DNP education can change how clinicians interpret recurring problems. Patient care still occurs one encounter at a time, but repeated problems can raise a broader question: Is something in the surrounding system contributing to what keeps happening?
A medication may be prescribed appropriately and never obtained. A referral may be entered correctly and fail before follow-up occurs. A policy may reflect current evidence while actual practice varies across clinicians. A workflow may solve a problem for one department while creating delays somewhere else. These situations require clinical judgment, but they may also require examination of patterns, evidence, processes, and outcomes.
The 2026 AACN Essentials identify systems-based practice, scholarship, and quality and safety among the domains of professional nursing education, with advanced-level competencies that include evaluating systems, translating evidence, and contributing to improvement (American Association of Colleges of Nursing [AACN], 2026). Those competencies provide a structured way to move from noticing a recurring problem to determining whether it warrants closer investigation.
Recognize the Pattern
Healthcare produces recurring frustrations that are easy to notice and harder to define. A specimen may need to be recollected, patients may return because follow-up did not occur, or a referral process may repeatedly fail at the same point. During clinical care, the immediate priority is usually to address the patient’s needs and keep care moving. Improvement work begins when repeated observations are examined as a possible pattern.
That requires more precise questions. How often does the problem occur? Where in the process does it happen? Who is affected? What consequences follow? Are delays, additional work, safety concerns, costs, or poorer outcomes involved? Are data already available that describe the issue?
A broad concern such as poor follow-up provides little direction. A more clearly defined pattern involving a specific population, setting, process, and measurable consequence creates a stronger basis for investigation. Recognizing the pattern is a starting point for inquiry, not yet a project plan or proposed solution.
Define the Problem With Data
Observation can identify a possible problem, but measurement helps determine whether the pattern exists and whether a change produces improvement. IHI describes measurement as central to answering the Model for Improvement question, “How will we know that a change is an improvement?” and recommends selecting measures that provide useful information for learning rather than collecting data without a clear purpose (Institute for Healthcare Improvement [IHI], n.d.-a).
Improvement work commonly uses outcome, process, and balancing measures. Outcome measures examine the result of interest, process measures assess whether the steps expected to produce that result are occurring, and balancing measures examine whether a change creates problems elsewhere in the system (IHI, n.d.-a).
| Type of measure | What it helps determine |
|---|---|
| Process measure | Whether the steps expected to produce improvement are occurring |
| Outcome measure | Whether the clinical or system result the project was intended to influence changed |
| Balancing measure | Whether improvement in one area created an important problem elsewhere |
Suppose a clinic creates a follow-up pathway for patients with newly identified hypertension. The percentage of eligible patients referred could serve as a process measure, while completion of follow-up within a defined period could serve as an outcome measure. Increased workload or excessive demand on the receiving service might function as a balancing measure.
Measurement should correspond to the problem and the change being evaluated. Data are most useful when they help determine whether the process is functioning, whether the intended result is changing, and whether unintended effects are emerging (IHI, n.d.-a).
Let the Evidence Reshape the Idea
Recognizing a problem does not establish which intervention should follow. A workflow may feel inefficient without producing a meaningful problem, while a longstanding practice may remain supported by current evidence. An intervention that works in one setting may also require careful consideration before being applied to a different population or clinical environment.
Evidence appraisal helps determine what is already known before resources are committed to changing practice. AACN describes advanced nursing scholarship as including the synthesis, translation, application, and dissemination of knowledge to improve health and healthcare (AACN, 2026). Methodological quality also affects how confidently individual studies should influence practice. Greenhalgh (1997) emphasizes examining study methods, population, measurement, analysis, and applicability before using published findings to support practice decisions.
The literature may change the original understanding of the problem. Evidence may show that a proposed intervention has limited support, that another approach has stronger evidence, or that the initial explanation for the problem was incomplete. Allowing the evidence to reshape the idea is part of the work rather than a failure of the original proposal.
