There is widespread agreement among members of the healthcare community and the public it serves that the transformation of healthcare is a top social priority in the United States. Supported by a series of pivotal reports addressing medical errors, patient care quality, and education for health professionals, the 2003 Institute of Medicine (IOM) document cited five core competencies required by nurses, physicians, and other health professionals practicing twenty-first-century healthcare. These competencies included: patient-centered care delivery, the ability to work in multidisciplinary teams, evidence-based practice, a strong focus on quality improvement, and the use of information technologies. Given the currently limited level of competencies in these areas, and the apparent failure of the educational system to prepare healthcare professionals for this reality, the need to focus on new technologies in healthcare education and service has never been greater.
This OJIN topic provides key insights on three essential aspects of the use of technology in nursing. These include a crucial discussion of the concept of innovation, along with exemplars from the field; a description of the technology implementation process in a practice setting, along with detailed examples; and an exploration of technological solutions for the age-old educational challenge of providing nursing students with enough of the right kinds of clinical experiences. Follow along as these authors take you on an inspiring journey of new technology, the innovation process that creates it, and real-life examples of the implementation trials, tribulations, and successes that technological applications bring to nursing and healthcare.
The first article by Blakeney, Carleton, Coakley, and McCarthy explores the concepts of innovation and the innovative process, offering a model for understanding this fundamental process. Focusing on the three interdependent elements of the innovation process, namely the innovation itself, the creativity needed and generated by individuals and teams during the process, and the environment that sustains the creative process, the authors note that innovation must be fostered in order to exist and flourish. Two types of innovations are identified, including “user-driven” innovations that usually involve improving existing products, and innovations that are “disruptive” or transformative in nature. The concept of creativity is examined, examples of each type of innovation are provided, and the all-important environmental characteristics that foster innovation are discussed. In addition, specific innovative methods are detailed, and examples of their use in healthcare are highlighted. Interesting examples of organizational support structures that foster nursing innovations are also described. The authors provide a sound and instructive foundation for the articles that follow.
The critical need for early nursing involvement in the introduction of a new technology in the patient care environment is emphasized by Weckman and Janzen in the second article. The authors point out that while technology specialists have expertise in their own field, they must work closely with nurses who are the content experts in patient care processes if the new technology is to succeed. Using an organizational case study of implementing a bar-coding system, the authors describe nurses’ value and central role in the design, implementation, evaluation, and ultimate success of this new product in a healthcare setting. Detailed descriptions of the Bar Code Medication Administration (BCMA) system, early design attempts, and specific examples of system flaws, failures, and remedies are also covered. This article provides a real-world look at the often bumpy road from innovation to implementation.
In the third article of this issue, Galloway views simulation techniques as a vital educational link between didactic content and sound clinical experience. The benefits of simulation in education include the provision of a wider variety of experiences than the learner might otherwise have had, and provision of experiences that pose no risk to the patients. Simulation is a learner-centric experience that allows learners to draw on their multiple intelligences rather than limiting them to memorization and linguistic intelligence. Galloway defines simulation and provides a useful typology as she describes six types of simulation. The various venues in which simulation is applied in nursing education and practice are explored, including undergraduate and continuing education settings. Examples of simulation methods used in a variety of university and clinical settings are described, and the benefits of simulation for interdisciplinary teamwork and competency validation are highlighted. The author makes the important point that due to increased patient acuity and patient safety concerns, it is not enough for nurses to simply remain at the advanced beginner level of expertise in today’s healthcare organizations. Current care complexity dictates the need for nurses to continuously work to reach the expert level of competence, a level that requires considerable clinical experience. Galloway cautions, however, that the sophistication of current simulators is still best suited for use with the novice, advanced beginner, and competent-level staff rather than the expert nurse. The knowledge, skills, and attitudes required for simulation faculty are also discussed, and key simulation resources are provided in this useful state-of-the-art overview.
The three articles in this topic have initiated a formal dialogue in OJIN on innovation and implementation associated with nursing technology. The word dialogue comes from the Greek “dia” (through) and “logos” (word or meaning), thus suggesting a free flow of meaning. Continuing this dialogue will necessarily involve future discussions about innovations in care delivery services, models designed to improve the efficacy and safety of patient care, and the wealth of innovative products that await us. The role of nursing leadership and in fact, all nurses, in creating and sustaining the personal and professional ability to innovate is also a critical conversation for our discipline. Estrin (2009) has observed that “Innovation is not optional.” There is urgency in this reality proposition. Innovation and its resultant technologies, whether product or service driven, is the key to our future, determining whether or not we will survive or thrive as individuals, as a profession, as a society, and as humankind. The journal editors encourage you to join this important dialogue by writing a Letter to the Editor or submitting a manuscript that will further this dialogue regarding innovation and implementation related to nursing technology, a dialogue that is necessary for our personal and professional future.
Holly A. De Groot, PhD, RN, FAAN
Internationally recognized for her work in nursing and healthcare, Dr. Holly De Groot is founder and Chief Executive Officer of Catalyst Systems. She leads Catalyst in its mission to assist healthcare organizations in attaining a strong evidence base for staffing, care delivery systems, professional practice, and work-environment-related decisions. She has held a variety of staff, management, administrative, education, and research positions during her more than 30 years of experience in nursing. Her areas of expertise include innovations in evidence-based staffing, workload measurement, patient classification/acuity systems, care delivery system evaluation, work environment, financial management, healthcare technology, vision development, innovation, leadership, staffing legislation, and regulation.
Article published May 31, 2009
Estrin, J. (2009) Closing the Innovation gap. New York: McGraw-Hill.