Accepted Manuscript

Innovation in creating a strategic plan for research within an academic community

Kaitlin M. Best, MS, RN, Doctoral candidate, Olga Jarrín, PhD, RN, Claire M. FaginFellow National Hartford Center of Gerontological Nursing Excellence, Alison M.Buttenheim, PhD, MBA, Assistant Professor of Nursing, Kathryn Bowles, PhD, RN,FAAN, van Ameringen Endowed Professor in Nursing Excellence, Director of theCenter for Integrative Science in Aging, Martha A. Q Curley, PhD, RN, FAAN, Ellenand Robert Kapito Professor in Nursing Science

PII: S0029-6554(15)00038-X

DOI: 10.1016/j.outlook.2015.01.005

Reference: YMNO 1019

To appear in: Nursing Outlook

Received Date: 17 October 2014

Revised Date: 4 January 2015

Accepted Date: 10 January 2015

Please cite this article as: Best KM, Jarrín O, Buttenheim AM, Bowles K, Q Curley MA, Innovation increating a strategic plan for research within an academic community, Nursing Outlook (2015), doi:10.1016/j.outlook.2015.01.005.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.

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Innovation in creating a strategic plan for research within an academic community

Kaitlin M. Best,a MS, RN aDoctoral candidate

University of Pennsylvania School of Nursing 418 Curie Blvd

Philadelphia, PA 19104 USA

Olga Jarrín,b PhD, RN bClaire M. Fagin Fellow

National Hartford Center of Gerontological Nursing Excellence University of Pennsylvania School of Nursing

418 Curie Blvd Philadelphia, PA 19104 USA

Alison M. Buttenheim,c PhD, MBA

cAssistant Professor of Nursing University of Pennsylvania School of Nursing

418 Curie Blvd Philadelphia, PA 19104 USA

Kathryn Bowles,d PhD, RN, FAAN

dvan Ameringen Endowed Professor in Nursing Excellence Director of the Center for Integrative Science in Aging

University of Pennsylvania School of Nursing 418 Curie Blvd

Philadelphia, PA 19104 USA

Martha A. Q. Curley,e PhD, RN, FAAN eEllen and Robert Kapito Professor in Nursing Science

University of Pennsylvania School of Nursing 418 Curie Blvd

Philadelphia, PA 19104 USA Corresponding author and request for reprints: Martha A.Q. Curley, RN, PhD, FAAN University of Pennsylvania Claire M. Fagin Hall 418 Curie Boulevard - #424 Philadelphia, PA 19104-4217 USA

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Office Phone: (215) 573-9449 Funding: None Keywords: Research priorities; Nursing science; Strategic initiative Text pages: 12 Tables: 1 Figures: 2

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Abstract Strategic planning for research priorities in schools of nursing requires consensus building and

engagement of key stakeholders. However, traditional approaches to strategic planning using

workgroups and committees sometimes result in low rates of faculty participation and fail to

engage other important stakeholders. The purpose of this article is to describe the unique low-

cost, high-yield processes that contributed to the rapid development of our school’s strategic

research plan over the course of one month. Using the name recognition of the National

Collegiate Athletic Association’s annual basketball tournament, we were able to encourage high

levels of participation by faculty, doctoral students, and post-doctoral fellows in not only

developing a consensus around eight broad lines of inquiry, but also offering tangible

recommendations for accomplishing those goals within the next five years. Other schools of

nursing seeking to evaluate their research enterprise and align their science with national

priorities could easily replicate this approach.

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Introduction

Achieving consensus around a strategically planned research agenda is no small matter. It

requires balancing the successful trajectories of established academic researchers with the need

for cutting-edge innovation. Meanwhile, many academic nurses find themselves in a rapidly

changing research environment, wherein new patient-centered methodologies (Patient Centered

Outcomes Research Institute, 2013), an emerging emphasis on incorporation of biomarkers

(National Institute of Nursing Research, 2011), and need to increase research training

opportunities for younger nurses (Institute of Medicine, 2010) are defining features. Research

communities are being challenged to come together to hold meaningful dialogues about these

issues, while also proposing rapidly responsive solutions.

