The COVID-19 pandemic continues to reveal unique patient needs and innovative approaches to patient-centered problem-solving. The COVID-19 pandemic continues to reveal unique patient needs and innovative approaches to patient-centered problem-solving. While COVID-19 treatment methods have been somewhat effective, there is scant evidence to support complete recovery and comprehensive health restoration (Esakandari et al., 2020). During the time of social isolation due to quarantine, alternate methods of patient access and care were required. This necessitated collaborative problem-solving activities, such as hackathons (Mevawala et al., 2021).

While a meeting of collaborative experts from disciplines such as engineering or software design to identity and propose solutions is not novel, the formal inclusion of nurses as content experts in a series of COVID-19 hackathons is less common. Nevertheless, registered nurses (RNs), nurse scientists, nurse academics, and nurse innovators who are founding members, board members, and participants of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders (SONSIEL) mentored competitors at two, three-day hackathons in May and June 2020. These events were sponsored by the Massachusetts Institute of Technology (MIT). To date, no reports of outcomes related to the inclusion of RNs with any level of education and certification and in any role (e.g., mentor, judge) at an interprofessional hackathon are found in the extant literature. This article adds participant perceptions of consulting nurses as content experts to the literature through discussion of the results of an investigator-developed survey.

Nurses as Content Experts

Nurses have conceived ideas and developed innovative solutions...since the inception of the nursing profession. Nurses have conceived ideas and developed innovative solutions designed to positively impact patient care, with intent and determination, since the inception of the nursing profession. The pandemic has revealed significant gaps in care that require creative and innovative problem-solving to direct meaningful change. The literature suggests that change cannot occur without readiness and cautions the innovator that change based solely on personal passion is infrequently successful (Price, 2006). Further, it is most beneficial to identify practice that is poised for change before suggesting innovation because the idea is more likely to be successful and may result in collective interest for colleagues to engage in meaningful collaboration. Such collaboration can result in clarity about the situations, problems, or needs, and in identification of additional information to better explicate actionable plans (Mevawala et al., 2021). As healthcare professionals, we are currently in a time requiring innovation, creativity, and change.

...it is most beneficial to identify practice that is poised for change before suggesting innovation because the idea is more likely to be successful...Nurses have historically steered innovation at clinical levels and continue to lead the charge toward patient-centered care. There are numerous examples of influential nurse leaders and innovators in the literature and current media pieces. While a comprehensive description of nurses who have developed innovative solutions is beyond the scope of this discussion, it is key to review a paper that discusses characteristics of nurses who tend to lead innovation (Hughes, 2006). Although not current, Hughes describes principles of innovation and characteristics of innovators which are all harmonious with the current state-of-the-art. It is clear that the reasons we innovate have not changed, nor have the motivations. However, patient/provider needs and the environment have significantly shifted during the COVID-19 pandemic.

Principles of Innovation

There are numerous examples of influential nurse leaders and innovators in the literature and current media pieces. Innovation begins only after comprehensive analyses of opportunities and further requires a supportive infrastructure that encourages creativity. Therefore, leadership is a crucial factor for successful nursing innovation. Note that an innovation is not necessarily new or untested but could be technology or other ideas that are used differently in a dissimilar environment or for a diverse purpose. Last, innovation is usually singularly focused on solving a problem rather than a comprehensive plan meant to solve all associated problems (McLeod et al., 2019).

Characteristics of Innovators

...leadership is a crucial factor for successful nursing innovation. Innovators tend to use old ideas to generate new ones by constantly assessing for new ideas; keeping successful ideas alive through communication and collaboration; and understanding how old ideas can be reused for more contemporary needs. The literature suggests that nurse innovators share high levels of tenacity and determination, are self-confident, and are conscientious (Hargadon & Sutton, 2000). Innovators are considered risk-takers by some (Yates, 2019), while others suggest innovation is less about risk and more about the design of practical solutions for specific problems (Hughes, 2006). Innovators are, therefore, often early adopters of practices and technologies.

