To promote a culture of innovation, healthcare leaders must exhibit foster, promote, and reward five key characteristics: divergent thinking, risk taking,
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107 KB – 35 Pages
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2˜is project was supported by the Robert Wood Johnson Foundation Executive Nurse Fellows Program. ˜e contents are the sole responsibility of the authors and do not represent the o˚cial views of the Robert Wood Johnson Foundation. The authors would like to acknowledge the contributions of the following individuals and organizations to this project: Dr. Roy L. Simpson, Vice President, Nursing Informatics, Cerner Corp Sarah Lowe, Associate Professor, University of Tennessee, Knoxville Ellen Loring, Center for Creative Leadership Robert Wood Johnson Executive Nurse Fellow Cohort 2014 ©2016 Innovation Works. The authors are listed alphabetically; each contributed equally to this project
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3CONTENTS 02 Acknowledgments 04 Introduction 06 The Characteristics of Innovation 06 Divergent Thinking 07 Risk Taking 08 Failure Tolerance 09 Agility and Flexibility 10 Autonomy and Freedom 13 The Components of Innovation 13 Employee Feedback 14 Role Filling17 Role Modeling 17 Employee Engagement 19 Education 20 Protected Time 21 Technological Support 21 Rewards 22 IDEO Methodology 22 Budgeting 23 Leadership 24 Team Collaboration: Innovation in Action 26 Unlikely and Diverse Team Members 26 Productive Interaction 27 Play 28 Pauses and Breaks 28 Skillset Development 30 Conclusion 32 References
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4The Innovation Road Map: A Guide for Nurse Leaders INTRODUCTIONInnovation is fithe design, invention, development, and/or implementation of new or altered products, services, systems, organizational structures, or business models for the purpose of creating new value for customers and ˛nancial returns for the ˛rmfl (The Advisory Committee on Measuring Innovation in the 21st Century Economy, 2008, pg. i). In the current U.S. healthcare system, organizations can no longer thrive by meeting needs, providing adequate quality, o˜ering acceptable customer service, and avoiding mistakes. Healthcare leaders, including nursing school faculty, need to consider what the industry will look like in the 22nd century. Dramatic changes that will be required to improve the quality of patient outcomes, increase care access, and reduce costs in light of new technologies including telemedicine, genome therapy, and online healthy lifestyles resources. According to the International Council of Nurses (ICN) (2009), innovation is central to improving healthcare quality. Innovation can be de˚ned as putting new ideas into practice or incorporating existing ideas into practice in a new way (Melnyk & Davidson, 2009; Fagerberg, 2004). While innovation often is thought of in terms of high-cost, high-tech solutions, the need for innovationŠeven the lower- tech varietyŠis evident worldwide (ICN, 2009). Global workforce shortages also increase the need for innovation, as fewer healthcare workers are required to complete even more tasks. Traditional approaches to advancing businesses employ incremental, formulaic strategies that use a slow, steady approach to achieve a pre-conceived outcome by avoiding errors and completing tasks at prescribed intervals. Such approaches cannot produce the innovation needed to transform healthcare. Even job titles for healthcare industry executivesŠ administrators or supervisorsŠsuggest a role more like an overseer or steward rather than a leader and active manager (Zuckerman, 2012). To produce innovative solutions, healthcare organizations need to function innovatively. Unlike traditional organizations that tend to be more comfortable with the status quo and even sti˛e creativity, innovative organizations not only permit, but also foster creative functioning among sta˜ members (Siegel & Kaemmerer, 1978). ˝e ˚rst obligation of healthcare providers, to do no harm, explains the risk-averse nature of the healthcare industry, where too much risk can result in patient injury or death. While such high stakes require hospitals and healthcare centers to deliver clinical care within a tight structure of quality and risk management, the leaders of these organizations must begin to think innovatively in order to grow, expand, and solve problems amid delivery system reforms. Innovative organizations have several unique Introduction
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5INTRODUCTIONcharacteristics, such as welcoming constant change, supporting continual learning, promoting ongoing experimentation with alternative problem-solving approaches, and encouraging thinking that is di˜erent from the norm (Siegel & Kaemmerer, 1978). While healthcare leaders might recognize the need to foster such characteristics in their organizations, they often do not know how to create the considerable and sustainable change required to achieve them. ˝is idea book can serve as a jumping o˜ point for nurse leaders who wish to introduce the spirit and practice of innovation to their organization. ˝e following sections discuss innovation characteristics fi˜is idea book can serve as a jumping o˝ point for nurse leaders who wish to introduce the spirit and practice of innovation to their organization.fl of innovation (to exhibit, promote, foster, and reward); the components of innovation (to try, test, adopt, and adapt); and team collaboration, which is both a catalyst for and a microcosm of the larger innovation process.
