Health Policy Final Project Outline

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Health Policy

  • Provide leadership in analyzing, developing, revising, implementing, or evaluating a policy based on best evidence
  • Collaborate on legislative change project using evidence

Health Policy Projects

Health policy projects may focus on either governmental health policy (e.g. federal, state or municipal policy) or organizational policy.

Section One: Nature of the Problem

  1. Introduction to the policy problem

Provide an overview of the health policy issue or problem including:

  • A description of the policy problem/issue, with a clear description of how it is either a governmental or organizational policy problem;
  • A description of the underlying clinical/health/health professions problem that is the source of the policy problem/issue. This may be necessary to give your reader the full picture.
  • Evidence that supports the significance of and rationale for addressing the problem, which should be sufficient to be compelling.
  • The relevance of addressing the policy problem/issue for nursing and/or health care.
    • If this is a governmental policy problem, how will addressing the problem be relevant to nursing/health care at the target level, i.e. federal, state, or municipal?
    • If this is an organizational policy problem, how will addressing the problem be relevant to the organization?

2. Purpose of policy project

  • This is a broad reflection of the focus of your project.
  • Purpose has logical flow from introduction to the problem.
  • C. Include a description of the population of interest, setting, and potential policy solution/option (intervention). The population of interest should be those persons who will be most affected by the policy option/intervention (e.g. if government then citizens or “persons with; sometimes licensees.” If organizational then staff, or patients, etc.)
  • Project Objectives, described in realistic terms. I.e. what can realistically be accomplished as a result of completing this policy project?

Section Two: Review of the Literature

  1. Policy problem statement

The Policy Problem is to be formulated and stated using the PICO(T) format of Population, Intervention, Comparison, Outcome, Timeline (the T is optional).

  • The Intervention should reflect the new “policy option/solution”
  • The Comparison should reflect the policy as it stands currently (policy may currently be silent).
  • The Outcome should circle back to the Population, and be a result of the Intervention.

Policy usually constitutes an intervention, therefore an intervention-type PICOT template should be used.

2. Evaluation/Summary of the Evidence from the Literature

  • Develop and implement an exhaustive search process. Review current research, related literature, and other relevant sources.
    • Consider both global evidence (broad evidence from around the nation/globe that is applicable/transferable to this policy project) and local evidence (evidence that is more narrow/confined to the immediate and relevant political, demographic, or other climate that informs your particular policy project).
    • During the course of your literature search, you may identify sources such as statute, regulation, government agencies, and/or certain organizational, professional, or accreditation association policy may be required to inform your policy project. (use caution – some organizational/professional policy may qualify as Level VII Expert Opinion, therefore “evidence.”) Although some of these may not be categorized as evidence on an evidence hierarchy, you may still need to include them. Categorize them, accordingly, as government documents – but include them in your document in some way if they are relevant.
  • Describe in a narrative format the following items:
    • Evidence search method, including research databases used, handsearch/snowballing, etc.
    • Selection criteria.
    • Publication/document years included in search.
  • Synthesize the evidence that supports the project utilizing appropriate synthesis table(s) followed by a narrative synthesis including the following items; strength of the body of evidence, quality of the body of evidence, generalizability of the body of evidence to answer your inquiry, feasibility of implementing the evidence in the proposed setting.
    • Review current research, other related literature, and government documents (as appropriate).
    • Complete an Evaluation/Summary Table to summarize the literature.
    • Review of current guidelines on the clinical topic that informs the policy question may be appropriate. If so, they may be found in the following informational databases:
    • National Guideline Clearinghouse
    • Best Evidence
    • Joanna Briggs Institute
    • Others
    • If guidelines exist, rate the guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument.
  • Review each document:
    • Review each article using the appropriate Critical Appraisal Tools.
    • Review statute or regulation for its relevance to the proposed policy change at large, describe whether it is current, whether there is indication it is based on evidence, and whether it constitutes global or local policy.
    • Review professional or accreditation association policy for its currency, rigor (i.e. is it based on a body of evidence), and relevance to your proposed policy change. However, if it constitutes evidence, use the appropriate Critical Appraisal Tool.
  • There must be adequate evidence to support the proposed problem and the subsequent proposed recommendation for a policy change
  • If applicable evaluation summary of any internal (Organizational) evidence. Examples may include:
    • QI Data;
    • Quality Metrics