Innovators are,...often early adopters of practices and technologies.More recently, researchers identified 57 examples of situations that could benefit from an innovative solution, and coded according to challenges. They then identified eight characteristics of nursing innovation (Joseph, Huber, Bair, Moorhead, & Hanrahan, 2019). Generally, the process of innovation begins when an assigned task or patient need causes thought about alternate ways to approach the problem. The authors offer eight characteristics that drive the need for a solution or progress (DePasse et al., 2014):

1. A challenge
2. Need for progress
3. Source of opportunity
4. Need for collaboration
5. Defining the innovation or solution
6. Managing barriers
7. Managing facilitators
8. Achieving a level of progress with the innovation

Joseph et al. (2019) described progress as synonymous with impact, including the creation of awareness and interest; momentum toward increased knowledge and commitment; adoption and actionable support; and evidence of integration and sustained use. Certainly, the process of innovation supported through laboratories, foundations, organizations, and private groups has resulted in numerous successful projects, start-ups, and stable businesses.

Environments and spaces that demonstrate significant successes in healthcare innovations include hackathon events.One such group stated they have developed a makerspace (Kouame, Logue, & Mears, 2019) where healthcare professionals work collaboratively and where no rank or hierarchy exists (Marshall, 2019). It is in these types of environments that innovators, participants, and healthcare professionals are provided the means, opportunity, and motivation to develop solutions for current healthcare problems (Fasolino, 2019). Environments and spaces that demonstrate significant successes in healthcare innovations include hackathon events.

Hackathons

To bridge the needs between patient and systems, many organizations and academic institutions offer hackathons (Angelidis et al., 2016; Ghouila et al., 2018; Groen & Calderhead, 2015; Lyndon et al., 2018; Walker & Ko, 2016; Wang, Roy, Barry, Chang, & Bhatt, 2018). The definitions and types of hackathons are diverse (Angelidis et al., 2016; Ghouila et al., 2018; Lyndon et al., 2018; Walker & Ko, 2016; Wang, Roy, Barry, Chang, & Bhatt, 2018), but they are typically considered time-limited design sprints that vary in length. Hackathons focus on opportunities to examine methods and systems and to reconstruct (i.e. hack) new and effective changes in patient care and system needs. To do so, nurses receive education and training in design thinking and the iterative process in nurse-driven innovation prior to and while participating in hackathons.

The definitions and types of hackathons are diverse...To inform nurses and support innovation, universities on the cutting edge offer courses in innovation (Cusson, Meehn, Bourgault, & Kelley, 2020) and design thinking (Ku & Lupton, 2020). Design thinking is differentiated from traditional problem-solving due to the requirement to deeply examine an identified problem before any solution is designed or implemented (Roddy & Polfuss, 2020). Because exploration occurs first, there is less threat of problem-solving based on innovator/designer assumptions and bias.

In the context of healthcare, this process results in patient-centric designs. Five steps organize the design thinking framework and underpin the innovation process (Clipper et al., 2019; Ku & Lupton, 2020). The goal is to identify the best solution based on collaboration and feedback with end-users and stakeholders. In the context of healthcare, this process results in patient-centric designs. The steps begin with an effort to empathize and understand the problem, which leads to definition of the problem. Then, it is possible to think collaboratively about the problem and potential solution(s), resulting in a concept that is demonstrable. Last, it is important to test the innovation in the intended population, to receive feedback, and then attend to iterative updates. The process is often cyclical as the innovators seek the most appropriate solution(s) to manage or eliminate the problem.

Iterative Process

Using the design thinking framework at hackathons and following through the iterative process often results in a fully informed solution for an identified problem. The next section of this article describes a survey to determine nurse-collaborator outcomes from two weekend events where innovators gathered into groups; defined problems; researched existing solutions; interviewed stakeholders and end users; developed solutions (or pivoted back to a step in the design thinking framework); hacked; gathered feedback; and iterated. The final pitches on the concluding days were presented with proof of concept models or working prototypes.

Methods

Two months after the hackathon concluded, and following IRB approval from Molloy College, an investigator-team designed a survey that was sent to all participants via the general announcement channel on SLACK, the communication platform used for the MIT events. Completion and submission of the survey constituted respondents’ consent to participate, per IRB. No participant identifiers were collected.

Study Design
We used a nonexperimental, descriptive survey design. The goal of the study was to describe and analyze outcomes related to the nurse/participant dyads at two MIT hackathon events.

This process required forward and backward progress through the model until a clear and tangible solution was learned.The hackathon process was described as several steps that included: identify the problem; break the problem down (into a clear understanding of the root cause); brainstorm for solutions; and iterate and improve. This process required forward and backward progress through the model until a clear and tangible solution was learned.