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6THE CHARACTERISTICS OF INNOVATION The Characteristics of Innovation Because divergent thinking is the cornerstone and arguably the source of all innovation, it is important to de˚ne the term and its opposite, convergent thinking. Convergent or linear thinking works towards a discrete answer or solution (Blakeney, Carleton, McCarthy, & Coakley, 2009). In contrast, divergent thinking consists of thought processes that do not necessarily move toward a single solution (Guilford, 1967). Guilford (1967) recognized divergent thinking as a vital underlying element of creativity and innovation, which allows for the connection or consideration of unrelated matters while contemplating a speci˚c problem (Guilford, 1957; Blakeney et al., 2009). Healthcare organizations, including nursing schools, tend to value convergent thinking over divergent thinking, which can serve as a barrier to innovation. For example, while nurses often are natural problem- solvers, they may not necessarily be naturally convergent thinkers. More likely, they have been trained to suppress their divergent thinking tendencies To promote a culture of innovation, healthcare leaders must exhibit foster, promote, and reward ˛ve key characteristics: divergent thinking, risk taking, failure tolerance, agility/ ˙exibility, and autonomy/freedom. Divergent Thinking in the healthcare setting, as they spend most of their time on discrete or linear tasks. Encouraging and valuing divergent thinking among nurses, as well as other healthcare employees and nursing students, will build a foundation that promotes creativity and enables innovation (Blakeney et al., 2009). ˝inking proactively instead of reactively can be considered an aspect of divergent thinking. In healthcare, leaders generally identify weaknesses or system risk points only after catastrophic events or near misses occur. For example, in nursing education, leaders generally focus on graduates™ NCLEX pass rate. When a school achieves a 95% or greater pass rate, business continues as usual. Rather than resting on the laurels of a high passing rate, the innovative faculty leader would determine how to prepare for or re˚ne e˜orts for the next semester. In bedside healthcare, humans, equipment, and protocols all are subject to failure. ˝e innovative thinker is able to anticipate a variety of failures and address them prior to a disaster or near miss. Innovative employees consider changes before adverse events require them. Similarly, healthcare leaders and nursing faculty need
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8THE CHARACTERISTICS OF INNOVATION Failure Tolerance What is a person risking while engaging in risk- taking behavior? Failure. Failure tolerance is accepting the path to success is paved with many failures. Without failure tolerance, there can be no risk-taking behavior. ˝ere are many examples of individuals whose serial risk taking and failure tolerance led to enormous success. J. K. Rowling™s Harry Potter book series was rejected more than a dozen times by publishers. Michael Jordan, arguably the greatest basketball player of all time, missed more than 9,000 shots, 26 of them potentially game wining. Inventor ˝omas Edison ˚rst found 10,000 ways his light bulb did not work before ˚nally discovering how it did work. ˝ese pioneering risk takers chose to focus on what they learned instead of the failure that inevitably accompanies taking risks. Being willing to tolerate and learn from failure is a foundation of the innovative organization. ˝is characteristic is crucial because failure is the result of fi– learning, iteration, adaptation, and the building of new conceptual and physical models Action Ideas for Encouraging Risk-Taking Behavior Establish a risk-taking framework for direct-report employees Introduce a policy that prohibits concealing information about taking risks on the jobRefrain from blaming employees when their attempted innovations fail Educate employees across the organization on the organization™s risk-taking stance Opportunities and Action Ideas for Encouraging Risk-Taking Behavior Make risk taking a standing meeting agenda item (potential, current, future, and follow-up) Create an award for those who proactively identify and address risk Complete a cost analysis for risk-taking versus not taking a risk Opportunities for Encouraging Risk-Taking Behavior ˜ Moving from hospital-based clinical experiences to simulation-only laboratories ˜ Making all home healthcare visits through telemedicine ˜ Using virtual ICUs for all critical areas
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9THE CHARACTERISTICS OF INNOVATION Agility and Flexibility Two important attributes that describe an individual™s or an organization™s innovation readiness are agility through an iterative learning process– [and] almost all innovations are the result of prior learning from failuresfl (Hess, 2012). Kelley (2001) said the possibility of innovation is born when people transcend the beliefs that limit their thinking, but they can progress into that creative space only when the fear of making mistakes is removed (Bonfante, 2012). Because embracing the freedom to fail may be counterintuitive in the risk-averse world of healthcareŠwhere employees often feel pressured not to make mistakesŠexplicit attention must be given to the development of failure tolerance. While organizations transition to a structure that supports exploration