-choose a health care organization (your choice)-a specific HCO

-review attached articles

-describe the healthcare organization website you reviewed. 

-Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). 

-explain whether this healthcare organization’s work is grounded in EBP and why or why not. 

-explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. 

-Be specific and provide examples

-350 words

-3 reference

-use references from articles attached

-APA

R
esearch studies show that
evidence-based practice
(EBP) leads to higher qual-

ity care, improved patient out-
comes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care.1-5 Despite
these favorable findings, many
nurses remain inconsistent in their
implementation of evidence-based
care. Moreover, some nurses,
whose education predates the in-
clusion of EBP in the nursing cur-
riculum, still lack the computer
and Internet search skills neces-
sary to implement these practices.
As a result, misconceptions about
EBP—that it’s too difficult or too
time-consuming—continue to
flourish.

In the first article in this series
(“Igniting a Spirit of Inquiry: An
Essential Foundation for Evidence-
Based Practice,” November 2009),
we described EBP as a problem-
solving approach to the delivery
of health care that integrates the
best evidence from well-designed
studies and patient care data,
and combines it with patient

preferences and values and nurse
expertise. We also addressed the
contribution of EBP to improved
care and patient outcomes, de-
scribed barriers to EBP as well as
factors facilitating its implementa-
tion, and discussed strategies for
igniting a spirit of inquiry in clin-
ical practice, which is the founda-
tion of EBP, referred to as Step
Zero. (Editor’s note: although
EBP has seven steps, they are
numbered zero to six.) In this
article, we offer a brief overview
of the multistep EBP process.
Future articles will elaborate on
each of the EBP steps, using
the context provided by the

Case Scenario for EBP: Rapid
Response Teams.

Step Zero: Cultivate a spirit of
inquiry. If you’ve been following
this series, you may have already
started asking the kinds of ques-
tions that lay the groundwork
for EBP, for example: in patients
with head injuries, how does
supine positioning compared
with elevating the head of the
bed 30 degrees affect intracranial
pressure? Or, in patients with
supraventricular tachycardia,
how does administering the
β-blocker metoprolol (Lopressor,
Toprol-XL) compared with ad-
ministering no medicine affect

By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,

FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.

Williamson, PhD, RN

The Seven Steps of Evidence-Based Practice
Following this progressive, sequential approach will lead
to improved health care and patient outcomes.

This is the second article in a new series from the Arizona State University College of Nursing and Health Innova-
tion’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving
approach to the delivery of health care that integrates the best evidence from studies and patient care data with clini-
cian expertise and patient preferences and values. When delivered in a context of caring and in a supportive organi

Implementing EBP Column

Improving Patient Care Through Nursing
Engagement in Evidence-Based Practice
Elizabeth Crabtree, MPH • Emily Brennan, MLIS • Amanda Davis, MPH, RD •
Andrea Coyle, MSN, MHA, RN, CMSRN

This column shares the best evidence-based strategies and innovative ideas on how
to facilitate the learning of EBP principles and processes by clinicians as well as
nursing and interprofessional students. Guidelines for submission are available at
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787

INTRODUCTION AND BACKGROUND
The Medical University of South Carolina (MUSC) is a large
academic health science center, with a 700-bed medical cen-
ter (MUSC Health), and six colleges that train approximately
2,600 healthcare professionals annually. The MUSC Center
for Evidence-Based Practice (EBP), housed jointly in the Li-
brary and the Quality Management department of the MUSC
Hospital, aims to promote scientific inquiry, EBP, and quality
outcomes at MUSC. Through education, the development of
evidence-based clinical decision support tools and outcomes
research, the Center for EBP has begun to transform the cul-
ture of MUSC into one that incorporates best evidence into
clinical practice on both an individual and system level.

One of the strategies implemented by the Center for EBP
to promote cultural change is an educational course: the EBP
Nurse Scholars course, where nurses are taught about the the-
ory, practice, and dissemination of EBP.

DETAILED DESCRIPTION OF STRATEGY
Nurses serve on the frontline of health care, and have a
unique opportunity to improve patient care through EBP
(Hockenberry, Walaen, Brown, & Barrera, 2008). The staff
nurse is a critical link in bringing evidence-based changes into
clinical practice. Best practice only occurs when staff continu-
ally ask questions about treatment and care, have the resources
and skills necessary to search for and appraise research ev-
idence, implement the evidence in practice, and evaluate its
effectiveness (Dawes et al., 2005; Hockenberry et al., 2008).

