Academic-Practice Partnership Builds Innovation and Creative Capacity Following a Human-Centered Design Workshop

Innovation is the capacity of organizational teams to adapt to environmental changes, generate new value, and integrate changes into the system (Schumpeter, 2000; Zuber & Weberg, 2020). In healthcare settings, innovation requires creative thinking and problem-solving to tackle daily and transformational challenges (Zuber & Moody, 2018). Frontline nurses often apply innovative thinking and creative problem-solving as they provide patient care. While nurses create innovative solutions to problems daily, most do not learn the methodologies required to take an issue needing innovative thinking from the problem to the solution space (Bravo, 2023; Isangula et al., 2023). Furthermore, nurses often lack time in their compressed patient care schedule to commit to system redesign (McCord et al., 2022).

Frontline nurses often apply innovative thinking and creative problem-solving as they provide patient care.

These challenges translate to direct care nurses working around the healthcare system to achieve patient care goals instead of redesigning the system to work more effectively and efficiently (Bianchi & Ghirotto, 2022; McCord et al., 2022; Tucker et al., 2020). Preliminary research results have indicated that, once nurses learn these skills, they are empowered to change inefficiencies, products, and technologies (Kagan et al., 2021). Such innovation skills are not typically taught in a classroom setting. Little is known about the interest and capability of direct care nurses in developing and using innovation skills. This article reports the findings of the study that explored the impact of a training session on practicing nurses’ creative self-efficacy (Tierney & Farmer, 2011), psychological empowerment (Menon, 2001), and traits of design thinkers (Blizzard et al., 2015; Coleman et al., 2020).

These challenges translate to direct care nurses working around the healthcare system to achieve patient care goals...

Review of Literature

Human-Centered Design
Human-centered design (HCD) centers on human beings and their interactions with the environment in product and system (re)design (van der Bijl-Brouwer & Dorst, 2017). HCD is based on empathy, and in a healthcare setting, helps the clinician understand a problem from the users' perspective, e.g., Veterans, patients, families, or nurses (Altman et al., 2018; MacFadyen, 2014; Roberts et al., 2016; Rowe, 1991). From the user point of view, clinicians brainstorm various creative strategies or innovative solutions to address the problem. Then, they test these with users.

HCD focuses on understanding fundamental causes of the problem from the user perspective and iteratively tests and validates the solution through rigorous prototyping that engages the users. The cyclical process creates user-driven solutions that can innovate workflows, products, and technologies (Rahemi et al., 2018). The goal of the HCD process is to foster the creation of unexplored solutions. HCD and similar methodologies of user-centered design and design thinking continue to evolve (Altman et al., 2018; Blizzard et al., 2015; Brown & Watt, 2010; Meinel et al., 2010; Rowe, 1991). We broadly define them as “HCD” in this article.

The goal of the HCD process is to foster the creation of unexplored solutions.

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity Report (National Academies, 2021) recognizes HCD curricula as a requisite for competency-based nursing education. In addition, the American Association of Colleges of Nursing (AACN) Competencies include competencies specifically related to innovation-related skills. However, HCD and related methodologies are rarely taught in nursing programs (Bravo, 2023). Therefore, limited research indicates the outcomes of HCD training with nursing students or practicing nurses. The authors’ previous research has indicated that after participating in HCD experiential learning activities, graduate nursing students reported increased creative capacity, feeling empowered to change healthcare inefficiencies, and possessing design thinking skills (Holt et al., 2022).

Academic-Practice Partnerships
One solution for the missing HCD curricula in nursing and healthcare education is collaboration between healthcare systems and university innovation centers to facilitate training through academic-practice partnerships. We purposely built our academic-practice partnership by establishing common goals, mutual respect, and shared knowledge in the context of innovation and HCD (AACN, 2012). Each organization offered the ability to strengthen ideas and innovation through new perspectives and the power of connection.

Each organization offered the ability to strengthen ideas and innovation through new perspectives and the power of connection.

