New study reveals one reason why many hospitals continue to struggle with quality, safety and costs
Dr. Bernadette Melnyk
The Ohio State University College of Nursing
Elsevier Clinical Solutions
COLUMBUS, Ohio – As hospitals across the country continue to feel pressure to improve patient outcomes and reduce costs, a new study published today in Worldviews on Evidence-Based Nursing reveals one reason why many organizations continue to fall short.
A research team led by Bernadette Melnyk, dean of the College of Nursing at The Ohio State University, surveyed 276 chief nurse executives across the United States to gauge how highly evidence-based practice (EBP) ranks as a priority in their institution. Findings from multiple studies support that care that is evidence-based results in high quality care, improved population health and a better patient experience, and lower costs, often referred to as the “Triple Aim” in health care.
Despite this fact, data from the survey revealed that the implementation of evidence-based practice among chief nurses and their hospitals is relatively low. Additionally, many of the hospitals involved in the study reported poor scores on key performance measures, such as falls and pressure ulcers.
“We found that a substantial percentage of hospitals were not meeting national benchmarks for quality and safety,” explained Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, who also serves as Ohio State’s associate vice president for health promotion and chief wellness officer. “As you look at explanations for why 30-40 percent of these hospitals aren’t meeting benchmarks on key quality indicators—one key explanation is the low level of evidence-based practice happening in those hospitals.”
Evidence-based practice is an approach to decision making in health care that brings together evidence from research, a clinician’s expertise, and patient preferences and values to drive the best patient care and outcomes. However, this application of EBP is not the norm. For example, children with asthma continue to be treated with nebulizers in many emergency rooms across the U.S. even though numerous studies have indicated better outcomes and fewer hospitalizations when children are given a bronchodilator with a metered-dose inhaler and spacer.
“When patients get evidence-based care, they have 28 percent better outcomes. That’s a big deal,” said the study’s co-author Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC. “When they don’t get evidence-based care, those outcomes go away. There’s a public perception that this is what hospitals are already doing, and the sad news is, many are not.”
Gallagher-Ford directs Ohio State’s Center for Transdisciplinary Evidence-based Practice (CTEP), which works with organizations to effectively implement EBP in both clinical and academic settings.
While most chief nurses who participated in the survey said they believe in the value of EBP, more than half of them reported that evidence-based care is practiced in their organization “not at all” or only “somewhat.” When asked to list their organization’s top three priorities, quality and safety ranked first and second. Evidence-based practice was ranked among the lowest. These results cast doubt on the Institute of Medicine’s goal that 90 percent of health care decisions will be evidence-based by 2020.
The study points to a lack of understanding as the root problem.
“The chief nurses we surveyed reported that they planned to focus on EBP as soon as they had a handle on quality and safety. That’s the disconnect—leaders think EBP is a competing priority when in reality, EBP is the exact mechanism that needs to be integrated in order to achieve and sustain quality and safety,” explained Gallagher-Ford, also noting that this misconception likely exists among other hospital leaders, not just nurses.
Researchers say that without leadership support and engagement, it’s nearly impossible for an organization to successfully sustain a culture of EBP. Many hospitals stop at some EBP education of front line staff and fail to create leadership champions who can help create an environment of success.
The study also revealed that nearly half of the chief nurses surveyed were unsure of how to measure patient outcomes, a statistic Melnyk and her team find concerning.
“To me, this finding signifies a real gap in the preparation of nurse leaders,” said Melnyk, co-editor of the widely-used book Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice and editor of the top-ranked journal Worldviews on Evidence-based Nursing. “If we’re graduating nurses with graduate and doctoral degrees who have not mastered EBP, and a part of that is measuring outcomes of evidence-based practice changes, then we’re not going to have nurse leaders with that knowledge and skill set. And, if these leaders don’t have those EBP skills, how are they going to be able to create the culture and infrastructure that’s needed for their staff to practice evidence-based care in a consistent manner?”
Melnyk stresses the importance of patients asking for EBP when they receive health care services. She says patients should ask their provider for the evidence behind the care, medications or treatments they are receiving. If patients are not satisfied with the answers given, they should seek out a nurse practitioner or physician provider who does deliver evidence-based care.
Researchers emphasize that until hospitals can rally leadership to support investment in EBP education, infrastructure, job description changes, accountability, and cultural changes across all disciplines, quality, safety and patient outcomes will continue to suffer.
The study was conducted in 2014 and received funding from Elsevier Clinical Solutions. “Discovering the barriers to EBP is important in order for providers to deliver EBP as a standard of care,” said Michelle Troseth, RN, MSN, DPNAP, FAAN, Elsevier’s chief professional practice officer and one of the researchers who contributed to the study. It was published by The Honor Society of Nursing, Sigma Theta Tau International (STTI).
Other researchers who contributed to the study are: Bindu Koshy Thomas, MEd, MS, The Ohio State University College of Nursing; Kathy Wyngarden, RN, MSN, FNP; and Laura Szalacha, EdD, University of Arizona.
About The Ohio State University College of Nursing
The Ohio State University College of Nursing is the world’s preeminent college known for accomplishing what is considered impossible through its transformational leadership and innovation in nursing and health, evidence-based practice and unsurpassed wellness. As part of the largest health science campus in the U.S., the College of Nursing offers seven innovative academic programs. The college’s graduate nursing programs are among the top 5% in the country, according to U.S. News and World Report, while its online graduate program is ranked 4th and its RN to BSN program is ranked 7th as part of Ohio State’s ranking for online bachelor’s degree programs. Annual college enrollment is approximately 1,950 students. The college celebrated its centennial in 2014.
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligence and ClinicalKey — and publishes more than 2,500 journals, including The Lancet and Cell, and more than 33,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group plc, a world-leading provider of information solutions for professional customers across industries.
The Honor Society of Nursing, Sigma Theta Tau International (STTI) is a nonprofit organization whose mission is advancing world health and celebrating nursing excellence in scholarship, leadership, and service. Founded in 1922, STTI has more than 135,000 active members in more than 90 countries. Members include practicing nurses, instructors, researchers, policymakers, entrepreneurs and others. STTI’s roughly 500 chapters are located at approximately 700 institutions of higher education throughout Armenia, Australia, Botswana, Brazil, Canada, Colombia, England, Ghana, Hong Kong, Japan, Kenya, Lebanon, Malawi, Mexico, the Netherlands, Pakistan, Portugal, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan, Tanzania, Thailand, the United States, and Wales. More information about STTI can be found online at www.nursingsociety.org.