Strategic planning is a “systematic process of envisioning a desired future, and translating this

vision into broadly defined goals or objectives and a sequence of steps to achieve them” (Luthra,

2007). Unlike long-range planning, strategic planning “focuses on the near future (3-5 years) and

assumes that an organization’s environment is in flux (Mizrahi & Davis, 2008).” Traditional

approaches to strategic planning in academic settings have involved either face-to-face meetings

of select representatives of the faculty (i.e. committees) (Kulage et al., 2013; Milone-Nuzzo &

Lancaster, 2004; Peirce, Cook & Larson, 2004), or iterative multistage Delphi surveys (Hasson,

Keeney & McKenna, 2000). However, these processes frequently do not engage the entire school

in conversations about the future of the research enterprise or capture the perspectives of diverse

stakeholders, such as doctoral students and post-doctoral fellows. Increasing student input on the

scientific development of academic environments is particularly important for continuing the

generation of high-impact nursing science (Potempa & Tilden, 2004). Furthermore, previous

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projects in this area have been top-down approaches initiated by the dean of nursing (Peirce,

Cook & Larson, 2004), or reactions to the pressure of external funding climates (Kulage et al.,

2013; Milone-Nuzzo & Lancaster, 2004). By contrast, our faculty recognized the benefits of a

proactive approach to enable quick and decisive responses to emerging research trends and

funding opportunities. Rather than waiting for our new dean to conquer institutional inertia, we

utilized a period of transition within our school’s leadership as an opportunity to reexamine our

research priorities and develop recommendations grounded in extensive self-knowledge, which

will provide an ideal starting point for our collaborative work moving forward.

Very few peer-reviewed articles have been published outlining approaches to strategic planning

for research in academic nursing (Kulage et al., 2013; Milone-Nuzzo & Lancaster, 2004; Pierce,

Cook & Larson, 2004). Therefore, the purpose of this article is to describe the processes that

contributed to our strategic research plan and the products of our work. Although there may be

some aspects of our experience that are unique to our institution, we believe that the process

itself is worth replicating because of the excitement and unprecedented levels of involvement

that it inspired within our community. It engaged all faculty and doctoral students to reflect on

the aims of our science, and renewed their commitment to building a research agenda benefitting

this and future generations of our students and patients.

Methods

In the Fall of 2013, the Research Center Directors and the Research Committee of the School of

Nursing convened a series of joint meetings to discuss directions for future research within the

school. Our School of Nursing is consistently ranked in the top 10 for NIH funding, and consists

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of approximately 57 standing faculty, 7 research/practice faculty, 14 post-doctoral fellows, and

85 doctoral students spanning seven research centers that focus on geriatrics, global women's

health, health equity, health outcomes and policy, health transitions, biobehavioral research

including developmental disabilities and autism, and nursing history. The Research Committee,

charged with examining the research mission of the school and advising the Dean and the

Faculty Senate on policies related to research, includes the Associate Dean for Research, three

members of the standing faculty, one member of the research faculty, one student from the

Doctoral Student Organization and one post-doctoral fellow. With the support of the seven

Center Directors, the Research Committee took the lead in designing and implementing a plan

that engaged faculty, current doctoral students, and post-doctoral fellows in the construction of a

strategic plan to guide our research community over the next five years. With a Spring timeline

and desire to engage the School’s research community in a creative and fun process, we

brainstormed a few possible themes and quickly chose basketball. During the month of March,

the Research Committee utilized an iterative process, themed after the National Collegiate

Athletic Association’s (NCAA) basketball tournament bracketing system, to generate research

ideas and immediate actions for positioning the School of Nursing for future success. The

process of idea generation and prioritization is presented here.