Study Population and Sample
The study population was persons who participated for any length of time in the MIT COVID-19 Challenge “Beat the Pandemic II” (held May 29-31, 2020) and “Latin America versus COVID-19” (held June 19-21, 2020) hackathons. Participants younger than 18 and unable to procure guardian consent or hackathon participants who did not have any experience or interaction with nurse experts during the event were excluded from participation in the survey. All other participants regardless of gender, race, ethnicity, disability, or country of origin were included.

The final 25-item survey required no more than five minutes for completion. It was disseminated though the SLACK platform to a convenience sample of all participants (n = 1,812) in the MIT COVID-19 Challenge hackathons.

Data Collection Instrument
Our study survey was co-developed by the investigators. Two screening questions determined participation eligibility by establishing age and confirmation of collaborative interactions with at least one RN during the hackathon. Questions on the survey were related to the iteration process described in the distributed hackathon materials (also described stepwise above).

The survey was implemented using skip logic. Questions related to demographics included age of the participant, gender, level of education, discipline, region of the world, and self-identified race/ethnicity. Participants were directed to check “all that apply” about the RN’s role with the hackathon participants (e.g., scientists, designers, engineers) in several ways. For example, roles included mentor (work with teams throughout the event); pitch mentor (mentor competitors in the process of pitching an idea to judges); judge (collaboratively decides on progress and/or award winning pitches); team lead (participate as a lead on a competitive team); or team member (collaborator on a team).

Likert-type questions assessed nurses’ contributions to the four areas of the hackathon process framework; the quality of interactions (4 questions); and the likelihood to engage with an RN in future hackathon events (4 questions). One question solicited three descriptors from the participants’ views of the nurses. Respondents were invited to add narrative suggestions, problems, or comments about interaction and collaboration with RNs.

Results

Participant Demographics
The total number of participants at two MIT hackathons was 1,812, from 88 countries. Of those, 692 participants (38.2%) were between the ages of 18-24; 667 (36.8%) between 25-34; 188 (10.4%) between 35-44; 86 (4.8%) between 45-54; 112 (6.2%) less than 18 years; 46 (2.5%) over the age of 55; and 20 (1.7%) preferred not to say while one (1) person did not respond. Preferred pronouns were identified as he (984; 54.3%); no preference/prefer not to say (30; 2%); she (770; 42.5%); they (14; 0.8%); and ze (6; 0.3%), with 8 (0.4%) participants identified as a “pronoun not listed.”

Primary and secondary background information was mainly represented by business/finance, followed by engineering (e.g., electrical, biological, chemical). Scientists and data engineers also participated. Other participants identified as designer; clinician (physician, nurse practitioner, physical therapist, emergency medical technician [EMT], nurse); health policy/law/regulatory; and patient/patient family. Others self-identified as software professional and writer/journalist. Further, 821 participants were professional/non-student, while 991 (54.6%) were students. 

Table. Demographic Data

Notes. Reported data are included in this table. N=13. Since there was a small number of nurses who interacted with a limited number of participants, we cannot say with certainty how many people in total they were able to reach during the events, nor do we have an accurate number of nurses who were present at those MIT events. Given this limitation the authors chose to focus on an exploratory approach to begin to understand how others perceive nurses at non-nurse led hackathons. This point of clarification can be used in text below where we offer sample size with percentages, i.e. 19(1%) .

The nursing role was represented by a substantially smaller number...The nursing role was represented by a substantially smaller number, with a total of 7 RNs who were available throughout the weekend to support innovation. RN roles were mainly identified as pitch mentors, but they also participated as team members, final pitch judges, and team leads. Out of 19 (1%) responses to the authors’ survey, 13 (0.07%) met the inclusion criteria. Given the exploratory descriptive nature of this article, the focus is on experience of others working with nurses, rather than the quantitative nature of the survey. The numbers generated here are purely to complement the qualitative aspect of this article.

Survey respondents self-reported that they were predominantly male, with diverse backgrounds including Caucasian, Asian, American Indian, African American, and South African Indian. Most respondents were between ages 18 and 34 years old (77%) and held a bachelor’s degree or higher (see Table).