MUSC’s experience in preparing practicing nurses to do
EBP was limited. To address this, the Center for EBP, in part-
nership with the Center for Professional Excellence, developed
a 12-week, project-based course to prepare nurses to engage in
EBP. The Center for Professional Excellence collaborates with

internal and external customers to create growth and devel-
opment opportunities for registered nurses. Additionally, the
center is responsible for Magnet application and designation.
The EBP Nurse Scholars course provides nurses with a com-
prehensive overview of EBP, prepares them to frame clinical
questions, perform literature searches, analyze and evaluate
evidence, and translate that knowledge into something clini-
cally meaningful. Members of the Center for EBP staff and
library faculty provided lectures and individual co

Original Article

Predictors of Evidence-Based Practice
Implementation, Job Satisfaction, and Group
Cohesion Among Regional Fellowship
Program Participants
Son Chae Kim, RN, PhD • Jaynelle F. Stichler, DNS, RN, NEA-BC, FACHE, FAAN •
Laurie Ecoff, RN, PhD, NEA-BC • Caroline E. Brown, DEd, CNS •
Ana-Maria Gallo, PhD, CNS, RNC-OB • Judy E. Davidson, DNP, RN, FCCM

Keywords

evidence-based
practice,

fellowship,
EBP beliefs,

EBP
implementation,
job satisfaction,

group cohesion,
group attractiveness

ABSTRACT
Background: A regional, collaborative evidence-based practice (EBP) fellowship program utiliz-
ing institution-matched mentors was offered to a targeted group of nurses from multiple local
hospitals to implement unit-based EBP projects. The Advancing Research and Clinical Practice
through Close Collaboration (ARCC) model postulates that strong EBP beliefs result in high EBP
implementation, which in turn causes high job satisfaction and group cohesion among nurses.

Aims: This study examined the relationships among EBP beliefs, EBP implementation, job satis-
faction, group cohesion, and group attractiveness among the fellowship program participants.

Methods: A total of 175 participants from three annual cohorts between 2012 and 2014 com-
pleted the questionnaires at the beginning of each annual session. The questionnaires included
the EBP beliefs, EBP implementation, job satisfaction, group cohesion, and group attractiveness
scales.

Results: There were positive correlations between EBP beliefs and EBP implementation (r = 0.47;
p <.001), as well as EBP implementation and job satisfaction (r = 0.17; p = .029). However, no
statistically significant correlations were found between EBP implementation and group cohesion,
or group attractiveness. Hierarchical multiple regression models showed that EBP beliefs was a
significant predictor of both EBP implementation (β = 0.33; p <.001) and job satisfaction (β =
0.25; p = .011). However, EBP implementation was not a significant predictor of job satisfaction,
group cohesion, or group attractiveness.

Linking Evidence to Action: In multivariate analyses where demographic variables were taken
into account, although EBP beliefs predicted job satisfaction, no significant relationship was
found between EBP implementation and job satisfaction or group cohesion. Further studies are
needed to confirm these unexpected study findings.

BACKGROUND
The adoption and implementation of evidence-based practice
(EBP) in nursing and other healthcare disciplines are recog-
nized as essential in ensuring optimal patient outcomes and
quality of care (Aarons, Ehrhart, & Farahnak, 2014). Although
EBP is considered to be the gold standard in nursing practice,
the actual implementation of EBP has been inconsistent due
to barriers related to nursing workload, lack of organizational
support, lack

The Quadruple Aim: care, health,
cost and meaning in work

Rishi Sikka,1 Julianne M Morath,2 Lucian Leape3

1Advocate Health Care, Downers
Grove, Illinois, USA
2Hospital Quality Institute,
Sacramento, California, USA
3Harvard School of Public
Health, Boston, Massachusetts,
USA

Correspondence to
Dr Rishi Sikka, Advocate
Health Care, 3075 Highland
Avenue, Suite 600, Downers
Grove, Il 60515, USA;
[email protected]

Received 5 March 2015
Revised 6 May 2015
Accepted 16 May 2015

To cite: Sikka R, Morath JM,
Leape L. BMJ Qual Saf
2015;24:608–610.