Innovation in isolation, disconnected from outside influences, such as the academic or practice setting, may lead to ineffective solutions. Innovation requires a team (Drach-Zahavy & Somech, 2001; Johnsson, 2017). The mere act of innovation within one setting, with no external touchpoints, potentially misses essential opportunities for valuable connections that co-join ideas or key thoughts to action. Examining innovation using strengths and resources across settings enables innovators to see their ideas from many perspectives. It can open channels of input that may significantly influence design, manufacturing, and dissemination (Thayer et al., 2018).

In this study, an academic institution and a federal healthcare system partnered to deliver HCD training to practicing clinicians and administrators. The partnership offered fluid pathways to expand perspectives and strengthen the understanding of organizational data, information, and knowledge. Consequently, the academic-practice partnership garnered new ideas, innovations, and designs, and motivation to transform patient care. Outcomes from this academic-practice partnership contribute to understanding opportunities for innovation and HCD in nursing and healthcare.

Examining innovation using strengths and resources across settings enables innovators to see their ideas from many perspectives.

VA Innovation Ecosystem
The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, employing over 119,000 nursing staff in 2023 (Office of Nursing Services, 2024). The 2022-2023 VHA Nursing Workforce Strategic Plan highlights the importance of innovation, research, and evidence-based practice in supporting nursing advancement and healthcare transformation to help VHA nursing serve the nation's Veterans (Office of Nursing Services, 2024). Recognizing the collective power of innovation champions across VHA and academia, VHA must leverage partnerships with academia to develop training and curricula to support VHA nurses' knowledge and skills in innovation and creative problem-solving.

VHA Innovation Ecosystem (VHA IE) drives the discovery and dissemination of mission-focused healthcare innovations that surpass expectations, restore hope, and build trust within the Veteran Community. VHA IE harnesses the collective power of innovation champions across the VA, academia, non-profits, and industry to implement innovation within the nation's largest integrated healthcare system (Vega & Kizer, 2020; Veterans Affairs, n.d.). Innovation is essential, given that VHA is the largest integrated healthcare system in the United States. With over 9 million Veterans eligible for healthcare, the VHA strives to deliver the best care anywhere, utilizing its 370,000+ employees.

Using HCD models, VHA employees take calculated and responsible risks, methodically test assumptions, learn from challenges, and reinvent care models. Previous examples include the first clinically successful implantable cardiac pacemaker and 3D bioprinting. The VA has led the charge to create novel approaches to complex healthcare problems (Veterans Affairs Office of Healthcare Innovation and Learning, n.d.).

Study Aims

Leveraging the strength of the academic and practice partnership, a mid-western VHA healthcare system partnered with an R1 research university school of nursing and innovation center to co-create an HCD workshop and study its outcomes. Our study aims were:

• To evaluate if, in a sample of VHA clinicians and administrators, creative self-efficacy (Tierney & Farmer, 2011), psychological empowerment (Menon, 2001), and traits of design thinkers (Blizzard et al., 2015; Coleman et al., 2020) increased after participating in the 8-hour in-person HCD workshop;
• To understand clinicians and administrators’ HCD post-intervention reflections.

Creative self-efficacy measured participant belief that one can create imaginative outcomes (Tierney & Farmer, 2002). Psychological empowerment was measured by evaluating the participants’ sense of perceived control, perceived competence, and goal internalization (Menon, 2001). Finally, traits of design thinkers (TDT) measured the participants’ affinity towards collaboration, experimentalism, optimism, feedback-seeking, and integrative thinking skills, enabling them to tackle complex, open-ended, and ill-defined real-world problems (Blizzard et al., 2015; Coleman et al., 2020). The university IRB deemed this study as exempt.

Methods

Design, Sample, and Setting
Design. The mixed-method study used a convergent parallel approach (Schoonenboom & Johnson, 2017). Specifically, we used a deductive-simultaneous design, with the quantitative survey as the core component and qualitative post-intervention reflections as the supplemental component (Schoonenboom & Johnson, 2017). The quantitative and qualitative data were analyzed independently and then brought together to explore their convergence and divergence. The convergent parallel approach expands the understanding of the workshop outcomes to multiple paradigms.

