“Rather than setting the bar at an unattainable level, hospitalists should consider getting involved in quality improvement research, since hospitalists are often ideally suited to participate [in] and lead the interventions themselves,” says Dr. Lindenauer. “It’s not the only kind of research, but it’s a natural, given the roles that hospitalists play. However, hospitalists can be involved in clinical trials, in analyses of secondary data, and even in doing intervention studies at their own institutions.”
And a quality improvement project, if conducted correctly, is likely to be accepted for publication and/or presentation. “While QI research is somewhat different than traditional, clinical research, there’s an increasing interest in seeing [QI] research published in established medical journals,” explains Dr. Lindenauer. “Some hospitalists have been very successful at doing this and [in] publishing the results and … giving presentations.”
Steps to Get Started
So how should you go about setting up your first QI research project?
Your first step—and possibly the most important—is selecting a research topic. “It’s important to come up with good research questions,” says Dr. Lindenauer. “One framework for choosing a topic is the acronym FINER, which stands for: [is it] feasible, interesting, novel, ethical, and relevant?”
Once you have a likely focus for quality improvement, outline how you mean to go about the project. “You have to choose a study plan and make sure the plan matches the question,” says Dr. Lindenauer.
When you have a basic idea for your project, says Dr. Lindenauer, “You have to find time in an already busy life, and you have to find support.” For one thing, very few questions can be answered by a single physician. For another, you’ll need your hospital’s buy-in.
“For QI research, it’s natural to go to your hospital’s quality improvement department,” says Dr. Lindenauer. “Ask the director of the department to sit down, and then find out what’s on the hospital’s agenda. You’ll need to find some common ground, some overlap between your interests and the hospital’s. Support is so important, and given all the external pressures for improving quality, it’s unlikely that your quality improvement department will support a project that doesn’t align with their plans or focus. So align your interests with those of the hospital and go from there.”
Ideally, you’ll also find some mentorship before or during your first project. “At a community hospital, where no faculty is available, you must identify potential mentors from outside your hospital,” says Dr. Lindenauer. “Find faculty at a university that your hospital is affiliated with or someone who was a mentor to you during your residency or medical school. And sometimes a quality improvement department can supply a mentor.”
Lastly, “find some degree of training,” advises Dr. Lindenauer. “SHM has regularly offered workshops as a first step to starting research. Other societies offer short, intensive training—or a fellowship. If you get … charged up doing research, find a fellowship.”
Build in Review by an IRB
There’s one more crucial step involved in setting up and conducting a QI research project, assuming you want to get your results published: “You should notify [your institutional review board] and have them look at your project,” says Dr. Lindenauer. “The best time to do this is during the conceptualization, once you have your research protocol.”
You should take care of this on your own because your QI department isn’t likely to think it’s necessary. “There’s often a disconnect between the perceived need for the involvement of the IRB between researchers and QI folks,” explains Dr. Lindenauer. “Usually, QI departments don’t tend to seek IRB review for their projects. But if you’re contemplating publishing your research—which is typically the ultimate goal to a research project—this always requires IRB review. This is true even though the case is often that QI projects are exempt.”