Making Your Research More Robust With Implementation Science

Purpose: Implementation science is the study of methods, interventions, and variables that promote uptake and use of research and other evidence-based practices by organization with the goal of improving health care quality. This study applies the Consolidated Framework for Implementation Research (CFIR) and its constructs to describe the implementation experiences of 34 Magnet hospitals in the United States and Saudi Arabia participating in the Readiness Evaluation and Discharge Intervention (READI) Study. The READI study seeks to implement discharge readiness as a standard of nursing practice. The study has three phases: Phase 1 nurses perspective of discharge readiness, Phase 2 patient perspective of readiness added to nurse perspective, and Phase 3 addition of a discharge action guide. The study is implemented over 12-months. Formative evaluation was used to gather information on the facilitators and challenges of the implementation process from the site Principle Investigators (PIs).

Methods: Each participating hospitals designated a site PI who was responsible for implementation of the READI study in their hospital including obtaining institutional review board (IRB) approval. The site PIs were invited to participate in an interview in the last phase of the READI study (Phase 1 + Phase 2+ Phase 3 [discharge action guide]). The interview guide was developed by the READI researchers using a Delphi process identifying CFIR constructs significant to the study process from among the 38 constructs in the framework. The constructs were used to develop an interview guide around eight themes. After IRB approval, each site PI was invited to participate in the interview using Go-to-Meeting. The national study team conducted each interview, one team member asked questions and one team member recorded notes. Interviews were recorded to clarify any missing information. NVivo 10 was used for analysis.

Results: CFIR constructs identified as important to the implementation process included the site PI role and recognition within the organization, the skills/attributes important to being the site PI, logistics planning with the unit staff, changes to hospital leadership particularly the Chief Nurse, engaging leaders, and identifying unit champions. When queried about adding the patient’s perspective of discharge readiness (Phase 2), to the nurse’s perspective (Phase 1), several site PIs identified positive changes in Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) scores, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. Overall patients welcomed the dialogue with the nurse as part of their discharge care. Improvement in HCHAPS scores was an unexpected study finding.

Conclusion:  The CFIR proved to an optimal framework for developing an interview guide for formative research. Although the main quantitative READI study outcome was to reduce unplanned readmissions, the formative evaluation process of interviewing site PIs identified additional outcomes that provide measures of study success important to hospitals: bringing research to bedside nurses, having practicing registered nurses see the value of participating in clinical research, and recognizing the importance of the patient s perspective of discharge readiness. The information gathered from key stakeholders (site PIs) provided additional evaluation information of study success and challenges from the organizations perspective