Idea

Gaming For A Solution to the Future of Hospitals

by Nursetopia on December 13, 2012

A new Institute for the Future initiative and game, “Future of the Hospital” asks a provocative question, “What if your hospital wasn’t there when you needed it most?”

Yes, you read correctly – the collaborative forecasting game allows experts and “ordinary people” to submit ideas reinventing the community hospital, an institution facing near insurmountable challenges, or so it seems. The game is January 8-9, 2013, but you can whet your innovation appetite with pre-selected daunting questions and challenges via the Game Blog. These are behemoth questions, so tweet your wild ideas to @FutureHospitals, or use the #FutureHospitals hashtag.

Our current solution clearly isn’t cutting it, so why not forget everything you know about the community hospital and start anew? You know you have these ideas sitting at the nurses’ station or in between triaging patients or after a ridiculously challenging shift…”What if…” Go ahead, share those thoughts with us. Spur us to think differently.

Be sure to sign up for the game and to receive the weekly challenge questions in preparation of the game. I look forward to seeing your “crazy” ideas to transform the healthcare landscape.

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Ideas Are Good; Implementation Is Better

by Nursetopia on December 11, 2012

I can brainstorm all day. Allll daaaay. We could sit in a lovely space, order in, squeeze our creative juices, and generate the heck out of some ideas. Most people can spout ideas, too, and really great ideas at that.

Those ideas are useless without planning, though. A good portion of people have difficulty planning ideas – moving from the “what” to the “how.” It’s really hard (and confusing) to implement ideas without a plan – a plan that’s been effectively communicated to everyone. The steps seem simple, but they are easily and/or quickly overlooked in many business ideas and developments, including those in health care.

If you’re generating stellar ideas, focus on your planning. If your planning is set, focus on your communication of the plan. If you’re communicating the plan, shift your gears to implementation, which should also include rigorous evaluation.

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Nike, You Should Make Scrubs

by Nursetopia on July 13, 2011

I love Nike shoes and clothing. I do. There’s one thing Nike doesn’t make, though, that I wish they did – scrubs. Literally millions of healthcare professionals wear Nike shoes and other acceptable clothing to work, running up and down hallways and stairs and even climbing over items at times. Yes, healthcare professionals are athletes, too, in many senses of the word. There’s something to be said for remaining at top, live-saving performance 12 hours straight, so I think there is a natural marketing link there.

Nike is an innovative company, creating clothes and shoes to fit exactly what individuals need and want. I especially think Nike’s Dri-Fit® fabrics are perfect for the healthcare environment, wicking away moisture – whether it is your own or from others or the environment. Not only that, but the fabric is comfortable while still looking crisp. I’ve worn one-too-many wrinkled, scratchy scrub sets. In addition, Nike’s clean style speaks for itself. (Teddy bears and kittens, be gone!) I have felt strongly about this idea for almost two years now, and I just shared it with a colleague about a month ago. After I saw the nursing connection to the U.S. Women’s Soccer Team uniforms – which might not have been the best press for the team, it just seems even more of a fit.

Nike, you should make scrubs. Seriously.

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Nursing as Child’s Play

by Nursetopia on June 6, 2011

Dora the Explorer. Jake and the Neverland Pirates. Blues Clues. Handy Manny. Bubble Guppies. Signing Time. The list of children’s preschool cartoons goes on and on. Cartoons are not simply entertainment now. A few days ago my four-year old daughter told me the sun was really a big star. I asked her who taught her that, fully expecting her to pipe up with her favorite preschool teacher’s name. Nope. Bubble Guppies.

Health care and related themes are sprinkled throughout cartoons. Disney Junior does a great job discussing topics like handwashing, covering your mouth when you cough, and eating more fruits and vegetables, but if my daughter can learn Spanish by helping Dora cross the Big River (via Nick Jr.), then couldn’t she also learn anatomy, overcoming fear of immunizations, medication safety, preventing or managing diabetes, basics of the healthcare team, various healthcare roles, diversity within professions, etc., etc., via a healthcare-specific cartoon? My daughter is usually enthralled with my “magicscope” (e.g. my stethoscope) and other healthcare tools. One of her favorite games to play on my iPhone is fighting bacteria blobs. I have a feeling she would enjoy a cartoon about health and the healthcare team, as well. Not only does something like that have potential educational and workforce enhancement value, but it also has entertainment and marketing potential, as well.