Registered Nurse Participation
Responses from participants indicated their experience and/or interaction with RNs as positive...RNs mentored teams in the following roles: team mentor (n = 6; 37.5%), pitch mentor (n = 5; 31.3%), and team member (n = 3; 18.8%) during the hackathons. Of the 13 survey respondents, seven (53%) attended the “Beat the Pandemic II” event, five (38%) attended the “Latin America versus COVID-19” event, and one (0.07%) person attended both events. RN contributions were considered “very” or “extremely” valuable in the following areas: helping to identify the problem (n = 11; 84.6%); helping iterate and improve the solution (n = 11; 84.6%); helping brainstorm for solutions (n = 13; 100%); and helping to break down the problem (n = 11; 84.6%).

Participants rated the RNs’ abilities as an asset to the team and a valuable contributor (n = 12; 92.3%); as knowledgeable (n = 13; 100%); and as an effective communicator (n = 9; 69%) as “very” and “extremely” satisfied. Responses from participants indicated their experience and/or interaction with RNs as positive and indicated that RNs were “very” or “extremely” likely to recognize the nurses as a source of high quality information outside the clinical context (n = 12; 92.3%); to seek input/expertise from a nurse (n = 12; 92.3%); to request a nurse as a mentor (n = 11; 84.6%); and to have a nurse as a team member (n = 10; 76.9%).

Finally, two verbatim comments captured the intent of the collaborative events. One participant stated,

I was also able to connect with a nurse during the event, and we’ve had some very good conversations. I’m an engineer/designer and those interactions with her and the mentor encouraged me to continue towards the path I initialized recently of becoming a nurse so I can develop better solutions for the healthcare environment.

Another said, “I believe the nurse on our team led us to victory! Nurses are innovators and deserve recognition.”

Discussion

While nurses have always been known as informal innovators, this was an opportunity to formalize that role...The COVID-19 pandemic has disrupted all facets of life on a global scale since early 2020, forcing many well-established industries to rethink business models and approaches to achieving their work. Healthcare is no exception to this disruption, and the ensuing pace of rapid change was very uncharacteristic for such a highly-regulated, slow-moving industry. The use of open innovation frameworks such as the MIT COVID-19 Challenge events has been key in addressing this disruption. Along with this recognition of a “new normal” and the need to shift approaches in problem-solving came the inclusion of non-traditional voices in the multidisciplinary teams tasked with such work. While nurses have always been known as informal innovators, this was an opportunity to formalize that role, build it into the professional identity, and move forward with the opportunity that the pandemic has presented.

The purpose of this article was to report outcomes related to the inclusion of RNs with any level of education and certification and in any role (e.g., mentor, judge) at an interprofessional hackathon. Although the small numbers of RNs involved in two MIT-sponsored hackathons might suggest that consulting with RNs for the purpose of healthcare open innovation is unimportant, the results demonstrate that nurses have much to contribute to the conversations about how to best care for patients, families, and communities. Further, such collaboration is likely to result in solutions that are high-quality, effective, and affordable.

...the results demonstrate that nurses have much to contribute to the conversations about how to best care for patients, families, and communities. To expand this thought is to suggest that RNs are effective in addressing many COVID-19-related challenges, such as shortages of personal protective equipment, inadequacy of diagnostic tests, and absence of cutting-edge treatments. This type of collaboration is articulated as a method to accelerate innovation (Silver, Binder, Zubcevik, & Zafonte, 2016), promote diversity (Wang et al., 2018), and as preparation for clinicians and healthcare innovators to embrace a multidisciplinary effort to develop healthcare technology that is effective and meaningful (Lyndon et al., 2018). Such collaboration can be demonstrated through development of a workforce development-focused track at a surgical hackathon (Ruzgar et al., 2020); novel approaches to teaching aging and disability (Revell & Ayotte, 2020); and even a dental curriculum hackathon (Saffari, Frederick Lambert, Dang, Pagni, & Dragan, 2018).

What the literature fails to represent is active healthcare innovation collaboration with RNs. Significant changes in healthcare due to the pandemic require new models of care. As the MIT hackathons demonstrated, nurses provide vital contributions. Therefore, nurses should be involved in major decision-making not only for the duration of the pandemic, but also as a reliable resource for the advancement of clinical care post-pandemic. Nurses should be at every innovation table where they may contribute as organizers and subject matter experts when creating healthcare solutions.

Limitations and Implications for Future Study

This was a nonexperimental, descriptive study that was developed to evaluate two MIT hackathons, after which RNs and innovators sought to understand nurse-participant interactions and collaboration. A convenience sample was used and the number of respondents to the survey was small, which represents missed opportunities to understand engagement in healthcare needs and solutions from the perspectives of end-users, including nurses, other clinicians, and patients and families. However, the concept of hackathons, and information about nurse participation in them, is very young, and we submit this preliminary information to the scientific community as a glimpse of effective collaboration with RNs when developing healthcare solutions. In addition, the dataset was further informed by verbatim positive comments regarding the experiences of working with nurses in various roles. The authors suggest this is an area primed for further development, including a robust study design.

