Iowa Investigator - Dr. Jill Scott-Cawiezell - The University of Iowa College of Nursing

Iowa Investigator - Dr. Jill Scott-Cawiezell

What is the focus of your research?

My research has focused on identifying and understanding the critical organizational elements for the creation and sustainment of improvement. Most of our quality improvement and patient safety focused work has been within the nursing home setting. The aims of our research have been varied. In our first study we sought to understand the links between working conditions and organizational performance:

1) Determine the frequency and variability of selected working conditions (organizational culture and environment, staff interaction and staffing patterns) among a sample of Colorado nursing homes.
2) Determine the frequency and variability of targeted organizational performance measures (MDS Quality Indicators, state survey and complaint results, and perceived effectiveness) among a sample of Colorado nursing homes.
3) Examine the relationship between selected working conditions and targeted organizational performance measures.
4) Elicit an in-depth description of organizational culture (rituals, heroes, ceremonies) from key informants and explore their relationship to quality care.

In our most recent study we consider the impact of technology and focused quality improvement upon medication safety practices:

1) Determine baseline medication safety practices (order entry, alerts to prevent adverse drug event and special medication precautions, resident identification, and dispensing) in the nursing home setting.
2) Evaluate the One Touch eMAR System and QIPMO in the nursing home setting as they relate to reduction of adverse drug events and medication error rates.
3) Elicit the organizational and individual barriers to safe medication practices within the nursing home setting.
4) Assess the nursing home culture through the use of the Competing Values Framework to determine organizational readiness to embrace innovation and new quality improvement strategies.
5) Explore the costs of medication administration and error in the nursing home setting.

What led to the development of interest in this topic?

While working on an early translation grant with international clinical experts, it became clear that the organization could facilitate or impede the “uptake” of improvement efforts. As a former nurse executive, this made a great deal of sense to me and I wanted to better understand the link between such things as organizational culture and climate and performance.

What impact do you predict coming from this research?

We have been very excited to see our work have wide dissemination. Our organizational survey has been picked up in 18 states by the Quality Improvement Organizations. Our measures have also served as precursors to AHRQ safety culture surveys. Additionally, our work has really explicated the impact of the nurse leader in building high performing teams.

How does the research integrate into education/practice/service?

The explication of the nurse leader in our work has provided excellent case studies for self reflection, information for the Quality Improvement Organizations to use in the field as they help nursing home build capacity, and in our own guidance of graduate nurse education.

December 10, 2008