Sample and Setting. The study occurred at the innovation center at the largest urban research-intensive R1 university located in the midwestern state. The innovation center provides flexible spaces for students, entrepreneurs, advisers, and the broader community. The 24,000-square-foot facility offers co-working and collaboration spaces to share ideas in a collaborative environment, a flexible instruction classroom that accommodates experiential and engaged learning, innovation labs and “maker” spaces to experiment and prototype products and software, as well as touchdown and launch spaces to work on building new ventures.

Guiding Models
The study was informed by the Inquiry, Improvement, and Innovation (I³) Model for Advancing Quality Patient-Centered Care developed by Hagle and colleagues (2020). They created the model to recognize and describe how nurses and clinicians improve patient care, quality of care, and patient outcomes. The I³ model depicts the interconnected and unique steps of healthcare research and evidence-based practice (inquiry), quality improvement, and innovation. It provides steps and decision points based on a clinical issue or problem question. For example, the innovation ‘arm’ asks, Is there a new way?; the inquiry ‘arm’ asks, Why are we doing it this way?; and the improvement arm asks, How safe are patients? How satisfied are patients? Is there a better way? (Hagle et al., 2020).

In addition, we used the 5e Instructional Model (i.e., engagement, exploration, explanation, elaboration, evaluation) as the guiding pedagogy for the HCD intervention format (Bybee et al., 2006). The 5e’s are an iterative series of methods to organize educational content, where experiential learning (i.e., exploration) occurs before concepts are labeled and defined (i.e., explanation). Exploration provides participants a shared experience to base new knowledge, processes, and skills. Experiential learning activities help participants link prior knowledge to generate new ideas, brainstorm questions, and identify potential problems and solutions (Bybee et al., 2006).

Measurement
We administered an online pre-test survey before and post-test survey after the 8-hour workshop. Participants created a unique code to keep survey responses anonymous, allowing us to pair the pre-and post-test responses at the participant level.

The pre-and post-test surveys included demographic questions, and the three outcome measures: creative self-efficacy (CSE), psychological empowerment (PE), and traits of design thinkers (TDT). CSE is “the belief that one can produce creative outcomes” (Tierney & Farmer, 2002, p. 1138). It has three items measured on a scale ranging from 1 (strongly disagree) to 5 (strongly agree) with good reliability ranging from ⍺ = 0.83-0.87.

PE is “a cognitive state characterized by a sense of perceived control, competence, and goal internalization” (Menon, 2001, p.161). It has nine items, three items per sub-scale measured on a 6-point Likert Scale ranging from 1 (strongly disagree) to 6 (strongly agree). PE has a high internal consistency, with Cronbach's alpha values ranging from 0.80 to 0.90 for the overall scale and its subscales, ⍺ = subscales: perceived control (.86), perceived competence (.78), and goal internalization (.86).

TDT are “abilities to handle complex, open-ended, and ill-defined real-world problems” (Coleman et al., 2020, p. 3). It has 10 items, two items for sub-scale measured using a 5-point Likert Scale ranging from 0 (strongly disagree) to 4 (strongly agree). The authors report good internal consistency, with Cronbach’s alpha values ranging from 0.70 to 0.90 across different dimensions of design thinking traits, i.e., feedback seeking, integrative thinking, optimism, experimentalism, and collaboration) (Coleman et al., 2020). Table 1 includes the outcome measures and items.

Table 1. Measures, Scale, and Reliability

Open-Ended Reflection Survey
The research team developed a five-item reflection survey to understand potential change in participant perceptions, feedback about the workshop, and future application of the workshop concepts. Participants completed the reflection survey after the CSE, PE, TDT, and demographic items in the post-test survey. The reflection survey instructed participants to complete the following sentences: Based on your design experience in this workshop, I used to think…Now I think. Reflecting on your design experience in this workshop I liked…, Reflecting on your design experience in this workshop I wish…, Reflecting on your design experience in this workshop I wonder… and Reflecting on your design experience in this workshop what actions may you take after the workshop: "I plan to apply...”

