Strategic Leadership for Organizational Change

JONA Volume 44, Number 6, pp 309-312 Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Funding Big Research With Small Money Joanne V. Hickey, PhD, RN, APRN, ACNP-BC, FAAN, FCCM Mary Koithan, PhD, RN, CNS-BC, RN-C Lynn Unruh, PhD, RN, LHRM Vicki Lundmark, PhD

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change ini-

tiatives. In this article, the guest authors introduce crowd sourcing as a strategy for funding big research with small money. Innovative funding models can be used to conduct adequately powered and rigorous studies for small money, generate meaningful findings, and also mentor novice researchers. Does that sound impossible? It is happening right now. In 2010, the American Nurses Credentialing Center (ANCC) inaugurated an innovative ‘‘pay-toparticipate’’ model through the leadership of the ANCC Research Council.1 Magnet hospitals were invited to participate in a multisite study to be conducted by an experienced multidisciplinary research team testing the effectiveness of guideline-based patient education and follow-up for patients with heart failure (HF). To participate, 40 hospitals paid $10,000 annually for 2 years. In return, these facilities received study materials and ongoing mentorship for their staff from research team members through the conclusion of the study in 2013. The 40 participating hospitals represented Magnet-recognized organizations across the United States and varied A

Author Affiliation: Professor (Dr Hickey), School of Nursing, The University of Texas Health Science Center at Houston, Texas; Associate Dean (Dr Koithan), College of Nursing, University of Arizona, Tucson; Professor (Dr Unruh), College of Health and Public Affairs, University of Central Florida, Orlando; Director (Dr Lundmark), Institute for Credentialing Research, American Nurses Credentialing Center, Silver Spring, Maryland. Dr Koithan is a consultant with the Accreditation Program of the American Nurses Credentialing CenterA (ANCCA). Dr Lundmark is an employee of the American Nurses Credentialing Center. The remaining authors declare no conflicts of interest. Drs Hickey, Koithan, and Unruh are members of the ANCC Research Council. Dr Lundmark is director of ANCC’s Institute for Credentialing Research. Maria Shirey, regular author of this department column, is a member of the ANCC Research Council. Correspondence: Dr Lundmark, American Nurses Credentialing Center, 8515 Georgia Ave, Suite 400, Silver Spring, MD 20910 ([email protected]). DOI: 10.1097/NNA.0000000000000072

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in size from facilities with less than 100 to more than 1,000 licensed beds. By pooling the individual contributions of each hospital, $800,000 was available to fund the Improving HF Outcomes (IHO) study (Table 1). This innovative approach to funding research created opportunities for hospitals to be involved in a large-scale study. Rigorous research was conducted on an important topic that otherwise might not have been launched because of funding and organizational barriers. Novice nurse researchers were able to receive ongoing mentorship about the conduct of clinical research from an experienced research team. The purpose of this article was to discuss a ‘‘pay-to-participate’’ model to fund large-scale research.

The ‘‘Pay-to-Participate’’ Research Study ANCC’s Research Council, an advisory body of volunteers, developed the idea for organizing the 1st Magnet multisite study. An impetus for arranging the study opportunity was the belief that Magnet-recognized healthcare organizations are well positioned to engage in cooperative

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Strategic Leadership for Organizational Change Table 1. Magnet Multisite Study: Improving Heart Failure Outcomes Study Title Objective

To evaluate the effect of 3 nurse-centric recommendations: & Teaching standardized HF content & Making a follow-up appointment before discharge & Calling patients after discharge to clarify instructions and promote self-care

No. of participating hospitals Principal investigator

40 Magnet-recognized healthcare organizations Robin Newhouse, PhD, RN, NEA-BC, FAAN, University of Maryland School of Nursing, Baltimore

models to advance nursing knowledge and build organizational research capacity. The ANCC Research Council acted as a catalyst, planning how a multisite research opportunity could be made available for Magnetrecognized organizations. With the 1st initiative, testing the feasibility of the pay-to-participate model was of primary importance. Therefore, the Research Council chose to commission a research team that could implement a tested and reliable protocol across participating Magnet organizations. Future studies would be selected through a competitive call for proposals. More than 75 Magnet organizations expressed interest in learning more about the opportunity to participate in the IHO study, supporting ANCC’s business decision to continue with the initiative. Following negotiation of a contract to commission the study, ANCC shared the list of interested Magnet organizations with the principal investigator. The researchers then began the process of enrolling interested Magnet organizations as participating sites. Two research team members were concurrently serving terms on the ANCC Research Council. However, neither the ANCC Research Council nor ANCC or any of its employees had any role in the conduct of the research. ANCC re-

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IHO

ceived periodic reports of the study’s progress. The pay-to-participate funding model also required a legal agreement between ANCC and each participating Magnet organization, which specified the fee payment obligations, data ownership, and publication rights. Participation fees funded the research budget and the nominal direct expenses ANCC incurred to organize and manage the participation agreements. No additional revenue was generated. Each hospital received summaries of its own and aggregate data for comparison purposes.