The NCAA’s Division I Basketball Championships, popularly termed March Madness®, is a

single-elimination, rank-order tournament played each spring to determine the top-ranking

college basketball teams (National Collegiate Athletic Association, 2014). Winning teams from

Division I schools around the United States are invited to participate, and “seeded” or ranked

based on their records relative to other schools divided across four regions. The ranked teams in

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each region are organized into a single-elimination bracket, which pits lower-ranked teams

against higher-ranked teams (Figure 1). A loss leads to elimination from further participation in

the tournament (i.e. single-elimination). Each round of play yields progressive elimination of

teams; although 64 teams are initially invited to participate, the elimination of losing teams

winnows the field to the sixteen, eight, and four competing teams, followed by the final National

Championship game. We adapted this process to develop an online, rank-ordered, pair-sorting

method for nursing faculty and pre/post-doctoral scholars to vote on the school’s top research

priorities.

Given the popularity and general enthusiasm for the March Madness® competition, we felt that

important groundwork was already laid for launching an initiative to obtain faculty and student

feedback. A general outline of the process and timeline is shown in Figure 2, which was carried

out from March 3, 2014 to April 6, 2014. First, for week one blank posters and markers were

placed in a public lounge outside of faculty and student offices, and e-mails were sent

encouraging respondents to visit the lounge to answer the question, “What are the transformative

research priorities for the nation’s health in the next three to five years?” Incentives were

provided in the form of snacks and beverages in the lounge and placing basketball-themed

balloons and posters throughout the school increased visibility. Research committee members

staffed the lounge throughout the day to engage visiting faculty and students in meaningful

dialogues and to encourage written responses. Reminder e-mails with encouraging quotes and

feedback on the volume of responses received thus far were sent throughout the first week.

Faculty and students were also provided with the option of submitting their responses via e-mail,

if they were not able to be present in the school.

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At the end of the first week, research assistants photographed and transcribed verbatim the

responses that had been hand-written on the posters. One of the authors (K.M.B.) then condensed

the responses into emerging categories, preserving the original responses for review by the

Research Committee. Committee members and Research Center Directors then refined and

prioritized the final list of 32 statements, which were divided into four topical areas and paired

based on highest to lowest rankings within each quadrant (Figure 1) to create the following

week’s “bracket.” Using Qualtrics survey software (Qualtrics, 2014) all faculty and students

within the school were contacted by email to participate in week two, in which respondents

selected their top-ranking priority within each pair to advance the top research priorities for the

future. Participants were unaware of the rank-order and the paired items were presented

randomly, with higher ranked items sometimes appearing first, and sometimes appearing last. A

“wildcard” free response section was also provided, in order to capture any new ideas garnered

while participating in the survey.

To maintain momentum and enthusiasm, an initial “Top Sixteen” survey was released on

Monday and responses were required within 48 hours, to facilitate the release of the “Top Eight”

and “Top Four” surveys on Wednesday and Friday of the same week, respectively. Responses

were assigned a value of 1 if the first member of a pair was selected, and 2 if the other statement

was chosen. Built-in analytics in the Qualtrics software were used to obtain mean scores and

standard deviations for each response pair, with means less than 1.5 indicating support for the

first statement and scores greater than 1.5 demonstrating consensus for the second statement.

Two of the authors (K.M.B., M.A.Q.C.) again matched the highest scoring responses with the

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lowest scoring responses within each quadrant to form the next round’s survey. Responses at

every stage of the process were anonymous, although respondents were asked their role within

the school (i.e. faculty, doctoral student, post-doctoral fellow, etc.) in order to track overall

participation rates.

The top research priorities were used as the starting place for the next community conversation

that generated ideas for how the school could position itself to “compete” in these areas. Armed

with a list of nursing research priorities, the process was re-started in week three. Respondents

were asked a second question, “What do we need to do now to be positioned to compete in these

top game-changing research areas?” Blank posters and markers were again placed in a public

lounge outside of faculty and student offices, and a similar process of transcription and category

generation was followed. Once the 32 statements were finalized, a second set of brackets was

created and opened up for voting in week four. The process concluded after responses to the final

week four survey were tallied.

Findings

Over the course of a month the walls of the central lounge area were literally covered with ideas

big and small. There were 133 discrete statements written on the blank posters in response to the

week one question, “What are the transformative research priorities for the nation in the next

three to five years?” The responses included both short, bulleted points offered by individual

faculty and students, as well as paragraph length, typed statements from entire research centers.