Recruitment Procedures
The research team at the academic institution collaborated with the team from a midwestern VHA healthcare system for recruitment. The healthcare system has approximately 1200 nurses. The VHA team included the medical center’s innovation specialist; the Associate Chief Nurse for the Nursing Education, Research, And Simulation Division; and the medical center’s two nurse scientists. Approval was sought from the healthcare system’s associate director for patient care services (ADPCS)/nurse executive team. After endorsement, leaders of clinical areas reporting to the ADPCS (including Nursing, Rehabilitation Therapies, Food and Nutrition Services, and Sterile Processing Services) were invited to recommend candidates for the professional development opportunity to expose clinicians to innovation and HCD methods. Leaders provided 40 VHA clinicians and administrators who were supported to attend the training as a professional development day.

The Associate Chief Nurse from the Nursing Education, Research, and Simulation Division contacted the clinical division and program managers to explain the training objectives. The VA Innovation Specialist emailed nurse managers, inviting them to consider who on their team would be good candidates for participating in a professional development opportunity to expose clinicians to innovation and HCD methods. The email included four participant learning objectives, as follows.

After attending the Human-Centered Design Workshop, participants will be able to:

• Describe the principles of Human-Centered Design in healthcare.
• Identify areas in healthcare that need innovations to support and strengthen clinician, patient, and family health outcomes.
• Apply the principles of Human-Centered Design to develop and test solutions to healthcare problems.
• Understand the focus on the user experience and the steps of the Lean Start-Up process in developing an innovation.

The nurse managers provided the VA Innovation Specialist with the names of clinicians and administrators. On the day of the workshop, after arriving at the university innovation center, the principal investigator (PI) approached participants about the optional research study to assess and compare participant experiences before and after participating in an HCD workshop. Recruitment included information about the pre-and post-surveys, including the approximate time for completion, i.e., 10 to 15 minutes, and questions about their creative confidence, design thinking capacity, and feelings of empowerment. The PI informed participants that survey answers were anonymous and voluntary, and their employment or performance would not be affected by their choice to participate.

Workshop Pre-Work
One month before the workshop, the VA Innovation Specialist emailed a brief questionnaire and pre-work to the 40 selected VHA clinicians and administrators. The questionnaire assisted facilitators to understand participant level of knowledge about HCD before the workshop. The pre-work provided a shared level of baseline knowledge of the workshop concepts. Questionnaire items included:

• Are you familiar with any of the principles of Human-Centered Design (HCD), such as empathize, define, ideate, prototype, & test? If so, please identify which principles and enter them into the box below.
• Have you ever used Human-Centered Design (HCD) principles (empathize, define, ideate, prototype, etc.) to develop and test solutions to healthcare problems? (Yes/No)
• When you have a difficult healthcare problem to solve, do you focus on the user experience and then use this information before developing an innovation? (Yes/No)
• Who do you go to when you identify innovative ways to support and strengthen clinician, patient, and family health outcomes? Please enter your response in the box below.

Most participants were not familiar with HCD principles...

Most participants were not familiar with HCD principles (79.4%) and had never used HCD principles to develop and test solutions to healthcare problems (82.4%). However, 94.1% indicated they focused on the user experience and used that information to develop an innovation. They identified their direct or divisional organizational leader, e.g., nurse or program manager or peers as colleagues they approached for support when they identified innovative ways to support and strengthen clinician, patient, and family health outcomes. The pre-work included watching a TEDx Talk by Doug Dietz, titled “Transforming Healthcare for Children and Their Families” (2012), and reading the I-3 Model article by Hagle and colleagues (2020).

