Part 1: Transforming Nursing through Innovation
Guest Overview:
Dr. Clipper is the founder of Innovation Advantage, a consultancy that focuses on helping health care organizations adopt innovative approaches. She is a trailblazer in her industry and was the first Vice President of Innovation at the American Nurses Association. Dr. Clipper is the sole nurse member of the HIMSS Innovation Board of Advisors and is a start-up coach for MATTER international health tech accelerator.
Her recent book, “The Innovation Handbook”, is a pragmatic guide and toolkit that seeks to enlighten nurse leaders as they evolve through the current healthcare crisis.
Memorable Quotes:
“When we have technology that tries to design workflows for us without ever understanding how the work really happens. That's a recipe for disaster. ” - Dr. Bonnie Clipper
“More importantly, are we measuring the impact of human factors on the safety of that care model?” - Dr. Bonnie Clipper
“These days, technology seems to be very expensive. And I say, when you're making the investment, make an investment that's future -facing. So don't buy technology that literally is going to be out of date in a year. Instead, you may have to spend more, but lean into technology. That has the opportunity to grow with you and with your organizational needs. To take you in that direction in the future.” - Dr. Bonnie Clipper
Show Links:
Innovation Advantage: www.innovationadvantage.com
Innovation Handbook: https://www.sigmamarketplace.org/the-innovation-handbook
Transcript:
Intro - 00:00:00: Welcome to The Factor, A global medical device podcast series powered by Agilis by Kymanox. Today's episode is hosted by Denise Wagner, Senior Director of Human Factors and Usability Engineering at Agilis by Kymanox. She's joined by Dr. Bonnie Clipper, Healthcare Executive at Innovation Advantage, coach and international speaker. She's also the author of several books, including the Innovation Handbook: A Nurse Leader's Guide to Transforming Nursing, and The Nurse's Guide to Innovation: Accelerating the Journey. And that's the topic we're digging into today, innovation in nursing and the potential transformation of healthcare through technology. Here's Denise.
Denise – 00:00:50: So Bonnie, welcome to the show and thank you for joining us.
Bonnie – 00:00:54: Thank you so much Denise. It's always my pleasure to talk to you.
Denise – 00:00:58: Tell us a little bit about your company, Innovation Advantage.
Dr. Bonnie – 00:01:03: Absolutely. So being a nurse for quite a long time and having been a chief nurse for over 20 years. One of the things that struck me as I was a Robert Wood Johnson fellow was the lack of understanding that nurses have about innovation, around what it is and how we can use it to actually help us with care transformation. So probably at the worst time to actually start a business, I created my consultancy during the pandemic. And really started to talk to nurse leaders. That at the time we're looking for new ways to do things. But we're uncertain of how to go about that. We kind of have some traditional frameworks and structures that we still to this day, tend to operate within healthcare, not just nursing, but in healthcare. Sometimes because we have, safety concerns but quite often because this is really what we know there's a lot of rigidity and lack of flexibility within healthcare and we for probably a lot of the right reasons, have a very, very low tolerance for change, for risk, and just for doing things differently. So that really was an opportunity for me to work with organizations across the country. And actually I do some international work as well. To help people learn to think different. So not just do a hack at that. But really help to go into the organization, dive deep around. How can we teach you skills? To think differently. Let's use some of your existing at internal challenges that you have right now. To work through and then let's create processes so you understand how to apply these skill sets. And you can use them on your own anytime going forward. To come up with different solutions to problems that are vaxing you today. And as a result of doing that work, what really emerged is that many organizations are doing care transformation. So I have been able to emerge as an expert in virtual nursing. Simply because of my exposure to hospitals around the country. That are implementing these care models. And need assistance with building processes in assembling all of the pieces that go into how an inpatient virtual nursing model works.
Denise – 00:03:32: So in your work, I mean, it sounds fascinating and it's exactly the right time to do this, right? There's been a lot of strain on the healthcare system and this is the right time to continue to push for innovation and transforming the care model. In your work, have you heard of human factors engineering?