Crowd Sourcing, Crowd Science, and Citizen Science The ANCC pay-to-participate approach to funding a large-scale research project is innovative but has similarities to a new approach being implemented in a number of scientific endeavors, including research in healthcare. This new approach is called crowd sourcing, crowd science, or citizen science, which is used to indicate collaboration among a large number of scientists or between scientists (professionals) and ‘‘crowds’’ or ‘‘citizens’’ (nonprofessionals) in order to complete largescale projects.2-5 The various terms refer to the collaboration of differ-

ent individuals, groups of people, or organizations in funding or contributing to a project. In research endeavors, ‘‘crowds’’ usually contribute by providing data or funding the study. Crowd sourcing arose in response to the need to collect and manage large amounts of data.5 It is being used in diverse areas in science, including astronomy, biology, ecology, pharmacology, genetics, and disease treatments.3-8 In astronomy, for example, large numbers of volunteers are used to examine data from telescopes and images of interstellar dust particles.2 Enthusiasts believe that crowd sourcing enables researchers to step outside their silos by adding diversity and new perspectives.4

Why Participate in Large-Scale, Pay-to-Participate Research? The incentive for hospitals to participate in a pay-to-participate multisite study is 3-fold. First, lack of research expertise in individual hospitals is common. Most small- to medium-size hospitals do not have the resources to hire experienced researchers or the support services, such as a statistician, required to guide meaningful clinical research projects. Without such expertise, there is usually no one to mentor

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Strategic Leadership for Organizational Change or guide the nurses on staff, who typically are not trained to design and conduct even small-scale studies. The pay-to-participate model provides experienced research leadership so that nurses at a variety of levels can develop a working knowledge of research and nursing science. Through this participatory model, nurses can appreciate the possibilities of advanced degrees, the challenges of innovation, and the excitement of being involved in discovery. In a recent publication, nurses who participated in the IHO study described some of the benefits they and their organizations experienced such as strengthening their HF interventions and patients’ success postdischarge, improving interdisciplinary team practice, increasing nursing engagement in patient education, and cultivating a culture of clinical inquiry.9 Second, many studies are too small in scale to lead to meaningful findings. When published reports state that a study was too small to yield meaningful findings, they often suggest that the study should be refined and replicated using a larger sample size. But in truth, the subsequent replication studies are rarely conducted. The pay-to-participate model enables hospitals to conduct well-designed studies with large enough samples that are adequately powered and sufficiently rigorous to contribute meaningful findings. Third, conducting research is costly. Most facilities cannot support the magnitude of an IHO study without outside funding. Conventional sources of funding are very limited, and the lengthy time lag from application to award discourages clinical facility engagement. The pay-to-participate model offers alternative funding opportunities with a relatively short time span from conception of the research proj-

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ect to implementation. This cooperative method provides a new avenue to conducting meaningful clinical research for small money while contributing to nursing science, professional development, and quality of care that benefits patients and organizations. Taking into account these 3 reasons for engaging in a pay-toparticipate study, this model of funding is ideal for hospitals looking for ways to meet the Magnet standards for research required to renew their designation. Study results will contribute significantly to the body of research and therefore be likely to support a case to meet the Magnet standards. The pay-to-participate approach provides an experienced research team to guide the study and mentor staff in the participating sites. Finally, the cost of conducting the research using this innovative approach will usually not be prohibitively high for most institutions.

cation via webinars, conference calls, and other formats to sustain the integrity of the intervention across a variety of clinical environments. Yet, these challenges pale in comparison to the achievement of completing a high-quality, large-scale, and clinically relevant research study and the excitement of building sustainable research capacity in multiple organizations across the country.

Conclusions Based on our experience, we contend that the pay-to-participate research model is a financially feasible way for hospitals to build research capacity while contributing to science for practice and care. This model offers a unique way to fund quality research, increase the number of clinical research studies, and engage nurses at the point-of-care delivery in scholarship and discovery. This innovative model is ideal for hospitals seeking ways to meet Magnet research standards.

Challenges in Pay-to-Participate Models A number of special challenges always exist in the implementation of any study, and a large-scale payto-participate research model is no exception.3,9 Prior studies have found difficulties in building the ‘‘crowd,’’ attracting the right people, and maintaining crowd engagement.4 With the IHO project, both ANCC and the research team experienced challenges. For ANCC, clarifying the intent of the pay-toparticipate model and executing participation agreements with 40 individual Magnet organizations were challenging. For the IHO research team, challenges included awaiting the institutional review board approval for 40 different sites and maintaining continuous communi-

REFERENCES 1. Newhouse RP. Advancing research: American Nurses Credentialing Center’s Research Council mission and accomplishments. J Nurs Adm. 2013;43(5):243-244. 2. Franzoni C, Sauermann H. Crowd science: the organization of scientific research in open collaborative projects. Res Policy. 2014;43(1):1-20. 3. Hochachka WM, Fink D, Hutchinson RA, Sheldon D, Wong WK, Kelling S. Dataintensive science applied to broad-scale citizen science [published online ahead of print December 20, 2011]. Trends Ecol Evol. 2012;27(2):130-137. 4. Sindlinger T. Current literature. Crowdsourcing: why the power of the crowd is driving the future of business. Book review. Am J Health Syst Pharm. 2010; 67(18):1566. 5. Young JR. Crowd science reaches new

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Strategic Leadership for Organizational Change heights. Chron Higher Educ. 2010;56(37): A13-A15. 6. Adams SA. Sourcing the crowd for health services improvement: the reflexive patient and ‘‘share-your-experience’’ websites [published online ahead of print February 18, 2011]. Soc Sci Med. 2011; 72(7):1069-1076.

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7. Armstrong AW, Cheeney S, Wu J, Harskamp CT, Schupp CW. Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments. Am J Clin Dermatol. 2012;13(6):405-416. 8. Carey B. Crowd-sourcing expands power of brain research. New York Times. 2012.

Late edition (East Coast), April 16, 2012: A.11. 9. Johantgen M, Newhouse R. Participating in a multihospital study to promote adoption of heart failure guidelines: lessons for nurse leaders. J Nurs Adm. 2013; 43(12):660-666. http://links.lww.com/JONA/ A266. Accessed January 31, 2014.

JONA  Vol. 44, No. 6  June 2014

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Funding big research with small money.

This department highlights change management strategies that maybe successful in strategically planning and executing organizational change initiative...
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