Trail Pack: INQUIRE: A Navigation Model

INQUIRE—Your Project Compass to Choosing QI, EBP, Innovation, or Research

Alyson Keen,  PhD, RN, ACNS-BC
Tiffany Rader, MSN, RN, AGCNS-BC, CMSRN, FCNS

Writer’s Camp Guest Counselor

Abstract

Welcome to our monthly Trail Pack! This month we have an interesting article on the INQUIRE approach for choosing a problem solving method in health care. If you are new to Trail Packs, they are multi-faceted learning experiences bringing together original research, a podcast/video, and a concise article written exclusively for Writer’s Camp that summarizes the original article and highlights its key insights. Begin with the short article, and when your curiosity is sparked, follow the trail to the full research report. The accompanying podcast offers a personal touch and shares the story behind how the study developed plus implications for writing and publishing. If you would like to receive 2 contact hours for reading and watching, you can! Scroll all the way to the bottom of the page for details. I hope you find this format both engaging and valuable. I would love to hear your feedback; please share in the comments below. — Leslie H. Nicoll, Camp Director

Click here to read the article on the Nursing Care Quality website. The article has been made free for Writer’s Camp campers.

Keen A, Radecki B, Snyderman W, Rader T, Hemmelgarn A, Sierp A. INnovation, QUality Improvement, Research, and Evidence-based practice (INQUIRE): A navigation model for change and discovery: A navigation model for change and discovery. Journal of Nursing Care Quality. 2024;39(1):18-23. doi:10.1097/NCQ.0000000000000724

Listen to an interview podcast with Alyson and Tiffany:

Why the Spaghetti Method Is Not Effective for Problem-Solving

Based on the number of problems that we have to solve in healthcare, we should be excellent problem solvers, right? The reality is that we are often unsure of where to start and we typically end up throwing spaghetti at the wall hoping it will stick. As clinical nurse specialists in healthcare, we have seen the spaghetti method favored over established problem-solving methods. Why is this you might ask? The temptation of a brainstorming session is far more exciting than strategically investigating the problem and available solutions. Our gut reaction is to discuss the issue quickly and identify the best collective ideas that we can think of to attack the problem today. Brainstorming sessions typically begin with a broad problem and end with an action plan with a laundry list of changes to implement. The result? Implementation of a change poorly aligned with the specific problem, lack of outcome improvement, and discouraged team members. In an attempt to solve the problem, we have now caused chaos and exhausted our resources in the process.

Where Do I Even Begin?

Now that we have shut down the spaghetti method, we arrive at our next roadblock. How do we decide among problem-solving methods such as innovation, quality improvement (QI), research, and evidence-based practice (EBP)? There are established methods such as Plan-Do-Study-Act for QI and the Seven Steps of EBP.1,2 Unfortunately, we often do not have clarity on what method to use based on the specific problem we are trying to solve. We become comfortable in health care using the same problem-solving methods repeatedly that we are most familiar with to arrive at a solution quickly. We can use QI to improve processes, but we risk becoming highly reliable delivering care that is not evidence based if this is our “go to” method. Similarly, if we are applying EBP methods to generate a new solution, we end up searching for evidence rather than designing something new. We need a decision-making pathway to select the best problem-solving method that the matches project scope and solution availability. A clear pathway can help us make data-driven decisions as we work towards healthcare improvements.

Meet INQUIRE: A Clear Path from Question to Action

The INQUIRE (INnovation, QUality Improvement, Research, and Evidence-based practice) Model is a practical, step-by-step guide that can help us consistently match our identified trigger (problem, opportunity, challenge) to the right problem-solving method. Think of INQUIRE as your project compass. INQUIRE will keep you on the right path for your project by following defined steps:

  1. Identify the Trigger: What do you need to solve? Who will be impacted?
    • Goal: Define the project scope and available resources.
  2. Confirm/Create Demand: Is the trigger a priority for your department/organization?
    • Goal: Align with a priority or use an executive summary or SBAR (Situation, Background, Assessment, Recommendation) to create demand.3
  3. Study the Trigger: What information is available about your trigger?
    • Goal: Describe current state through exercises such as the 5 Why’s or Appreciative Inquiry.4,5
  4. Scan for Solutions: What is already working?
    • Goal: Identify potential solutions by reviewing articles, guidelines, or policies that match the trigger and current state.
  5. Determine if Sufficient Evidence/Established Practice is Available: Is there a known solution available?
    • Yes: Does solution involve a process change (QI) or practice change (EBP)?
    • No: Are we creating a new solution (innovation) or generating new knowledge (research)?
    • Goal: Select a problem-solving method(s)

INQUIRE provides us with a consistent process to follow in the project planning stage that leads us from question to action. After landing on a problem-solving method(s), we can connect with our organization-specific models/frameworks, such as Plan-Do-Study-Act (Taylor et al., 2014) for QI or the Seven Steps of EBP.1,2

INQUIRE Problem-Solving Methods Simplified

Now that we understand the INQUIRE steps, let’s break down each problem-solving method individually. We may need more than one method, so it is important to be clear on what project needs signal QI, EBP, innovation, and research. Take time to consider: What method(s) best meets my project need?

Implementation Pathway: We have identified a solution—now what? The implementation pathway involves integration of a new practice or process change. QI is the ideal method if we know what we need to do and need a process for how to do it. EBP is our method if we need a comprehensive review and synthesis of the literature to determine the best practice change to match our trigger. We can use these methods together to identify the best available evidence (EBP) and identify the process (QI) to implement the evidence into practice.

Innovation/Research Pathway: We can’t find a solution— where can we start? The innovation/research pathway involves creating a new solution or generating new knowledge related to our trigger. Innovation is the target method when a new solution is needed or the available solution does not apply to the environment or has previously failed.6  Research is needed when our intent is to generate new knowledge that is generalizable. We can use these methods together to generate a new solution (innovation) and test the solution to build on scientific knowledge (research).