Dr. Bonnie – 00:03:52: Absolutely, absolutely. I am working with an organization now and we are doing some study work. In fact, we're doing some work around what is the right number of patients. For a virtual nurse who is a nurse located remote from the unit where the care is being provided, yet is still part of a care team. So we're studying, what is the right number of patients for a virtual nurse to care for? And we are actually doing some human factor analysis and particularly looking at some of the safety attributes. We have some engineers that are involved in this and we are looking at things fascinating to me, but we're actually looking at perspiration heart rate, eye movement, eye fatigue. Things of that nature to understand what is the right number of patients for a virtual nurse to serve? Now we know there's two different models of virtual nursing that have emerged. And of course this work is early, so we are probably going to continue to see change. But if you have a nurse that is remote, that is doing admissions, discharge, and transfer paperwork, known as the ADT model or you have a nurse doing a care partner virtual nurse kind of model, meaning they can assist with paperwork, they can assist with patient education, they can answer call lights, they can do hourly rounding. Dual nurse verification. How do we know in either of those models, what's the right number of patients to assign to a virtual nurse? And I'll tell you Denise, in talking to organizations around the country. We see everything from five or six patients per virtual nurse up to organizations that is assigned 24 to 30. So what's the right number? And how do we decide what that workload looks like? But more importantly, are we measuring the impact of human factors on the safety of that care model?
Denise – 00:05:46: Exactly, and there's this tension between technology, like being an enabler, but then also all of the care providers have to learn that technology. But with the right technology, possibly that's going to affect the number of patients in that care model, right? That's what a nurse can take care of. So tell me a little bit about that, because I've listened to some of your podcasts and I know you're an advocate for the use of technology to enable nursing care. So tell me about maybe some of the technologies you think that can help.
Dr. Bonnie – 00:06:25: Yeah, absolutely. I'd be happy to talk about that. You know, first and foremost, I think for any technology, it's important that nurses are involved in the design and development. And the reason for that is because being trained as nurses and having had the opportunity to care for patients. Nurses are the ones that understand those workflows. So when we have technology that tries to design workflows for us without ever understanding how the work really happens. That's a recipe for disaster. That isn't going to work. And while you might actually produce a nice shiny technology. You might even sell the nice shiny technology, it isn't going to be utilized which means if you're using a subscription model or if you're ever looking for upgrades and renewals. Facilities aren't going to pay for because it's not being used. So step one is always, always, always go to where the work is being done. So go to the nurses that are involved in this particular area. If it's inpatient, outpatient, perioperative, whatever it might be, get the Design Input directly from those nurses. And it's also important to take a look at companies that are out there to see where they're getting this input. Do they have an advisory board? Do they have nurses on the advisory board? Did I have a CNO? Do they have nurses on their executive team? Those are all important clues. Then really that next step is to look at what technologies are out there, but first you have to figure out what problem do you want to solve? Because there are technologies for everything. So you could spend a whole lot of money and not necessarily solve your problem. So for example, virtual nursing is some of the space that I'm the most familiar with. And there are different tools that can be deployed across that space. So if you think about one of my favorite happens to be looking for the opportunity to offload non-value added work from nurses. So we know 36% of a nurse's time is literally spent on a combination of documentation and hunting and gathering. If you could offload hunting and gathering. And there are robots out there that will actually do this work for you. That will go get you the supply out of the supply room or go get you the telemetry box that you're missing or go get you the discharge medications that you're waiting for for a patient. We have to identify those kind of technologies. And then bring those on board with the acquisition of that tech in an organization. Teach people so that they know how it works. What it's going to do? What's the best way to leverage that and then continue to bake in the utilization of that? Otherwise that stuff is very expensive and it sits in a corner. We have to make sure that we can demonstrate the value. There's also other amazing technology out there. Doing the virtual nursing work, I see a spectrum. I see everything from tablets to camera speakers and microphones in rooms. To ambient augmented intelligence. Ambient computer vision. I think that there is a time and place for all of that technology. It depends what problem you're trying to solve. These days, technology seems to be very expensive. And I say, when you're making the investment, make an investment that's future -facing. So don't buy technology that literally is going to be out of date in a year. Instead, you may have to spend more, but lean into technology. That has the opportunity to grow with you and with your organizational needs. To take you in that direction in the future.