All of the statements were consolidated into 32 categories, which broadly reflected themes such

as care delivery models, new science, vulnerable populations and community-based care. The

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Research Center Directors and the Research Committee rank-ordered the 32 categories in order

of importance. The categories were then paired based on highest and lowest rankings per

quadrant for the purposes of week two voting.

After the first week, 103 completed surveys were submitted for the “Top Sixteen” voting. Of the

100 respondents who provided their “player association,” or role within the school, the majority

of respondents reported being standing faculty or doctoral students. The survey methodology

elicited feedback from 71% of standing and research/practice faulty, and 51% of doctoral

students. Item scores ranged from 1.18 (SD 0.38), indicating overall support for the first member

of a given pair, to 1.75 (SD 0.44), reflecting a consensus vote for the second statement.

In addition to the 16 categories that were selected to move on to the next round based on their

scores, four of the original 32 statements were separated by a single digit vote, so they were

moved into the next round of voting. There were also two wild-card statements that were not

captured by the original 32 statements, so they were brought forward as well.

In total, the second phase of week two voting included 22 statements arranged into eleven pairs.

There were 109 completed surveys submitted for the “Top Eight” voting. Almost all of the

respondents provided their “player association,” and the response levels by position were similar

to the first survey. In fact, there appeared to be slightly higher participation among standing

faculty and research/practice faculty, with response rates of 81% and 86%, respectively (Table 2).

Over half (57%) of the school’s doctoral students voted as well. Item scores ranged from 1.32

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(SD 0.38) to 1.83 (SD 0.44). Due to close ties among several statements and a lack of score

variability, the list of priority research areas was finalized with eight topics (Table 1).

To re-start the idea generation process in week three, there were 80 discrete statements written

on blank posters in response to the question, “What do we need to do now to be positioned to

compete in these top game-changing research areas?” The responses again included both short,

bulleted points offered by individual faculty and students, as well as lengthier, typed statements

and clips from newspaper articles with highlighted quotes. All of the statements were

consolidated into 32 categories, which broadly reflected themes such as building alternative

research partnerships, realigning resources, optimizing organizational structure and focusing on

innovation. The categories were again paired for the purposes of survey voting, after the

Research Center Directors and Research Committee members rank-ordered the statements in

order of importance.

There were 106 completed surveys submitted during the first phase of week four voting. As in

previous rounds, the majority of respondents were standing faculty or doctoral students. There

was a 100% response rate among research/practice faculty, and standing faculty responses were

maintained at 71%. Item scores ranged from 1.14 (SD 0.35) to 1.67 (SD 0.47). In addition to the

16 categories that were selected to move on to the next round based on their scores, four of the

original 32 statements were separated by a single digit vote, so they were moved into the next

round of voting. There were also six wild-card statements that were brought forward.

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In total, the second phase of week four voting included 26 statements arranged into thirteen pairs.

There were 103 completed surveys submitted during this voting period. The response levels by

position were similar to the first phase of voting. In fact, there appeared to be slightly higher

participation among standing faculty and doctoral students, with response rates of 76% and 51%,

respectively. There appeared to be lower participation by the research/practice faculty during this

phase of voting. Item scores ranged from 1.28 (SD 0.30) to 1.80 (SD 0.40). As in week two, due

to close ties among several statements, the list of priority actions was finalized with eight topics

(Table 1).

Discussion and Recommendations

Using the framework of competitive, tournament-style bracketing provided a novel and exciting

approach to soliciting feedback from faculty and students throughout the school regarding our

strategic plan for research over the next five years. This was evidenced by the number of

responses recorded during the free response periods, as well as the high and sustained level of

response rates throughout the two rounds of repeated surveys: among standing faculty, response

rates never dropped below 71%. Previous initiatives for developing research priorities in schools

of nursing have seen lower response rates, ranging from 25% (Peirce, Cook & Larson, 2004) to

58% (Kulage et al., 2014). Respondents expressed their enthusiasm for the process through

anonymous comments on the Qualtrics surveys, and there was a general excitement throughout

the school for the month that the initiative was being carried out. Furthermore, the process

provided a quantifiable way to achieve consensus around a research agenda, while preserving the

anonymity of respondents.