Fit the Change Into the Real Workflow
An evidence-supported intervention still has to function within an existing healthcare system. A new process may affect staffing, documentation, available resources, professional responsibilities, patient access, and the work performed by other departments. Understanding those dependencies is part of determining whether a change can function in practice.
AHRQ describes workflow mapping as a quality-improvement method for understanding how work is currently performed, clarifying team responsibilities, identifying opportunities for redesign, and integrating evidence into practice procedures (Knox & Brach, 2018). Mapping the actual process can reveal gaps that are difficult to see when a proposed change is considered only at the level of policy or clinical rationale.
Consider a follow-up intervention after discharge. Evidence may support timely contact, but the local system still has to determine who qualifies, who identifies eligible patients, how the referral occurs, what information is transferred, who assumes responsibility afterward, and what happens when contact is unsuccessful. A breakdown at any point may prevent the intervention from reaching the intended patient.
The people who perform different parts of the work can help identify these dependencies. IHI recommends including team members who understand the processes being changed because they contribute perspectives about how the system functions and how a proposed change may affect other parts of it (IHI, n.d.-b). Frontline clinicians and other stakeholders may identify barriers or unintended consequences that are less apparent from outside the workflow.
Measure Whether Anything Actually Improved
Introducing a new process establishes that something changed, but measurement is needed to determine whether the intended improvement occurred. IHI places measurement at the center of improvement work because teams need evidence that a specific change is producing the desired effect (IHI, n.d.-a).
A project may have a sound clinical rationale and still produce little change in the intended outcome. Eligible patients may not receive the intervention, different clinicians may use it inconsistently, or the intervention may address only one part of a more complex problem. Process measures can help determine whether the intervention was actually delivered, while outcome measures show whether the result of interest changed. Balancing measures can identify important consequences elsewhere in the system (IHI, n.d.-a).
If few eligible patients receive an intervention, the workflow or implementation process deserves examination before concluding that the intervention itself failed. If the process functions consistently and the intended outcome remains unchanged, the intervention, assumptions behind the change, outcome selection, or local context may need reconsideration. Improvement work becomes more informative when findings are allowed to support continuation, modification, additional testing, or discontinuation rather than treating implementation itself as proof of success.
From Recurring Problem to Systems Thinking
DNP education provides a structured way to move from noticing recurring frustrations to examining them as potential practice problems. A pattern becomes more useful when it can be defined clearly, examined with appropriate data, compared with the evidence, understood within the surrounding workflow, and evaluated after a change is introduced (AACN, 2026).
This approach connects individual clinical encounters with systems-based practice without losing sight of either. Clinicians still need to solve the immediate problem in front of them. When similar problems recur, systems thinking creates an opportunity to ask whether something upstream, downstream, or within the process itself deserves closer examination.
That ability extends beyond the DNP project. Recognizing patterns, testing assumptions against evidence, understanding how work actually occurs, and measuring whether change produces improvement are skills that support ongoing practice improvement throughout an advanced nursing career (AACN, 2026).
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References
American Association of Colleges of Nursing. (2026). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2026.pdf
Greenhalgh, T. (1997). How to read a paper: Assessing the methodological quality of published papers. BMJ, 315(7103), 305–308. https://doi.org/10.1136/bmj.315.7103.305
Institute for Healthcare Improvement. (n.d.-a). How to improve: Model for Improvement: Establishing measures. Retrieved August 17, 2026, from https://www.ihi.org/library/model-for-improvement/establishing-measures
Institute for Healthcare Improvement. (n.d.-b). How to improve: Model for Improvement: Forming the team. Retrieved August 17, 2026, from https://www.ihi.org/library/model-for-improvement/forming-team
Knox, L., & Brach, C. (2018, October). How to map workflows in health care settings. Agency for Healthcare Research and Quality. https://www.ahrq.gov/evidencenow/tools/workflow-mapping.html