Innovation and Human-Centered Design Intervention
Before the workshop began, participants completed the pre-survey. The workshop started with introductions and welcomes from the university and VHA leadership, including the university Chief Innovation and Partnership, Interim Director of the Innovation Center, and Dean of the College of Health Sciences and Professions. The Director of the VHA healthcare system also welcomed participants. The workshop proceeded as follows:

• Part 1 was a Taste of HCD. Participants completed a rapid design thinking challenge to reimagine a travel experience with a partner.
• Part 2 was Design Thinking Drills. This set the stage for participants to notice problems and rapidly brainstorm solutions.
• Part 3 was a working lunch. The VHA nurse executive team invited participants to share any barriers observed in daily work that may need an innovative solution. Afterward, a VHA nurse shared an innovation journey, from experiencing a problem as a patient to finding a solution as an inventor.
• Part 4 was Innovation in Action. The facilitators shared healthcare innovations they had led and described how to interview stakeholders to test a hypothesis.
• Part 5 was Working Groups. Facilitators led small and large group debriefings of the day and action steps going forward. Finally, the participants completed the reflection survey after the CSE, PE, TDT, and demographic items in the post-test survey.

Analysis Methods

Quantitative Data
Pre-and post-test responses were paired using the unique identifier generated by the participant. Where unique identifiers did not match or no unique identifier was entered (n = 6 records), demographic information was manually compared to reconcile the records. The analytic sample comprised 31 reconciled records. Descriptive statistics were calculated and compared to find differences between pre-and post-test demographic responses.

Linear mixed-effects regression was also explored for the mean change in each outcome measure construct in pre- and post-test responses, with the unique identifier as the random effect. A few linear mixed-effect models were assessed using these different fixed effects: (a) the survey variable alone, (b) the survey variable with question items, and (c) a fixed effects model of questions nested in each survey. The model with the smallest Akaike's ‘An Information Criterion’ (AIC) was used to choose the preferred model. This generally was model (b). The R programming language (version 4.4.1) was used for data management and all analyses (R Core Team, 2023). The supporting R packages used were: dplyr (version 1.1.4), magrittr (2.0.3), nlme (3.1-164), ggplot2 (3.5.1), and ggpp (0.5.7). Statistical tests were considered significant at the Bonferroni-corrected 𝛼 level ≤ 0.0045.

Qualitative Data
To address study aim 2, to understand clinician and administrator HCD post-intervention reflections, we included five reflection questions in the post-test survey. We used a four-phased process of inductive thematic analysis outlined by Vaismoradi and colleagues (2016). The four phases included: (1) initialization - reading reflections, coding and noting the level of abstractions, and writing notes; (2) construction - organizing codes and comparing their similarities and differences; (3) rectification - relating themes to existing knowledge and coming to consensus among team members; and (4) finalization - aligning the themes to develop a storyline of the results (Vaismoradi et al., 2016).

Results

Quantitative Findings
Most participants (72.4%) were between the ages of 25 and 34, White (83.9%), non-Hispanic (96.8%), and female (77.4%). Most (77.4%) had completed a Bachelor of Science degree in Nursing, and 16.1% had earned a Master of Science in Nursing. About half (48.4%) of participants were first-generation students. Mean years worked was 3.46 (SD = 3.14). Table 2 presents additional participant characteristics.

Table 2. Descriptive Characteristics of Participants

There were statistically significant increases in post-test responses at the construct level, i.e., Creative Self-efficacy, Psychological Empowerment, and Traits of Design Thinkers (p<0.001). The linear mixed effects regression model had the following estimates for the constructs: Creative self-efficacy (Q4-Q6), 0.763 (95% CI: 0.540, 0.988); Psychological empowerment (Q7-Q15), 0.303 (95% CI: 0.203, 0.402); Traits of design thinkers (Q16-Q25), 0.177 (95% CI: 0.068, 0.286). The Psychological Empowerment sub-constructs and the Traits of Design Thinker sub-constructs of Feedback Seeking and Experimentalism were statistically significant increases in post-test responses. (See Table 3 and the plots in the supplemental material).

