NU823 Unit 10 Dissemination Reflection Example

The Number I Did Not Have: A Dissemination Reflection on Writing One Foot Exam Project for a Committee, a Journal, a Poster Crowd and Two Officers, and Why the Officers Were the Hardest Audience

[Student Name]

Purdue University Global

NU823: DNP Project Dissemination

Unit 10 Dissemination Reflection

[Instructor Name]

[Date]

The project, health center and audiences are composite; figures are bracketed and the officers appear by role only.

Four Audiences in the Order I Met Them

I wrote for the project committee first. The final report was long, close to sixty pages, and the difficulty was not what to say but how to make chapters written in three different terms read as one document. I had the material; I needed the discipline to cut three introductions to neuropathy down to one and to move my deviation memo into the methods chapter where it belonged. That was work, but it was work I knew how to do.

The journal manuscript came next, and SQUIRE 2.0 forced a rewrite I had not expected. I had described how we knew the exam was being done and what the exam was meant to change in the same section. The guideline keeps how the team checked delivery apart from what the change was meant to move (Ogrinc et al., 2016), and once I separated them, my methods became clearer and my results section shorter. The journal wanted structure, and the guideline supplied it.

The poster was the first time I felt resistance. Splitting the yearly exam rate into layers by source made my result look smaller: the outside podiatry reports were plainly part of the rise. I nearly drew a single line. A classmate at the practice poster session stopped at the board, looked at the layers for a long time, and said it was the most believable chart in the room. Honesty at a glance took nerve, but it required no evidence I did not already have. Imagery is what draws people to a poster in the first place (Rowe & Ilic, 2009), and the layered chart was the image they stopped for.

The Hardest Audience

The officers were different. I sent the executive summary to the chief medical officer and the chief operating officer, and the chief operating officer replied with one question: "Do the exams pay for themselves?"

I did not know. I had the cost side: roughly [three] added rooming minutes for each exam and about $[850] a year in supplies. I had the published terms of several value-based contracts that reward a diabetic foot exam measure, and the maximum each might pay. What I did not have was the number the officer actually wanted, the net amount the health center would receive, because that depends on the payer mix, on how each contract scores the measure and on the size of the attributed population in each one. Those figures sit with a revenue cycle team I had never met.

The officer's question was fair and simple, and the project had been designed without ever asking it.

I was tempted. I could have multiplied the contract maximums by the share of patients each payer covered, using a rough estimate of the mix, and presented the result as expected revenue. The number would have looked precise, and it would have answered the question. It would also have been the figure most likely to be checked by a finance office and found wrong. I labeled the contract figure as a maximum, said plainly that actual payment depended on information I could not see, and suggested that the revenue team calculate it.

What that decision gained was credibility. The chief operating officer forwarded the summary to the revenue cycle director with a note asking for the calculation, which suggests the page was taken seriously. What it cost was persuasive force. A summary that ends with "we do not know yet" asks leaders to fund something on trust, and the decision on rooming time was deferred to the next budget meeting rather than made that week.

What I Would Do Sooner

Advice on dissemination urges designing for the audience from the start rather than translating results at the end (Brownson et al., 2018), and I understand that advice now in a way I did not when I read it. Three of my four audiences wanted things my project produced as a matter of course. The fourth wanted something the project would have had to plan for from the first week. On another project I would meet the finance team during implementation, ask what figure the officers would need to keep the change going, and collect it alongside the fidelity data. I would also ask the officers, before writing anything, what decision they expected to make and what they would need to make it.

What Remains Open

The revenue figure is still being calculated. I do not know whether rooming time will be protected after I leave, and the sustainability plan's first owner, the clinic manager, will learn that before I do.

References

Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102-111. https://doi.org/10.1097/PHH.0000000000000673

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Rowe, N., & Ilic, D. (2009). What impact do posters have on academic knowledge transfer? A pilot survey on author attitudes and experiences. BMC Medical Education, 9, Article 71. https://doi.org/10.1186/1472-6920-9-71