Simply thinking out loud. Robert Wood Johnson Foundation + Disney Junior or Nick Jr…Hmmmm. I think it would work!

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Too much.

Too much paper. Too much information that I may never use. Signed papers. Photocopied papers. Brochures. Folders. Prescriptions. X-rays. Referral forms. And I only had one trip to the ER and an outpatient procedure. As I woke up to a new recycle pile, I saw every patient I wheeled out while piles of papers. I’m sorry.

Yes, some people need papers and folders and brochures and… Others, however, do not. With increasing personal electronic health record adoption, smart phone utilization, and general use of other electronic and mobile tools, there has to be another option to all the waste, to all the noise. Infographics have been suggested to redefine lab results for patients, so maybe something for discharge planning may follow?

Know of any facilities that should be replicated for the efforts streamlining hospital admission and discharge paperwork?

 

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In Desperate Need of Redesign – Pre-Op Holding

by Nursetopia on March 21, 2011

There’s nothing like seeing room for improvement when you’re looking at the issue from the other side. Case in point:

Unfortunately, I had to have lithotripsy last week, which gave me quite a bit of time viewing healthcare from the “other side.” One place in particular that stood out like a sore and ugly thumb – the day surgery pre-operative holding area. You know exactly what it looks like – tan and light blue walls, the usual blah hospital tile floors, stretchers interrupted with who-knows-what-patterned curtains that try to mimic private rooms, unadjustable overhead fluorescent lights, one bathroom, and yes, the typical and necessary medical equipment.

Even despite the deep need for redesign for pure aesthetic feel, the pre-op area is begging for redesign for one other very important reason – privacy. Plainly, there is none.

I changed into a hospital gown – while in pain – while my husband stood in front of the gaping hole where the two curtains “joined.” No matter where I moved in the “room,” I could still see out and others could still see in. Needless to say, I changed quickly and threw the blanket on myself, which wasn’t the best idea due to the wave of pain it caused.

At least I was set. I could just lay back, put the cold washcloth over my face, and try to not vomit everywhere while I waited quietly for my turn in the OR. Uhm, wrong.

No, I overheard everything for every single person having day surgery before noon that we pretend curtains “block” – every personal conversation, nurse-to-nurse interaction, doctor-patient Q & A session, and anesthesia pre-op meeting. I knew the last name of most everyone in holding, the majority of their physicians, their surgical procedure, and type of anesthesia. Not only that, but I knew their concerns and the concerns of their attending family members or friends. Yes, I am a nurse, but I gathered all this information while dealing with both pain and nausea. Hello? HIPPA?

I understand the need for pre-op holding to be a flexible space, but that is one area that deserves special attention not only for aesthetics but for privacy concerns, as well. There has to be a better way. Know of any facilities that have already figured it out?

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Rapid Cycle Change Projects Improve Quality of Care

by Nursetopia on March 18, 2011

This is part six of the Nursing Research Challenge.

The Article: Valente, S. (2011). Rapid cycle change projects improve quality of care. Journal of Nursing Care Quality, 26(1): 54-60.

Big Idea: Transforming Care at the Bedside (TCAB) is a national initiative to engage frontline nurses to improve care within medical-surgical units. Basically, it involves brainstorming, implementing small ideas, and evaluating them. If they work, the change happens on a bigger scale. If the ideas fail, they get scrapped and another idea is tested. In this study, the Greater Los Angeles Veterans Administration Medical Center, a tertiary care center, selected two units to serve as TCAB units. The TCAB teams focused on: improving storage and access to supplies, reducing wasted time, placing a TCAB banner on the units, improving pain medication order processes for all postoperative patients, a welcome banner for patients (which are Veterans, remember) with their permission, courtesy trays outside of meal hours, a unit quiet hour, an online orientation for physicians and trainees rotating to the TCAB units, hourly patient rounds, “Please Do Not Interrupt the Medication Nurse” poster/process, and several other great projects.

Survey Says!: Improvements have occurred all around – among nurses, patients, and family members. RN turnover for the units have decreased a whopping 58% percent! Direct patient care among TCAB RNs increased 10%, the number of certified nurses on the TCAB units increased 200%, and waste, falls, use of restraints, pressure ulcers, and codes have all decreased.

Quotable: “Rapid cycle change encourages the staff to try a potential change and test its effectiveness with 1 nurse, 1 shift, and 1 patient.”

“Nurse vitality has grown, and nurses have embraced their ability to have power and influence over change to improve care delivery for their patients. They have discovered that they can identify a problem and create, implement, and test the solution. They have also spread these innovative changes…to other units.”

