What’s in a Name: Performance Improvement, Evidence-Based Practice, and Research?

Abstract

Journal homepage: https://scholarlycommons.baptisthealth.net/nhsrj/ Participants of the Institute of Medicine's Roundtable on Evidence-based Medicine have identified that "by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect best available evidence" as a goal (Institute of Medicine, 2009). The committee felt every American should have as an expectation, at a minimum, this level of performance with health care delivery. Using resources already available to them, each organization should be able to motivate and track their progress. One of the challenges healthcare providers have in meeting the IOM's 2020 goal is a difficulty differentiating between performance improvement (PI), evidence-based practice (EBP), and research. The terms performance improvement, evidence-based practice, and research are frequently used inaccurately and interchangeably with evidence-based practice appearing to be the most misused of the three terms. The common goal between PI, EBP, and Research is to provide care to patients based on scientific evidence and meet the patient's needs. The final result is the same; they all should lead to improving clinical outcomes. Determining which process to use will be defined by what one wants to know. Questions that seek to answer a system issue, evaluate processes of care, or improve care delivery are addressed using quality improvement processes. Those that focus on how well existing science is used in care are evidence-based processes and those generating new knowledge about under-explored areas are answered using research methodologies. The purpose of this article is to review the distinction between performance improvement, evidence-based practice, and research. PERFORMANCE IMPROVEMENT The Centers for Disease Control and Prevention (2015) indicated that hospitals use a variety of terms to address similar principles (i.e., continuous quality improvement, quality improvement, performance improvement, six sigma, and total quality management). Performance improvement (PI) is comprised of systematic and continuous activities that result in measurable improvement in health care services and the outcomes of an identified group of patients (Health Resources and Services Administration, 2011). Donabedian (1966) proposed three components of health care quality when evaluating the quality of health care; structure, process, and outcome. He defined structure as the settings, qualifications of providers, and administrative systems through which care takes place; the organization's resources. Process is defined as the components of care delivered; how the system works and specific measures for aspects of care. Outcome is defined as recovery, restoration of function, and survival; the final product or outcome. (Donabedian, 1966). These concepts remain the foundation of quality assessment today. There are several defined methodologies used to conduct PI projects. Our organization most commonly uses the plan, do, check, act or PDCA cycle which is based on Demming's PDSA (plan, do, study, act) Model (The W. Edwards Deming Institute®, 2016). This is a four-step model of facilitating change usually depicted in a circle representing no end; it should be repeated again and again for PI and monitoring sustainability. The Agency for Healthcare Research and Quality (2013) defines the steps in the PDSA cycle as: 40 Prentiss and Butler: What's in a Name: Performance Improvement, Evidence-Based Practic Published by Scholarly Commons @ Baptist Health South Florida, 2018