Table 3. Mean Change (post-pre-test) per Construct and Sub-construct

Supplemental Material PLOTS

Qualitative Findings
Regarding results for Aim 2, most of the emerging themes from participant post-intervention reflections aligned with the constructs and sub-constructs in the instruments. This added urgency to apply learnings to their work context. Reflection narratives often identified a new sense of creative confidence, HCD skill proficiency, and enthusiasm to share their learnings with colleagues. In the summary below and in Table 4, we report these themes by respective prompts.

• Themes from the “I Used to Think, Now I Think…” prompt included the value of their newly gained HCD skills and ability to apply the concepts to the work environment with collaborators. They shared a new awareness of leadership support and resources at the VA and the confidence to use HCD skills to create change.
• Themes from the “I Liked…” prompt included examples of how the experiential learning format facilitated knowledge acquisition, with many participants naming the brainstorming exercises as particularly valuable. Several participants stated that the stories the facilitators shared of HCD projects resonated with them, as did the demonstration of leadership support.
• Results from the “I Wish…” prompt revealed the desire for continued HCD workshops with a shift to solving identified problems. Participants also desired an action plan for the next steps and wanted more team members to receive the HCD training. Several participants wished for more time to apply and further develop their HCD skills.
• Responses to the “I Wonder…” prompt included themes of galvanizing interest among colleagues who were not at the training and extending the learnings to their team members.
• Replies to the “I Plan to Apply…” prompt included examples of using their HCD skills directly in their team meetings, quality improvement projects, performance improvement projects, unit shared governance, and change management. They also reflected on how they will use the skills to inspire their team to collaborate to develop ideas and solve problems.

Table 4. Qualitative Themes and Representative Reflection Examples by Prompt

Discussion

...nurses without creative self-confidence and HCD skills may feel unempowered to discover new ways to improve ineffective processes and protocols

This study evaluated the outcomes of a one-day, in-person Human-Centered Design workshop with VHA nurses, clinicians, and administrators at a midwestern university innovation center. We found that participants reported statistically significant increases in the CSE, PE, and TDT outcome measures after completing the workshop. Quantitative findings provide preliminary evidence of a change in CSE, PE, and TDT, attributable to the training. Results from this study suggest that initial findings that the 8-hour HCD workshop increased participant creative self-efficacy, a critical skill needed to build nurses’ innovation ability (Tierney & Farmer, 2011). Nurse researchers have explored creative self-efficacy internationally, (e.g., Pakistan (Afsar & Masood, 2018), Taiwan (Liu et al., 2019), and China (Liu et al., 2021); however, researchers have not studied this construct in frontline nurses and clinicians in the United States. When building a patient safety culture, nurses without creative self-confidence and HCD skills may feel unempowered to discover new ways to improve ineffective processes and protocols (Risling & Risling, 2020). This intervention presents one way to build nurses’ innovation and HCD capacity to create and influence the tools and processes they use to deliver patient care.

In narrative responses that supported our qualitative findings, participants expressed a sense of urgency for additional workshops on specific healthcare problems and more training for team members. They shared how they planned to apply their new HCD skills in their work settings and desired more support and dedicated time. These reflections align with messages from nurse leaders about the critical need and opportunity for nurses to establish a more significant presence in the innovation and HCD realm (e.g., National Academies, 2021; Risling & Risling, 2020). In this study, participant reflections often aligned with the quantitative constructs that we measured; participants affirmed the need to include HCD content in their professional development.