In 2008, Donald Berwick and colleagues
provided a framework for the delivery of
high value care in the USA, the Triple
Aim, that is centred around three over-
arching goals: improving the individual
experience of care; improving the health
of populations; and reducing the per
capita cost of healthcare.1 The intent is
that the Triple Aim will guide the redesign
of healthcare systems and the transition to
population health. Health systems glo-
bally grapple with these challenges of
improving the health of populations while
simultaneously lowering healthcare costs.
As a result, the Triple Aim, although ori-
ginally conceived within the USA, has
been adopted as a set of principles for
health system reform within many organi-
sations around the world.
The successful achievement of the

Triple Aim requires highly effective
healthcare organisations. The backbone of
any effective healthcare system is an
engaged and productive workforce.2 But
the Triple Aim does not explicitly acknow-
ledge the critical role of the workforce in
healthcare transformation. We propose a
modification of the Triple Aim to acknow-
ledge the importance of physicians, nurses
and all employees finding joy and
meaning in their work. This ‘Quadruple
Aim’ would add a fourth aim: improving
the experience of providing care.
The core of workforce engagement is

the experience of joy and meaning in the
work of healthcare. This is not synonym-
ous with happiness, rather that all
members of the workforce have a sense
of accomplishment and meaning in their
contributions. By meaning, we refer to
the sense of importance of daily work.
By joy, we refer to the feeling of success
and fulfilment that results from meaning-
ful work. In the UK, the National Health
Service has captured this with the notion
of an engaged staff that ‘think and act in
a positive way about the work they do,
the people they work with and the organ-
isation that they work in’.3

The evidence that the healthcare work-
force finds joy and meaning in work is
not encouraging. In a recent physician
survey in the USA, 60% of respondents
indicated they were considering leaving
practice; 70% of surveyed physicians
knew at least one colleague who lef

Guest Editorial

Nurse Educators: Leading Health Care to
the Quadruple Aim Sweet Spot

E
ighteen years ago, an alarming
report on preventable deaths from
medical errors was released by

the Institute of Medicine (IOM, 2000).
That report featured the estimate that
approximately 100,000 people in the
United States die each year because of
preventable medical errors. A subse-
quent IOM report (2003) called for all
health professionals to be better pre-
pared to keep patients safe, focusing
on five core competencies for health
professions education: patient-centered
care, interprofessional collaboration,
evidence-based practice, quality im-
provement, and informatics.

Visionary leaders in nursing educa-
tion were ahead of the curve, responding
to the call for safer and more effective
care via the Quality and Safety Education
for Nurses (QSEN) project (Cronenwett
et al., 2007). In 2008, the Institute for
Healthcare Improvement announced a
major initiative—the Triple Aim—which
focuses on “simultaneous pursuit of three
aims: improving the experience of care,
improving the health of populations, and
reducing per capita costs of health care”
(Berwick, Nolan, & Whittington, 2008,
p. 759). Subsequently, Bodenheimer
and Sinsky (2014) proposed a fourth—a
quadruple—aim to improve the work life
of health care providers, both clinicians
and staff.

What progress has been made during
the past 19 years since the IOM report,
with 10 years of QSEN education, and
9 years after the Triple Aim was launched?
Improvements in some health outcomes
have been reported. For instance, the
United States has seen a 15% reduction in
infant mortality rates compared with 2005

(Kochanek, Murphy, Xu, & Tejada-Vera,
2014). Numbers of hospital-acquired con-
ditions, such as central line-associated
bloodstream infections (CLABSIs), pres-
sure ulcers, and falls with injuries have
significantly decreased from 2010 to
2013, according to a recent report from the
American Hospital Association (2015).
However, in terms of better care and lower
costs, we are not yet there. James (2013)
has estimated annual hospital patient
deaths due to preventable harm to be over
400,000 per year. Reports from consumers
of health care continue to include stories
of poor care experiences, including lack
of compassion and frustrations in navigat-
ing the complexities of the care system.
Further, the aim of lower costs per capita
has yet to become reality. Although an
estimated 20 million people were newly
insured through the Patient Protection
and Affordable Care Act (ACA, 2010),
political challenges to the ACA remain,
including rising costs, high out-of-pocket
expenses, and access to affordable insur-
ance.

