Activity	Expertise	Example
Identification of problem in healthcare setting: poor outcomes for patients with a specific clinical condition; or inefficient health care practices.	Clinical knowledge Stakeholder engagement Diagnostic research	ICU patients with vascular catheters for renal replacement therapy are not allowed to mobilize for fear of safety or equipment disruption despite evidence that mobilization improves health outcomes.
Identify evidence based recommendations for addressing poor outcomes.	Evidence-based practice	Recommendations were sought by clinical team but not identified.
If no clear evidence based recommendations, start defining them.	Evidence-based practice Stakeholder engagement Clinical knowledge	Local recommendations and procedures developed.
Review the evidence for interventions to address poor outcomes.	Evidence-based practice	No specific evidence found investigating whether it is safe for the patient and equipment to mobilize these patients.
If no evidence, start generating the evidence in local healthcare setting as a healthcare improvement research activity to address poor outcomes.	Lead and engage clinical team and health care setting. Prioritisation of clinical research (allocate time and resources away from clinical tasks) Specific skill set in conducting the research to determine the best way to address the poor outcomes.	Trial designed by clinical team in partnership with researchers to address this issue. Ethics approval gained and trial commenced on site.
Use in-house research findings to improve outcomes for patients and establish individuals, team and health care setting as leaders in clinical research for specific condition.	Clinical knowledge AND understanding of value of rigorous research.	Trial found no safety concerns for patients or equipment. Research published [18]. Local procedures changed in light of findings.