3. Critical Appraisal of the Evidence

  • This is an essential step of the evidence-based/evidence-informed policy project that moves the analysis beyond a mere review of the literature/evidence; you are appraising the quality and the strength of the evidence to answer your policy question and inform your policy option/solution/intervention.Synthesize the evidence that supports the project utilizing appropriate synthesis table(s) followed by a narrative synthesis including the following items; strength of the body of evidence, quality of the body of evidence, generalizability of the body of evidence to answer your inquiry, feasibility of implementing the evidence in the proposed project.
  • Interventions should then be evaluated for Effectiveness as related to Scholarly Examination. Examples of rating systems are provided in Evaluation of the Level of Effectiveness. Record on Summary of Effectiveness Table.
  • Utilize a Synthesis Table followed by a narrative Synthesis. Steps to accomplish would include:
    • Synthesize the body of evidence assembled to answer the policy question including a synthesis of:
      • the strength of the body of evidence;
      • the body of evidence related to outcomes of interest;
      • the body of evidence related to policy change recommendations;
      • the body of evidence related to implementation strategies, etc
    • The narrative synthesis/summary of the literature should be based on the synthesis table. This should include a thematic synthesis of the body of evidence assembled to answer the policy question, i.e. combine like-themed authors and findings in the same paragraph, making your case for the policy change.

Note: The Literature review (the narrative synthesis/summary section) may need to be divided into more than one section. Therefore more than one synthesis table may be required. E.g. a policy-focused project may require one synthesis table that describes the body of evidence describing the clinical issue that informs the policy direction, and a second synthesis table that describes the body of evidence specific to related policymaking in the setting of interest. The literature synthesis/summary should be divided/described accordingly.

  1. Presentation of theoretical basis

Theoretical base for investigation of the policy problem or implementation of the policy option/solution should be provided. This may include a conceptual framework; policy theoretical framework (e.g. Kingdon’s Streams Model, Advocacy Coalition Framework, PDSA, the CDC Policy Process or Framework, etc.); theoretical framework for implementation (i.e., change theory, EBP, or Evidence-Informed Health Policy models).

Presentation should include provision of:

  • A theoretical basis for the investigation of the policy problem (conceptual or theoretical framework, etc.);
  • An evidence-based or evidence-informed policy model that will guide the project; and
  • A description of how the project:
    • Fits the relevant government structure, process, and politics (government policy projects); or
    • Fits the organizational department’s theory of practice, or the organizational strategic plan or mission statement (organization policy projects).
  1. Feasibility/Utility
  • Complete a critique of applicability of your proposed intervention/implementation.
  • Determine the feasibility and usefulness (utility) of your proposed policy option/change/intervention.
    • If governmental:
      • Feasibility: If legislative, what is the likelihood of passing this measure considering partisan politics, timing in the General Assembly/Congressional cycle, issue prioritization, possible necessary budget allocation, political environment, etc. If regulatory, does the regulation have statutory authority? Is the relevant executive branch department open to discussion/change? Is there an advisory committee structure through which this measure would flow? Who are the key stakeholders? Is there a cost involved, and if so, how would the measure be funded?
      • Utility: how useful would the policy change be, and for whom? Which stakeholders, or which government agencies, or both?
    • If organizational:
      • Feasibility: what is the likelihood of implementation in the organization? Who are the key stakeholders, and would they be in favor of the policy change? What committee structures would it need to pass through? What financial and/or human resources would be needed to carry it out if it is actualized? Are resources sufficient?
      • Utility: how useful would the policy change be, and for whom? Which stakeholders, or which departments, or both? Would the policy change serve patients? If so, which patient populations? Or staff? What might be the anticipated outcomes as a result?
  • Analyze the benefits and risks of the policy option/solution.
  • Complete a cost analysis and indicate resources needed to implement the change including:
    • A budget, including funding sources, with consideration of human resources, operations, and capital equipment to implement the change ( this is a non-exhaustive list).
    • Education plan if applicable.
    • Timeline.
    • Including but not limited to personnel, operational, equipment, etc.