In the world of leadership, there is a
term referred to as the sweet spot, where
economic health and the common good
coexist and are the keys to

Implementing EBP Column

Improving Patient Care Through Nursing
Engagement in Evidence-Based Practice
Elizabeth Crabtree, MPH • Emily Brennan, MLIS • Amanda Davis, MPH, RD •
Andrea Coyle, MSN, MHA, RN, CMSRN

This column shares the best evidence-based strategies and innovative ideas on how
to facilitate the learning of EBP principles and processes by clinicians as well as
nursing and interprofessional students. Guidelines for submission are available at
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787

INTRODUCTION AND BACKGROUND
The Medical University of South Carolina (MUSC) is a large
academic health science center, with a 700-bed medical cen-
ter (MUSC Health), and six colleges that train approximately
2,600 healthcare professionals annually. The MUSC Center
for Evidence-Based Practice (EBP), housed jointly in the Li-
brary and the Quality Management department of the MUSC
Hospital, aims to promote scientific inquiry, EBP, and quality
outcomes at MUSC. Through education, the development of
evidence-based clinical decision support tools and outcomes
research, the Center for EBP has begun to transform the cul-
ture of MUSC into one that incorporates best evidence into
clinical practice on both an individual and system level.

One of the strategies implemented by the Center for EBP
to promote cultural change is an educational course: the EBP
Nurse Scholars course, where nurses are taught about the the-
ory, practice, and dissemination of EBP.

DETAILED DESCRIPTION OF STRATEGY
Nurses serve on the frontline of health care, and have a
unique opportunity to improve patient care through EBP
(Hockenberry, Walaen, Brown, & Barrera, 2008). The staff
nurse is a critical link in bringing evidence-based changes into
clinical practice. Best practice only occurs when staff continu-
ally ask questions about treatment and care, have the resources
and skills necessary to search for and appraise research ev-
idence, implement the evidence in practice, and evaluate its
effectiveness (Dawes et al., 2005; Hockenberry et al., 2008).

MUSC’s experience in preparing practicing nurses to do
EBP was limited. To address this, the Center for EBP, in part-
nership with the Center for Professional Excellence, developed
a 12-week, project-based course to prepare nurses to engage in
EBP. The Center for Professional Excellence collaborates with

internal and external customers to create growth and devel-
opment opportunities for registered nurses. Additionally, the
center is responsible for Magnet application and designation.
The EBP Nurse Scholars course provides nurses with a com-
prehensive overview of EBP, prepares them to frame clinical
questions, perform literature searches, analyze and evaluate
evidence, and translate that knowledge into something clini-
cally meaningful. Members of the Center for EBP staff and
library faculty provided lectures and individual co

Original Article

The Establishment of Evidence-Based
Practice Competencies for Practicing
Registered Nurses and Advanced Practice
Nurses in Real-World Clinical Settings:
Proficiencies to Improve Healthcare Quality,
Reliability, Patient Outcomes, and Costs
Bernadette Mazurek Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAANP, FAAN •
Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC • Lisa English Long, RN, MSN, CNS •
Ellen Fineout-Overholt, RN, PhD, FAAN

Keywords

evidence-based
practice,

competencies,
healthcare quality

ABSTRACT
Background: Although it is widely known that evidence-based practice (EBP) improves healthcare
quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still
not the standard of care delivered by practicing clinicians across the globe. Adoption of specific
EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world
healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health
care.

Aim: The aim of this study was to develop a set of clear EBP competencies for both practicing
registered nurses and APNs in clinical settings that can be used by healthcare institutions in their
quest to achieve high performing systems that consistently implement and sustain EBP.

Methods: Seven national EBP leaders developed an initial set of competencies for practicing
registered nurses and APNs through a consensus building process. Next, a Delphi survey was
conducted with 80 EBP mentors across the United States to determine consensus and clarity
around the competencies.

Findings: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors,
resulting in a final set of 13 competencies for practicing registered nurses and 11 additional
competencies for APNs.

Linking Evidence to Action: Incorporation of these competencies into healthcare system ex-
pectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion
processes could drive higher quality, reliability, and consistency of healthcare as well as reduce
costs. Research is now needed to develop valid and reliable tools for assessing these competen-
cies as well as linking them to clinician and patient outcomes.

BACKGROUND
Evidence-based practice (EBP) is a life-long problem-solving
approach to the delivery of health care that integrates the best
evidence from well-designed studies (i.e., external evidence)
and integrates it with a patient’s preferences and values
and a clinician’s expertise, which includes internal evidence
gathered from patient data. When EBP is delivered in a context
of caring and a culture as well as an ecosystem or environment
that supports it, the best clinical decisions are made that

yield positive patient outcomes (see Figure 1; Melnyk &
Fineout-Overholt, 2011).

Research supports that