Denise – 00:10:19: Okay, so there's a lot of synergies in what you're saying. So I think you're probably a human factors engineer at heart as well as a nurse. So a lot of synergies and what we do in helping medical device manufacturers reduce use error and make products and systems safer to use for the end users and ultimately the patients. So a couple of things I just want to point out that you mentioned that are near and dear to human factors engineers hearts is, identify the unmet need first. Don't develop the tech and then try to go discover a need for that tech, right? And the way that you identify that unmet need is being in the field, understanding the people that use the technology, who need the technology, and what their clinical workflows are. So this is exactly parts of the human factors engineering process. What is your advice to medical device manufacturers on getting a nursing panel in place or recruiting nurses or finding nurses to help provide insight into their product development?
Dr. Bonnie – 00:11:35: Yeah, there's different ways to go about that. I mean, I would tell you, Denise, on a monthly basis, I probably have about anywhere from five to 10 or 12 companies that reach out to me and they'll say, hey, would you be willing to look at this or look at that? And The way that I work is I typically have contracts with organizations over a period of time and we develop milestones for what they're hoping to gain and what they're looking for. I also encourage organizations, even small startups. Talk to the nurses that you might have as friends and family. Start to get input somewhere. And you can start by just getting some of that feedback for free. But as organizations begin to grow, they really do need to find ways to compensate nurses who are experts. On a regular basis to provide that kind of advisory board type of input. And don't mistake one discipline for another. I'm going to give you an example. When I was the Vice President of Innovation for the American Nurses Association. I had an organization that called, they wanted to demo a product for me and it was an OR-related product. So we did a demo via Zoom and we talked about it and I asked them what problem it was trying to solve because it didn't seem apparent to me what problem was. Instead, it felt like a cool technology looking for a problem.
Denise – 00:13:00: Right.
Dr. Bonnie – 00:13:01: So, I asked them what the problem was and what they articulated didn't really make sense. So I asked them if they had nurses involved or nurses look at this. And it was a guy that said he was the CEO of this very small company. He said, he said, yes. And I said, I'm kind of surprised what kinds of nurses did you have involved? And he was sort of quiet for a minute, and then he actually said. Well, I had a surgeon look at it. That's not a nurse, right? And we have really different skillsets and training and competencies and expertise. So it's important to make sure that you get, you know, a discipline isn't a discipline. We're all very unique. So getting the right feedback, and it may require that you have to get various viewpoints and feedback from a whole variety of disciplines. In order to come up with a good solution or a very well-considered product.
Denise – 00:13:58: Yeah, and I've run across that as well in helping manufacturers that make surgical products and they always will establish the surgeon panel, but setting up the equipment, taking down the equipment, assisting during the procedure might involve multiple other stakeholders as well as cleaning, maintenance, disposal, transportation of the system. So yeah, again, I think there are so many synergies between what your company is trying to advocate for and what human factors engineering tries to advocate for.
Outro – 00:14:42: Denise and Dr. Clipper are going to switch gears and be back soon with the remainder of this conversation. In part two, they go over the nursing shortage and how nursing is handled much differently outside of the United States. You won't want to miss that, so be sure you're subscribed to this podcast on YouTube or wherever you get your podcasts. For more information on Dr. Clipper and a place to purchase her books, visit innovationadvantage.com. This episode was edited and produced by Earfluence. We'll talk to you again soon on The Factor.
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