The HCD approach changes the core structure of systems, processes, or products to manage complex situations by creating solutions centered on people's needs

Traditionally, healthcare interventions and technology use a linear approach without user input (Lyon & Koerner, 2016; MacFadyen, 2014; Roberts et al., 2016). In the HCD process, the end-users are the experts, and innovation emerges from several cycles of empathy, ideation, prototyping, and testing. The HCD approach changes the core structure of systems, processes, or products to manage complex situations by creating solutions centered on people's needs (Göttgens & Oertelt-Prigione, 2021; Zuber & Moody, 2018). As indicated in the pre-workshop questionnaire, most participants in this study were unfamiliar with HCD principles. Nurses' unfamiliarity with HCD principles prevents them from significantly improving workflows, products, and technology using this approach (Risling & Risling, 2020). However, our study results suggest that nurses became more empowered to embark on an innovation journey once they gain innovation and creative capacity.

Implications for Academic-Practice Partnerships

The positive findings from this study indicated that outcomes of the one-day HCD training workshop led to increased creative self-efficacy, psychological empowerment, and traits of design thinkers for our participants. The workshop has translated into the rapid application of the HCD skills with a robust response and downstream effect for the flagship VHA innovation programs at the midwestern VHA healthcare system setting for this study (e.g., 2024 VHA National iNET Spark, Seed, Spread Program Application Cycle; IE VA Innovation Fellowship Applications; and VHA MIT Catalyst Fellowship Applications).

As an example, in 2023, three VHA employees from this site submitted ideas to the National iNET Spark, Seed, Spread Program Application Cycle. As of the application deadline, two months after the HCD workshop, 14 VHA employees from this site submitted applications to the various VHA Innovation programs this year. Furthermore, within two months of the HCD workshop, two nurse-led VHA teams enrolled in the National Science Foundation’s I-Corps™ Great Lakes Hub program hosted at the university (Walter, 2024). The continued engagement between these academic and clinical partners provides preliminary evidence for application of HCD skills to improve technology, products, or processes to improve patient safety and care.

VHA researchers have offered several recommendations to cultivate innovation in large healthcare systems that align with our findings (Vega & Kizer, 2020; Zuber & Moody, 2018; Zuber & Weberg, 2020). Vega and Kizer (2020) described essential innovation elements as a workforce capable of driving innovation, a culture that fosters innovation, and strategic external partnerships and collaborations that provide new perspectives and resources. Zuber and Weberg (2020) reported that an empowered network of clinicians, similar to what this study developed, can create innovation microclimates within the larger organizational entity. These innovation microclimates can test and iterate solutions before implementation across the system. Zuber and Moody (2018) advised harnessing curiosity and learning by creating a psychologically safe environment where innovators are seen as problem solvers, not troublemakers. Finally, researchers have suggested providing academic-practice opportunities to link clinicians who experience healthcare system problems with resources and guidance on discovering the root causes of an issue to empower clinicians to change the system (Zuber & Moody, 2018). Future studies can validate further and explore the impact of this training program within the participating institutions and other external academic and healthcare organizations.

Study Limitations

This study occurred within one Midwestern, urban city; therefore, the results may not be generalizable to other geographical areas. The homogenous sample may not represent the diversity of the broader population, further limiting generalizability. There is also the potential for selection bias because the nurse and program managers identified employees who were asked to participate in the professional development opportunity. Chosen participants may not accurately represent the studied population, leading to skewed results. Finally, the results need to be replicated in future studies with larger, more diverse samples to enhance the reliability of the findings.

Conclusion

Nurses creatively solve problems in their daily work; however, most do not learn how to apply human-centered design methodologies

Nurses creatively solve problems in their daily work; however, most do not learn how to apply human-centered design methodologies (Göttgens & Oertelt-Prigione, 2021; Harte et al., 2017) to seek a solution. Academic-practice partnerships offer one powerful venue to address this knowledge gap and empower participants to pursue innovation. These partnerships are a clever strategy to build HCD skill sets of clinicians and increase the capacity to address nursing practice and health system problems. Academic-practice partnerships maximize the strengths of strong innovation ecosystems at both the university and organizational levels, creating multiple sources of support, resources, and perspectives.

Disclosure of Funding: This work was made possible in part by support from VentureWell and the Lemelson Foundation (Holt, PI); the Building Bridges to Research-Based Nursing Practice Team Research Grant (Holt, PI); and the University of Wisconsin Milwaukee (UWM) Lubar Entrepreneurship Center (LEC) Kellner Foundation Curriculum Innovation Grant (Talsma, PI.)