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The entire initiative took place over the course of a single month. As such, it required a fast

turnaround from both the organizers and respondents. An entire week was devoted to each free

response period, but several phases of voting were compressed into the following week. This

approach strongly contrasts with those reported by other, similar institutions, where workgroups

may engage in identifying goals and developing recommendations by holding repeated meetings

over several months, and the entire process might take up to 18 months (Kulage et al., 2014). It

was felt that the fast turnaround provided by our approach helped to maintain high energy and

enthusiasm among participants, which in turn drove the sustained levels of involvement that

were achieved.

Humorous and informative emails were sent frequently by the Chair of the Research Committee

to keep the nursing research community informed and engaged. Additionally Research

Committee members and Center Directors encouraged participation among their colleagues over

the course of the month. Many attempts were made throughout the process of organizing the

strategic planning process to ease the burden of participation. By providing numerous avenues

for registering feedback during the free response periods (i.e. e-mail, writing on posters, and wild

card responses), as well as anonymous survey responses, this approach ensured that a large

diversity of opinions were captured. Furthermore, the free responses made it possible to identify

areas of high interest early in the process.

This approach was not without limitations. Although the intention of the single-elimination

March Madness® model is to hone each of the quadrants down to the four top responses, it did

not seem appropriate statistically to choose one statement over another in cases where they

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differed by a single vote. It was sometimes difficult to pair statements across quadrants when

they seemed radically different, and many respondents reported wanting to vote within a given

quadrant, rather than across them. However, a hidden benefit of the approach was that it forced

respondents to think about research priorities and actions outside of their own personal areas of

interest, and to instead think more globally about what would be strategic for the entire

community. As with any survey methodology, anonymous reporting of ideas during the free

response period may have biased responses toward more vocal individuals, leading some ideas to

get lost. Finally, although it was felt overall that the bracketing approach stimulated a great deal

of interest and a high level of involvement, gradual attrition was noted towards the end of the

month. Leadership by dedicated and energetic individuals was needed to maintain momentum

throughout the process.

Conclusions

In this paper, we have presented our experience with a quick and engaging way to solicit

feedback from all members of the research community in the process of developing a new

research agenda. Using the name recognition of NCAA basketball’s March Madness®, we were

able to encourage high levels of participation by faculty, doctoral students, and post-doctoral

fellows in not only developing a consensus around eight broad lines of inquiry, but also offering

tangible recommendations for accomplishing those goals within the next five years. This

approach was lower cost than bringing in external consultants, and it yielded a high rate of return.

The resulting Collaborative Report will be used as the basis for further strategic planning by our

new dean of nursing. The March Madness® executive report on research and action priorities

was distributed to the Faculty Senate and our new Dean in the Summer of 2014. The report will

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serve as a starting place for our next faculty retreat, and task forces are already addressing some

of the action items. Additionally, the report is a key document forming our School’s FY 2015-

2020 strategic plan. It is our hope that the broad consensus achieved by engaging stakeholders at

different levels of the research process will enable rapid and enthusiastic implementation of

recommended actions. Other schools seeking to evaluate their research enterprise and align their

science with national priorities could easily replicate this approach.

Acknowledgements The FY 2013-2014 Research Committee included Martha A.Q. Curley (Chair), Kathryn Bowles

(Co-Chair), Alison Buttenheim, Karen Hirschman, Yvonne Paterson, Olga Jarrín, and Danielle

Altares Sarik. The Research Center Directors were Linda Aiken, Kathryn Bowles, Julie Fairman,

Loretta Sweet Jemmott, Mary Naylor, Barbara Riegel, and Lynn Sommers. We appreciate the

creative efforts of Ms. Shaunna Lee, the production efforts of Mr. Glen Thomas, and the

pragmatic support provided by Ms. Laila Balkhi.

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technique. Journal of Advanced Nursing, 32(4), 1008-1015.

Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health.

