Background/Significance: Patients and the public expect high quality, safe care to be based on sound, scientific knowledge and the best clinical evidence; however, approximately 98,000 patients die each year due to preventable medical errors (Institute of Medicine [IOM], 2000), and new reports attribute medical errors to the 3rd leading cause of death in the U.S. (Makary, & Daniel, 2016). Since the Institute of Medicine’s landmark account, studies show that evidence-based practice (EBP) promotes safe, quality care; however, traditional methods of practice continue (Harper, 2017).
In addition to EBP, communication and collaboration are necessary for creating and sustaining a healthy work environment (HWE)(American Association of Critical Care Nurses [AACN], 2005). The Joint Commission (2005) cited communication among healthcare providers as the leading cause of adverse events in the hospital setting. When health care professionals do not communicate effectively, patient safety is at risk; therefore, communication and collaboration are essential to preventing medical errors and improving patient outcomes (O’Daniel & Rosenstein, 2008; AACN, 2005). Several studies have demonstrated that utilizing interprofessional training can help to increase effective communication techniques among healthcare providers, thus improving patient care (Fagan, Connelly, Williams, & Fisher, 2018; Luetsch & Rowett, 2015; Weinstein et al., 2018).
To foster the principles of interprofessional EBP, communication, and collaboration in a hospital setting, there must be shared leadership, collective decision-making, and effective communication and teamwork. The significance of this project is that organizational structures and processes designed to engage frontline staff in research, EBP, and shared governance will help to build interprofessional teams that connect and work collaboratively for sustainable change (Dearmon, Riley, Mestas, & Buckner, 2015).
Purpose/Objectives: Through an academic-practice partnership with Health Sciences Colleges, a biomedical library (BL), and a healthcare system, faculty and administration developed an Interprofessional Evidence-Based Practice Council (IEBPC). The goal of the IEBPC is to engage and empower an interprofessional team of frontline staff to work together in the translation of best available evidence combined with clinical expertise, and patient ideals, to foster a HWE that supports excellence in patient care. This project is unique in that many shared governance councils currently exist, but few have taken an interprofessional approach.
Objectives of the IEBPC will help to meet many of the six aims discussed in the AACN’s HWE standards (2005).
- Foster an interprofessional academic-practice partnership between faculty, frontline staff, and administrators.
- Provide a forum for stimulating and fostering a culture of inquiry among front-line clinicians.
- Integrate evidence-based practice into performance improvement, policy development, clinical practice, and competency development.
- Improve the quality, safety, and satisfaction of patient care outcomes.
- Mentor frontline staff in incorporating evidence-based guidelines into practice and dissemination of practice change outcomes.
- Promote interprofessional collaboration among multiple disciplines through the promotion of teamwork, communication, shared leadership, and collective decision-making.
Methods: Critical to the project was stakeholder involvement and buy-in; therefore, hospital administrative support for the project was established, and several meetings and presentations were offered to all departmental leadership with administrative endorsement. A steering committee for the IEBPC was created and (a) developed the mission, purpose, goals, and by-laws, (b) determined a shared-leadership and reporting structure, (c) created an orientation manual, (d) selected organizational EBP and interprofessional education models/evaluation instruments, (e) and constructed a curriculum to train IEBPC members.
The IEBPC meets monthly to provide opportunities for advanced learning and training. Educational content delivered to the initial IEBPC members by the IEBPC faculty and librarian focused on two core competencies: EBP knowledge/skills and interprofessional collaborative practice. All educational content was delivered through a combination of methods including a flipped classroom, team-based learning, self-study, and case study formats. The educational curriculum for the members of the IEBPC was divided into six meetings to include a discussion of (a) the purpose, benefits, and structure of the IEBPC; (b) research and EBP basics; and (c) effective interprofessional communication, leading interprofessional teams/providing support for the team, and interprofessional team roles.
During each meeting, participants from various disciplines must effectively communicate and collaborate with each other to complete activities and work on implementing EBP changes within the healthcare system. IEBPC members are given the authority to have shared-decision making when determining practice changes that are then disseminated to the necessary stakeholders within the hospital with the ultimate goal of improving patient outcomes based on evidence. This decision-making autonomy empowers the frontline staff, allows for positive recognition of their hard work, and cultivates leadership qualities in each participant.
Measurement: The following five instruments were utilized to measure outcomes of the implementation of an IEBPC pre-implementation and will be utilized again one year post-implementation.
- Organizational Culture and Readiness for System-Wide Integration of EBP Survey (Fineout-Overholt & Melnyk, 2006).
- EBP Beliefs Scale (Melnyk, Fineout-Overholt, & Mays, 2008).
- EBP Competence Scale (Melnyk, Gallagher-Ford, Long, Fineout-Overholt, 2014).
- EBP Implementation Scale (Melnyk et al., 2008).
- Assessment of Interprofessional Team Collaboration Scale (Orchard, King, Khalili, & Bezzina, 2012).
Outcomes: Implementing an IEBPC that utilizes an interprofessional shared governance model, as well as training in EBP and interprofessional collaboration will include staff, work environment, and patient-centered outcomes. The IEBPC was implemented in May of 2018 and includes 51 members from 8 different disciplines including: respiratory therapy, pharmacy, medical residents/attending physicians, physical therapy, speech therapy, case management, and nursing/nurse practitioners, unit secretary, and a librarian. Out of the 51 members, 13 have been able to participate in IEBPC meetings and completed pre-survey data. Initial analysis of the data reveals that the majority of staff believe that EBP results in best clinical practice; however, there was a reported lack of confidence in the essential steps of EBP and or how to evaluate outcomes of clinical care. Furthermore, staff reported that they had never shared evidence with or worked together in an interprofessional team to translate evidence into practice.
Recommendations: This project is ongoing, but the preliminary data confirms the need for EBP and interprofessional training of staff. The goal of the IEBPC is to empower the staff to promote interprofessional collaboration among multiple disciplines in improving the healthcare outcomes. Staff input and feedback are essential in creating an environment of shared leadership, and an interprofessional structure is essential to maintaining positive, respectful relationships, communication, and collaboration among all disciplines in designing safer healthcare systems and maintaining a HWE (AACN, 2005).