Authors

Jeana M. Holt, PhD, DNP, MSN, RN, FNP-BC
Email: jmholt@uwm.edu
ORCID ID: 0000-0003-3392-0164

Jeana M. Holt is an assistant professor in the College of Health Professions and Sciences School of Nursing at the University of Wisconsin-Milwaukee. She is a nurse scientist, nurse practitioner, and Kellner Entrepreneurship Fellow at UWM. Dr. Holt uses human-centered design (HCD) methodologies to develop and evaluate creative innovation and entrepreneurship models with autistic youth and young adults. Dr. Holt also co-develops, facilitates, and evaluates HCD interventions that empower graduate nursing students and clinicians to influence healthcare system change.

AkkeNeel Talsma, PhD, RN, FAAN
Email: Talsma@uwm.edu

AkkeNeel Talsma an associate professor in the College of Health Professions and Sciences School of Nursing at the University of Wisconsin-Milwaukee. Her research focus is the implementation of efficient, effective, and sustainable (technical) strategies for high quality of care and better outcomes for our patients and families. Dr. Talsma works on innovating clinical practices and healthcare systems by applying emerging technologies to support best practices and research evidence.

Jan Irene C. Lloren, MPH, RN
Email: jclloren@uwm.edu
ORCID ID: 0000-0002-4854-9057

Jan Irene C. Lloren is a Biostatistics PhD student at the Joseph J. Zilber College of Public Health at the University of Wisconsin-Milwaukee. Ms. Lloren assists researchers in evaluating project outcomes.

Ilya Avdeev, PhD
Email: avdeev@uwm.edu

Ilya Avdeev is the Director of the Lubar Entrepreneurship Center and Kellner Entrepreneurship Fellow at UWM. He leads campus-wide efforts of expanding learning opportunities for students around innovation and entrepreneurship. Dr. Avdeev is also a Professor in Mechanical Engineering and Director (PI) of the Milwaukee NSF I-Corps™ Program.

Colleen Lawlor Eckert, DNP, MPH, RN
Email: colleen.eckert@va.gov

Colleen Eckert serves as the VA Associate Chief Nurse for the Nursing Education, Research and Interprofessional Simulation Division. Dr. Eckert earned a Doctor of Nursing Practice -Executive Track from University of Wisconsin at Milwaukee, a Master of Public Health degree from the University of Illinois at Chicago and a Bachelor of Nursing Science degree from Marquette University College of Nursing.

Qiyan Mu, PhD, RN
Email: qiyan.mu@va.gov

Dr. Mu is the Co-Director of the VA Advanced Fellowship in Women’s Health and a clinician, educator, and researcher focusing on women’s sexual, fertility, and reproductive health.

Florine Ndakuya-Fitzgerald, PhD, RN, NPD-BC
Email: florine.ndakuya-fitzgerald@va.gov

Florine Ndakuya-Fitzgerald is a nurse scientist and the director of the VA Advanced Fellowship in Interprofessional Patient Safety. Dr. Ndakuya-Fitzgerald facilitates, leads, and supports clinicians in advancing veteran care through quality improvement, evidence-based practice and research.

Joann Jastrab, JD
Email: joann.jastrab@va.gov

Joann Jastrab has a Bachelor of Arts degree from the University of Wisconsin-Madison and a Juris Doctor from New England School of Law. She is a Change Management Practitioner and an Innovation Specialist. In this role, she identifies and evaluates new technologies and innovations that align with VA strategic goals, assessing their potential impact and feasibility for implementation; develop and manage pilot projects to test the viability of proposed innovations; establish partnerships with academic institutions, and other external entities to co-develop innovative products or services; and lead the creation of a culture of innovation within the VA by organizing educational events, sharing success stories, and recognizing team and individual contributions to innovation efforts.