6. Recommendations summary

  • Statement of the recommendations to proceed with the policy project.
  • Reference(s) in support of the recommendations
  • Identification of key stakeholders  and strategies to engage key stakeholders
  • Strategies to engage stakeholders
  • Identification of potential barriers
  • Strategies to address

Section Three: Methods

  1. Recommendations for implementation of policy option/solution/change

Use the synthesis tables of evidence to develop the policy option/solution/change. In narrative form, state the plan developed from the evidence- based/evidence-informed recommendations.

  1. Plan for the Evidence-based/evidence-informed Policy Change: Steps toward Development and Implementation

This is where you will describe your implementation strategy in detail. What do you propose as effective strategies to promote engagement and progress toward, or adoption of, this evidence-based/informed policy option/solution/change? How will the policy change be executed, and in the time designated? Or, if complete execution is not the goal (not possible), what outcome can be expected from this project?

  • If governmental policy, what is the project implementation goal, given the timeline? or;
  • If organizational, what is the role of your clinical agency with regards to the implementation plan?
    • Identify the specific evidence-based practice or evidence-based/evidence-informed policy model, identifying the statements/sections of the model that support implementation of the project.
    • Sample, Setting, Context Description, and Stakeholder Ethics and Values.
      • Identify and describe the sample and setting, including inclusion and exclusion criteria.
        • Approximately what size is the sample you will be using?
        • What is your rationale for choosing this sample and setting, keeping in mind your type of project (governmental or organizational policy)
      • How does the sample compare with those described in the literature/evidence?
      • Describe your process in the selection of the particular sample, setting, or context.
      • Identify the nature of the population, including a generalized discussion of relevant issue expertise and stakeholder values.
  • Identify the government or organization’s readiness for change
    • Government; from an assessment of the current political environment, and recent changes in the current congressional session, general assembly, or regulatory environment, depending on your project scope; is the government ready for evidence-based/evidence-informed policy change?
    • Organization; from an assessment from your organization’s change readiness based on recent history r/t policy change. Is the organization ready for evidence-based/evidence-informed policy change?
  • Construct a summary of the plan for implementation of the evidence-based/evidence informed policy change consistent with the model you have chosen.
    • Government: A suggested resource is Oxman, Lavis, Fretheim and Lewin (2009), “SUPPORT Tools for evidence-informed policymaking (STP) 16: Using research evidence in balancing pros and cons of policies. Include:
      • Potential barriers/cons.
        • Plan/strategy to address.
      • Potential facilitators/pros.
        • Plan/strategy to engage
    • Organizational: A suggested resource is Chapter 9, “Implementing Evidence in Clinical Settings,” by Hockenberry, Brown, and Rogers (In Melnyk & Fineout- Overholt, [Eds.] 2015). Include:
      • Potential barriers.
        • Plan/strategy to address.
      • Potential facilitators.
        • Plan/strategy to engage

3. Measurement methods/tools and Impact Evaluation

  • If using outcome measurement: What indicators will you use to measure the success of implementing the policy change? Consider outcome measures such as patient outcomes, patient satisfaction, provider satisfaction, access to care, public protection, or resource allocation. You may also consider organization performance indicators such as benchmarking data, cost effective analysis, infection control data, or quality improvement or risk data.
  • Describe the instrument/measurements/method to be used to measure your variables/outcome measures (directly or as a proxy measure; how scored; limitations) and describe why this instrument/measure/method is appropriate.
  • If using an established tool, identify the reliability and validity. Describe what populations this tool has been used in and how that is different/similar to the population you plan to use it on. Provide an electronic copy of the instrument and permission for use (if not public domain) in your appendix.
  • If using qualitative methods, provide a copy of the questionnaire or survey you used in your appendix.
    • If you constructed your own, indicate the literature (evidence) upon which you based the questionnaire/survey.
    • If you used an authored questionnaire/survey not in the public domain, provide an electronic copy of the questionnaire/survey and permission for use in your appendix.

4. Data collection process and logistics

  • Identify who will collect data and how they will be trained if more than one person is collecting data, discuss how you will determine inter-rater reliability.
  • Describe the process of data collection (e.g. access to data, privacy provisions, administration of the tool, any anticipated barriers to data collection).
  • Identify the time-frame for data collection (e.g., before you implement the change, how long you will wait before you re-measure.)
  • Cite sources as appropriate (e.g. Krueger & Casey for focus group data collection, etc.).