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advancing-health.aspx

Kulage, K.M., Ardizzone, L., Enlow, W., Hickey, K., Jeon, C., Kearney, J., Schnall, R., &

Larson, E.L. (2013). Refocusing research priorities in schools of nursing. Journal of

Professional Nursing, 29(4), 191-6. doi:10.1016/j.profnurs.2012.10.005

Luthra, V. (2007). BusinessDictionary.com Accessed December 16, 2014.

http://www.businessdictionary.com/definition/strategic-planning.html

Milone-Nuzzo, P., & Lancaster, J. (2004). Looking through the right end of the telescope:

Creating a focused vision for a school of nursing. Journal of Nursing Education, 43(11),

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Mizrahi, T. & Davis, L.E. (2008). Encyclopedia of Social Work (20 ed.) Oxford University Press.

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National Collegiate Athletic Association (2014). March Madness. Retrieved from

http://www.ncaa.com/march-madness

National Institute of Nursing Research (2011). Bringing Science to Life: NINR Strategic Plan.

Retrieved from https://www.ninr.nih.gov/sites/www.ninr.nih.gov/files/ninr-strategic-

plan-2011.pdf

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Patient Centered Outcomes Research Institute (2013). The PCORI Methodology Report.

November, 2013. Retrieved from http://www.pcori.org/assets/2013/11/PCORI-

Methodology-Report.pdf

Peirce, A., Cook, S., & Larson, E. (2004). Focusing research priorities in schools of nursing.

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Figure 1. Sample tournament bracket

Adapted from the National Collegiate Athletic Association’s (NCAA) Division I Basketball Championship bracketing system (NCAA, 2014).

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Figure 2. Tournament-themed approach to bracketing research priority rankings

Week 1

• Question: "What are the transformative research priorities for the nation in the next 3-5 years?"• Free text responses reduced to 32 statements• 32 statements were rank-ordered, placed into 4 quadrants then paired within quadrant

Week 2

• Two successive rounds of voting• 32 statements in "Top Sixteen" - 12 eliminated, 2 wild cards added• 22 statements in "Top Eight" - 14 statements eliminated

Week 3

• Question: "What do we need to do now to be positioned to compete in these top game-changing research areas?"• Free text responses reduced to 32 statements• 32 statements were rank-ordered, placed into 4 quadrants then paired within quadrant

Week 4

• Two successive rounds of voting• 32 statements in "Top Sixteen" - 12 eliminated, 6 wild cards added• 26 statements in "Top Eight" - 18 statements eliminated

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Table 1. List of final research and action priorities

Top Research Priorities Top Action Priorities • Develop, implement, and evaluate novel

behavioral interventions that improve health and reduce risk for individuals and populations.

• Engage communities to build healthy and sustainable environments.

• Develop and test interventions and deploy policies that reduce health disparities and promote health equity for all.

• Re-engineer care delivery to maximize quality and manage finite resources.

• Identify health outcomes most important to patients with the highest burden of disease, and measure the quality and success of our healthcare interventions and systems on those outcomes.

• Speed the pace of dissemination and implementation of evidence-based practices in care settings and communities.

• Harness innovative technologies to improve the health of individuals and communities.

• Promote inter-professional research teams to develop innovative solutions for individual and population-based health.

• Build a Biostatistics-Evaluation-Collaboration-Consultation-Analysis lab to promote stellar research design and analysis.

• Establish innovative research methodologies using health technology, telehealth and mobile applications that lead to behavioral change, symptom management, community wellness, and healthcare access.

• Re-think the current research centers; focus on the future and consider combining and/or eliminating centers.

• Examine how well the expertise of our current faculty matches both public and private funders’ priorities, then hire deficits that will leverage us for the future.

• Strengthen pragmatic support provided to investigators, unburdening them so that they will jump at an opportunity to expand research portfolio.

• Re-think our structure to better integrate teaching and research missions, and facilitate research productivity.

• Resource the research centers so that each includes a high level administrator, who is a grant seeker, grant writer, regulatory expert, and financier.

• Partner with city, state, and federal government organizations to increase dissemination and public health impact.

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Highlights

• Use of a tournament-style bracketing approach facilitates strategic planning

• Method is low-cost and yields rapid responses

• Innovative approach fosters enthusiasm and high levels of participation