Conclusion

Collaboration with RNs should be robustly encouraged by internal and external stakeholders. COVID19-exposed gaps in care that are currently being explored through innovation-fueled hackathons. The innovation community could further inform their solutions through the intentional and regular inclusion of RN knowledge, experience, and education. Collaboration with RNs should be robustly encouraged by internal and external stakeholders. Nurse scholars should continue to study and articulate the outcomes of this nurse leadership. RNs can and should be invited to the table of innovation as content experts to articulate problems, inform solutions, and represent patient needs.

Acknowledgement

Our thanks to Freddy Nguyen, MD, PhD, Research Fellow at MIT for assisting with data acquisition.

Authors

Rebecca Koszalinski, PhD, RN, CRRN, CMSRN
Email: Rebecca-koszalinski@ouhsc.edu

Rebecca Koszalinski is an Associate Professor at The University of Oklahoma Health Sciences Center, Fran and Earl Ziegler College of Nursing. She earned a BSN from the University of Wisconsin, Oshkosh, and a Master’s in nursing education, and a PhD at Florida Atlantic University. She is certified in both rehabilitation and medical surgical nursing. Her research is focused on improvement of health care-related communication and quality of care for underserved individuals who experience health care disparities. Among other honors, Dr. Koszalinski’s tech innovation, SFM-V, was recognized by Johnson & Johnson in #nurseschangelives. Rebecca is also a founding member and fellow (FIEL) of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders and an active member of several professional organizations and societies.

Olga Kagan, PhD, RN
Email: Okagan@molloy.edu

Olga Kagan is an adjunct faculty at CUNY SPS and Molloy College. She holds a Baccalaureate degree in nursing from Hunter-Bellevue School of Nursing, a master’s degree in Nursing Informatics and Administration, and a PhD from Molloy College. She is a founder of OKHCC, a healthcare consulting firm serving individuals, groups, and communities within public and private sectors. Dr. Kagan founded Food Allergy Nursing Interest Professional Group (FANI) on LinkedIn; she has received honors and awards for her contributions to nursing research and health policy. Dr. Kagan is a member of the NYAM, HIMSS-NY, AAAAI (technology & innovation committee), FAAMA, ENRS, and SONSIEL. Currently, she serves as an elected member on the board of ANA-NY, on the CUNY SPS Governing Council, and on the advisory board of the Center for Nursing Research and Evaluation at Molloy College

Joshua Littlejohn, MPH, MSN, RN
Email: joshua@envoyathome.com

Joshua Littlejohn has over 10 years of experience across the healthcare ecosystem to create products and experiences that bring value to patients, providers, and communities. He has a particular passion for products that not only keep us healthy, but foster better connections between people. Joshua began his career in healthcare as a bedside nurse at Tulane Hospital in New Orleans, and holds two master’s degrees in nursing from the University of Pennsylvania in healthcare leadership and public health. Since 2015 he has focused on enhancing delivery of home and community care using technology. He has created a range of products, including communication toolkits used by community health workers in rural Africa; cloud-based data visualization products for multi-hospital health systems; and consumer-facing digital healthcare platforms that deliver virtual caregiving to families and clinicians under DaaS and SaaS models.

Hiyam M. Nadel, MBA, RN
Email: hnadel@mgh.harvard.edu

Hiyam M. Nadel is the director of the Center for Innovations in Care Delivery at Massachusetts General Hospital. In this role, she is both a mentor and incubator of ideas for frontline caregivers, conceiving an idea to prototyping and beyond. She is currently an inaugural Johnson & Johnson Innovation Fellow. She earned a BSN from Northeastern University, Clinical Genetics Certificate from Brandeis University, and an MBA from Babson College with a focus on innovation and entrepreneurship. She is a founding member of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders. The most recent award she has received is the 2020 Extraordinary Women Advancing Healthcare Award from the Commonwealth Institute. This award recognizes 10 remarkable women in Massachusetts who are emerging and inspiring leaders pioneering advances across healthcare and who demonstrate collaboration, mentor others, and encourage diversity.