5. Plan for data analysis

  • If using quantitative data, describe how statistical procedures or other procedures will be utilized and why they are appropriate (what level of data will the tool yield)?
  • If using qualitative approach, describe the qualitative process that will be used to analyze the data. Cite sources as appropriate (e.g. cite any software used, such as NVivo, Excell, etc.; Miles, Huberman or Saldana for qualitative data reduction and analysis, etc.)
  • Describe the how you will prepare the data for analysis (i.e., who will enter data? Into what computer? Will there be double entry of data to insure no mistakes?, who will transcribe narrative?, How have these individuals been trained?, who is the statistical consultant for the project if needed?).

6. Model use analysis

  • Describe how you followed the steps/model for using an EBP, Evidence-based/evidence-informed Policy making, or Health-policy related model for implementation/dissemination of the project.

7. Proposed budget, time, and resources plan

  • Provide a budget. This will help you think through the resources needed, and whether you should plan to apply for a grant. Think about who will finance each aspect of the project. If you are the only financial support, you will have to manage the project accordingly.  If you plan on a grant application, include details. If the project proposes a governmental policy change, indicate the anticipated source of funding and how the revenue stream to the implementing agency will look
  • Provide a timeline for implementation of the plan (2-semester grid). This might change as you progress with the project. Usually every step takes longer than you anticipate. Be prepared to alter your plans if needed.
  • Identify resources available and/or needed (e.g., information technology, databases, personnel, statistician, settings, transcription service).
  • Identify deficiencies and how to alleviate those to achieve this plan (what you do not have and how you might get it; skills you may need to develop; consultants you may need to secure).

8. Ethics

Identify the process you undertook to establish the ethical conduct of your project. E.g.

  • It is assumed you completed the Feasibility Form. If it indicated that your project designated as EBP/QI, was there a next step?
    • E.g. if you were conducting an organizational policy project in OSUWMC, did you need to affirm EBP/QI by submitting an Executive Summary of your project to ORRPDeterminations?
    • If your project required that you approach staff nurses who are a part of a bargaining unit, did you need to request formal approval from that bargaining unit?
    • Was there any other procedure required by your organization/unit to assure ethical conduct?
    • If you answer yes to any of these, describe. Include any attachments as appendices to your document.
  • If it was determined that your project required IRB approval, describe the approval category, consenting procedure including protection of data, etc., and attach any documents as appendices.
  • If your project was determined to be EBP?QI, did you use standard consent procedures as appropriate? Describe, and attach the consent, script, or other document/electronic information used, as an appendix.

Section Four: Findings

  1. Results/Outcomes/Findings

Should be organized and linked to the policy problem statement, purpose, project objectives, and evaluation plan.  Include specific details as to how your project was evaluated (as appropriate):

  • What were the evidence-based/evidence-informed policy interventions that were applied to the evaluation plan?
  • What evidence-based measures/instruments were used for each objective or proposed outcome?
  • What method of analysis was used for each objective and/or outcome?
  1. Discussion/Conclusions

Describe the extent to which the objectives and/or project outcomes were achieved.

  1. Limitations

Describe the limitations of the project. Consider the nature of the population, scope of the project, measurement tools or methodology, realities of the political environment, and any other limitations that might apply.

Section Five: Recommendations and implications for policy and practice

  1. Project Summary
  2. Implications for Policy and practice. Discuss the recommendations and implications in relation to the policy change, its implications for health and/or practice, and the project site.
  • Discuss implications in relationship to DNP Essentials and policy/practice.
  • Discuss the implications for the site/context at which the project was conducted. These may include:
    • Should the project be continued, reduced, phased out, or expanded? Place your recommendation within the framework of the governmental policy agenda or the organization’s strategic plan and be sure to recommend who needs to be involved in or responsible for future phases.
    • Next, write recommendations regarding the possible application of this project in other (similar) settings.
  • Include recommendations related to identified facilitators/barriers and unintended consequences.
  1. Identify methods for dissemination
  • Describe one or two methods of dissemination of the results of your project including:
    • A statement on your selection these venues were selected, and justification as to why they will be the best/have most impact.
    • A description of who you would want to reach as your audience and why.