical units, appointing faculty to UMHS decision-making bodies, changing role expectations for faculty and clinical staff mentors, and creating small learning communities through clusters. Process changes included assigning students to staff mentors and teams rather than patients, and students and faculty participation in unit quality improvement activities. Changes in faculty, student, and nurse behaviors have occurred and we expect that these changes will improve nurse sensitive outcome indicators.