Utilizing a High Reliability Framework to Build Evidence-Based Practice in a Complex Organization

Friday, 28 July 2017: 11:05 AM

Kevin Browne, MS, RN, CCRN
Nursing, Memorial Sloan Kettering, New York, NY, USA


In 2014, the department of nursing at this ANCC magnet® designated and NCI designated comprehensive cancer center underwent structural changes at the executive nursing level. Recognizing that each division could no longer exist as configured, the divisions of nursing practice, quality and education were combined under the newly created office of the Deputy Chief Nursing Officer. The Division of PQE was created.


Nursing practice, quality, and education are fundamental domains within nursing; each unique however reliant upon one another. The three create a fluid paradigm that provides a foundation for the delivery of oncology nursing services and the 3000+ registered professional nurses within the system. Using a high reliability framework, the Deputy CNO set out to strengthen the approach to evidence- based practice (EBP). A partnership was forged with The Center for Transdisciplinary Evidence -based Practice (CTEP) at the Ohio State University College of Nursing to create a customized and novel deep dive immersion into EBP immersion.

The institution invested financial resources to support the attendance of 100 + nursing leadership in a week long EBP immersion. Nursing leadership included the Chief Nursing Officer, the executive nursing leadership team, frontline nurse leaders, NP coordinators, clinical nurse specialists, nurse informatics project managers and nursing professional development specialists. The team was divided into two tracks; leader and mentor. Sixteen distinct workgroups with representatives from each of the leadership roles were created. Each workgroup was assigned a pre-defined topic that was aligned with the department of nursing’s 2016 strategic goals. Twenty-one CTEP faculty provided instruction and support during the immersion, guiding leadership through EBP enculturation. Topics such as meaningful perioperative benchmarks, meaningful outpatient benchmarks, preceptor development, oral chemotherapy medication adherence, CAUTI, CLABSI, falls, peer review, hand off, communication across a complex organization, etcetera are being used to learn the methodology so as to achieve two distinct goals; lead the enculturation across the center and produce sustainable outcomes.


This unique approach resulted in the immediate creation of 16 multi-level teams from varied backgrounds with the responsibility to apply an evidence based problem solving approach to the key strategic nursing goals. This included set timelines and expectations for project implementation and completion. The teams have actively engaged in developing and implementing evidence-based action plans and measuring key outcomes.


A strategic, planned approach to; building EBP competence; creating EBP infrastructure and support, and; leading an EBP culture can provide the underpinning to build an effective program to address critical strategic goals in a complex health enterprise. Therefore, a second cohort is being planned for second quarter 2017.