INQUIRE In Action

We worked with a small group of practice leaders in our organization to try out the INQUIRE Model using common project scenarios. The 23 participants reported better accuracy selecting the right project method, better ability to scan for solutions, fewer missed project steps, and easier team building after using the model. Overall, the practice leaders perceived value in the model supporting project planning and early method identification.

Further evaluation is needed and this preliminary evaluation suggests potential for model usability in the clinical environment. Several leaders that participated in the evaluation reported continued model use as they lead projects and mentor others. Since publication, external organizations have requested permission to begin using INQUIRE to support method identification and resource allocation.

Test Your Project Compass: An INQUIRE Sprint

Now it is your turn to take INQUIRE for a test run. Think about a current or future trigger that you need to solve. Follow the prompts below to see where the compass leads you.

  1. Write down your trigger and why it is important for your department and/or organization.
  2. Complete a 10-minute assessment of the environment: What do clinicians or patients have to say about the trigger? What is causing the issue?
  3. Complete a 15-minute scan for solutions: Connect with a content expert; search for relevant articles, policies, and/or guidelines.
  4. Decide whether evidence is available (QI/EBP) or missing (Innovation/Research).
  5. Identify 3-5 core people that you need on your project team based on your selected problem-solving method.

The sprint exercise is a great way to practice using INQUIRE. Come back to this exercise as often as you need to connect your internal evidence (study the trigger) with external evidence (scan for solution) and arrive at a problem-solving method(s).

Conclusion: Charting Your Next Steps

We invite you to take your INQUIRE Sprint a step further by trying out the project worksheet or consultation navigator. You can find more information about the INQUIRE Model and Toolkit in the full article. Allow the INQUIRE Model to be your project compass and chart a successful path forward.

We can change lives in healthcare by improving the health and wellbeing of our patients and communities while preventing harm. It is time to evolve and leave the brainstorming and spaghetti throwing behind. Together, we can transform our problem-solving approach in healthcare into a one that is data-driven, impactful, and sustainable.

References

  1. Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Evidence-based practice: step by step: the seven steps of evidence-based practice. The American Journal of Nursing. 2010;110(1):51-53. doi:10.1097/01.NAJ.0000366056.06605.d2
  2. Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety. 2014;23(4):290-298. doi:10.1136/bmjqs-2013-001862
  3. Institute for Healthcare Improvement. SBAR Tool: Situation-Background-Assessment-Recommendation. Accessed April 29, 2026. https://www.ihi.org/library/tools/sbar-tool-situation-background-assessment-recommendation
  4. Lean Enterprise Institute. Clarifying the “5 Whys” Problem-Solving Method. Published July 19, 2018. Accessed April 29, 2026. https://www.youtube.com/watch?v=SrlYkx41wEE
  5. Cooperrider Center. Appreciative Inquiry at Champlain College. Published June 3, 2022. Accessed April 29, 2026. https://appreciativeinquiry.champlain.edu/
  6. Holden RJ, Boustani MA, Azar J. Agile Innovation to transform healthcare: innovating in complex adaptive systems is an everyday process, not a light bulb event. BMJ Innovations. 2021;a7(2):499-505. doi:10.1136/bmjinnov-2020-000574

Author: Alyson Keen

Reviewed and Edited by: Leslie H. Nicoll

Copyright © 2026 Writer’s Camp Alyson Keen and Tiffany Rader. CC-BY-ND 4.0

Citation: Keen A. & Rader, T. INQUIRE—Your project compass to choosing QI, EBP, Innovation, or Research. The Writer’s Camp Journal, 2(2):6. doi: 10.5281/zenodo.19896031

About the Authors: Alyson Keen, PhD, RN, ACNS-BC, is a Nurse Scientist at Indiana University Health’s Adult Academic Health Center, where she leads efforts to translate evidence into practice and strengthen infrastructure supporting nursing research, evidence-based practice (EBP), and innovation.

With more than 15 years at IU Health and a background as an Adult Clinical Nurse Specialist, she focuses on implementation science, program development, and integrating research into clinical care. She collaborates with nurses and interprofessional teams to design and evaluate initiatives that improve patient outcomes and advance nursing practice.

Alyson earned her PhD from the Indiana University School of Nursing, with research on patient activation in opioid use disorder. Her work has been widely disseminated through publications and presentations, and she is committed to advancing nursing science and using implementation science to drive sustainable change in healthcare.

Tiffany Rader, MSN, RN, AGCNS-BC, CMSRN, FCNS is the Manager of Nursing Practice and Quality at Indiana University Health Adult Academic Health Center in Indianapolis, Indiana. In this role, she leads a team of 17 Clinical Nurse Specialists, driving measurable improvements in nurse-sensitive outcomes and strengthening the integration of evidence-based practice across clinical settings. Tiffany is deeply committed to advancing professional nursing practice through education, scholarship, and mentorship. She has shared her work through presentations and publications at the international, national, and local levels, including conferences hosted by Sigma, AMPATH Global Nursing Conference in Kenya, and national professional organizations. Her efforts support workforce development, role sustainability, and practice excellence, including contributions to the design and evaluation of a local advanced practice internship program and co-authorship of national resources supporting leadership pipeline development.

A dedicated mentor to advanced practice nurses and doctoral students, Tiffany is passionate about developing future nursing leaders and advancing the profession. In recognition of her contributions, she received the 2024 Mentor of the Year award from the National Association of Clinical Nurse Specialists. She has also served in professional leadership roles at the state level and remains focused on improving patient outcomes, supporting nursing excellence, and influencing practice across healthcare systems locally, nationally, and internationally.

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