Friday, March 29, 2013

On Jumping Off a Cliff

Lori Melichar, PhD

Seven and a half years ago, I sat down at the computer to write a speech in hopes of convincing my peers to join me in jumping off a cliff.

As a program officer for the Robert Wood Johnson Foundation (RWJF), I was excited to be involved with RWJF’s work in support of the National Quality Forum (NQF). We had partnered with the Veterans’ Administration (VA) to fund NQF in their endeavor to generate a list of nursing-sensitive measures. The resulting report was the inspiration for the Interdisciplinary Nursing Quality Research Initiative (INQRI) program, an enterprise of which I am incredibly proud.

So, why the cliff?

At the time, many thought that the pursuit of research linking nursing to quality should be exclusively in the purview of nurse researchers.

But, I’m not a nurse researcher. I’m not even a nurse; I’m a labor economist who, way back in the fall of 2005, was relatively new to the field. However, as my work with RWJF and NQF evolved, I began to appreciate not only the plethora of gaps in what we knew about nursing, but also the role of nurses as valued team members.

When I began collaborating with Mary Naylor and Mark Pauly on brainstorming ideas for what would ultimately become the INQRI program, we settled on one thing at the outset: INQRI would not fund research that was solely conducted by nurses. We believed then and we believe now that interdisciplinary research allows researchers to break out of their siloes, develop new ideas, test old assumptions, and pursue an understanding of the issues facing us with strong methodological fervor.

It became my goal to convince other scholars from beyond the field of nursing of the merits of that idea. So, I began a road trip. I visited campuses across the country and attended national meetings to reach out to social scientists, economists, and many others to share my excitement about INQRI.

To prepare for this trip to visit those in the fields I knew well, I had to ask myself, what would I need to hear to convince me to try something new? I thought about the fact that as researchers, we were missing vital opportunities to uncover rigorously tested research demonstrating nursing’s causal link to the delivery of high quality care and that if we had that research, we could make an incredible impact on health care in this country. I thought about the fact that well-conducted research could lead to change, could reveal alternative strategies to reduce the nurse shortage and could prove what so many of us believed to be true – that nurses are often the unsung heroes on care teams.

I knew it couldn’t just be about the idea, though. I knew that INQRI would have to forge a new path, not only in conception, but in practice. That is why Mary, Mark and I developed strategies to form partnerships between researchers. On my road trip, I acknowledged the fact that we know change is hard, and I promised that the INQRI leadership team would be there to help. I talked about the support we would provide by linking researchers with potential end-users of their work. I offered to help researchers from outside of nursing to find a nurse partner so that they could form new teams when applying for INQRI funding. I explained that they would have ongoing support and guidance from a group of key stakeholders and that these connections would develop and continue throughout the life of the INQRI program.

As I look back now, remembering my trips and speeches and the stories that Mary and Mark told about the presentations they made on behalf of this program and this idea, I am in awe. We believed it could work. We were sure that we could convince scholars from outside of nursing to become co-investigators with nurse researchers to form research teams – a requirement for INQRI funding.

But, there is a difference between believing and knowing. And given that forty researchers from outside of nursing chose to jump off that cliff with me, we know it. We know that these interdisciplinary partnerships can change the way research is conducted and lead to positive change.

In just seven and a half years, the 40 research teams funded by INQRI have accomplished a great deal. This week, you have had the opportunity to learn about many of them, but I encourage you to visit to learn about all of them.

We took the jump together, and it has been an incredible journey for all of us!

Dr. Melichar is a Senior Program Officer for the Robert Wood Johnson Foundation and a member of INQRI's leadership team.

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival.

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