and innovation, it is incumbent on them to maintain a strong program of safety and quality oversight to ensure that innovative ideas are well tested before being implemented in the clinical setting. For leaders, inspiring coworkers to adopt a new problem-solving approach based on creativity, boundary spanning, and failure tolerance depends on their ability to model the innovative approaches they are promoting. Leaders also must condition themselves, and their team members, to accept failures as part of the pathway to innovation and be willing to reward learning that happens via trial and error. fiBeing willing to tolerate and learn from failure is a foundation of the innovative organization.fl and ˛exibility. ˝ese characteristics refer to the ability to adapt quickly to rapidly developing trends, treatments, regulations, and changing market conditions. Agility is de˚ned as the capabilityˆto adjust swiftly in response to global market changes. Flexibility describes the ability to provide di˜erent outcomes with the same resources by expanding, contracting, and shifting them to meet emerging needs. U.S. healthcare organizations exhibited agility and ˛exibility in the way they responded to the Ebola Virus. Organizations invested in infection control measures, supplies, education, and employee training to address patient, sta˜, and public safety needs. To be innovative, organizational procedures must acknowledge the impact global travel can have on the spread of viruses. However, in the face of such a threat, an innovative leader would consider if all hospitals and healthcare centers needed to focus that level of attention on education, supplies, and healthcare volunteers to deal with this now global illness. Changes in the healthcare environment often are motivated by rapid developments in technology, pharmacology, treatments, or disease migration. Innovative organizations need to be agile and ˛exible enough to evaluate these changes and design appropriate responses to address them in a timely manner.
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10Autonomy and Freedom Giving employees freedom to complete tasks as they see ˚t produces the autonomy they need to become more con˚dent about their abilities and decisions. Action Ideas for Improving Agility and Flexibility Opportunities for Improving Agility and Flexibility ˜ Having a contagious disease (e.g., the Ebola virus) threaten the workplace ˜ Malfunctioning of electronic medical record or electronic education system ˜ Having the bar code administration system fail to recognize medication packets ˜ Being a˜ected by unexpected blizzard or other adverse weather event ˜ Having job sharing and ˚exible scheduling practices challenge care continuity Develop an organizational design and strategies that reward agility and ˚exibility Hire employees who are able to quickly adapt to change Develop employee rules and procedures that support agility and ˚exibility Anticipate changes by performing a preemptive review of literature and work environment Opportunities and Action Ideas for Improving Agility and Flexibility Create employee teams that are readily available to provide input for emergent crisesEncourage shared governance, experiences, and storytelling Avoid developing habits of inertia or overcon˛dence Litwin and Stringer (1968) de˚ned employee responsibility as the degree of autonomy extended to employees, the perception of being their own bosses, and not having their decisions double-checked by higher-level employees. In nursing care, autonomy is de˚ned as the ability to act based on one™s knowledge
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11THE CHARACTERISTICS OF INNOVATION and judgment, within the full scope of practice as de˚ned by existing professional, regulatory, and organizational rules (Weston, 2008). When employees perceive inconsistencies in management expectations and a lack of clarity about their job responsibilities, they report feeling emotionally exhausted (Jaramillo et al., 2006). Conversely, figiving people latitude increases the chance that they will bring additional initiative, ideas, and energy to their jobsfl (Economy, 2014). ˝e values of employee autonomy and freedom should be at the core of every organization. Many healthcare organizations continue to use traditional hierarchical, top-down management approaches, which should be considered outdated for organizations that value innovation. Fortunately, many organizations are slowly shifting towards giving more autonomy in nursing practice. For example, collaborative practice agreements for Nurse Practitioners have been eliminated in several states, enabling these nurses to practice to the highest level of their professional licenses. Additionally, the push towards achieving Magnet status and nursing excellence has brought many bedside nurses into leadership roles through structured governance, committee placement, and encouragement in the quality and research arenas. Employees with autonomy and freedom are more likely to engage in divergent thinking and risk taking; accept failure as a necessary part of success; and exhibit agility/ ˛exibility in performing tasks and designing solutions with an innovative perspective. Once healthcare leaders understand the importance of the key characteristics of innovation, they are ready to examine the organizational components of innovation in light of their organization™s needs.
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