So What?: No one better ask this “So What?” question. There are numerous other articles highlighting the effectiveness of Transforming Care at the Bedside. It is good for healthcare, good for business, and good for nurses. Let’s follow the evidence. Why isn’t every facility implementing TCAB?

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This is part four of the Nursing Research Challenge. While this article is not a research article, as a case study, it is a form of evidence.

Levels of Evidence

The Article: Stefancyk, A. (2009). Transforming care at the bedside: One-hour, off-unit meal breaks. American Journal of Nursing, 109(1): 64-66.

The Big Idea: Nurses rarely eat or take full breaks, and when they do break for lunch, food is eaten quickly and the break is constantly interrupted by phone calls, overhead pages, and patient calls. In addition to staff satisfaction, decreased or lack of break times can result in exhaustion and, ultimately, errors. One unit decided to change the way their day-shift nurses (who work 12-hour shifts) eat lunch by implementing one-hour, off-unit meal times via Transforming Care at the Bedside (TCAB)* initiative. Typically eight nurses worked on a shift, so two lunch breaks were scheduled with four nurses attending each lunch break. Nurses rounded on patients immediately before leaving for lunch and then handed patients over to the other respective nurses. When that group returned, the other group proceeded similarly. In addition, the unit used positive peer-pressure to get all nurses to take their two fifteen minute breaks throughout the day.

Survey Says!: Surprisingly, nurses were very reluctant to take one-hour meal breaks off the unit, worrying about patients and lack of time to finish everything in a day. However, the entire unit agreed to work the project in its entirety for one to two weeks and see how it worked. All it took was one full lunch off the unit for nurses to realize the benefits to themselves and their care. Nurses’ spouses even came and ate lunch with them, and one time the group of four nurses ate outside on the hospital lawn, using the time to socialize and enjoy the day. The article reports nurses never miss their lunch now, and they look forward to the time. While the project data is currently being formally reviewed, the unit says they know of no incidences in which the one-hour, off-unit lunches negatively impacted patient care or communication with the healthcare team. To boot, the unit is quieter during the lunch breaks, possibly because nurses round on patients immediately before leaving the unit, taking care of any pressing needs. 

Quotable: “This change…required a shift in the culture, and it didn’t happen overnight. Surprisingly, our biggest barrier wasn’t finding coverage for patient care but rather the nurses’ own reluctance to take an hour-long break. Overcoming that resistance wasn’t easy.”

“We used the weekly TCAB meetings to conduct our focus group discussion about the change…The nurses talked about feeling as if they were just arriving for the day, refreshed and ready to go, when they stepped off the elevator upon returning from their meal.”

“The feedback at the TCAB meetings also validated our predicted outcomes: the nurses reported feeling refreshed and less fatigued, enjoying increased teamwork and familiarity with their colleagues, and having improved time-management skills.”

So What?: This article was fascinating. It is a short read, so if you have a moment, definitely click on the link. This is a great example of how nurses at the bedside can positively impact their own practice and lives. Maybe you should print the article and suggest a similar idea to your facility?

You can read an entire TCAB article series (for free!) at AJN.

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Dream On, Dreamer

by Nursetopia on January 6, 2011

Who wants a dream that’s near-fetched? ~Howard Schultz, Starbucks Founder

Isn’t that the truth? If you’re going to dream, dream big. Ridiculous dreams set the true innovators and trailblazers apart from everyone else who claim it on their resumes. Far-fetched ideas cause paradigm shifts. Outlandish visions make people doubt and hope simultaneously.

I once read that if your dream doesn’t seem impossible, it’s not big enough. Makes me think about my dreams. What about yours? Go ahead and (cue the Everly Brothers) dream, dream, dream, dreeeeeaaaaaam. Dream on.

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Scary Goals

by Nursetopia on October 19, 2010

A mentor once told me told me to make one goal every year so big it scares me. It has been a good practice for me, stretching me to reach higher and think beyond my usual resources.

However, to date all of my annual BHAGs have been professional in nature – present here, write there, take the organization to the moon and back…you get the idea.

Now I have a personal (non-nursing related) goal – a business idea actually - that is boring a hole through my brain. I think about it every day. Every. Day. Oh, yeah – and it scares me to death. I’ve only shared the idea with my husband, who whole-heartedly and biasedly loves it. At times I think, I can totally do this. Other times I think, There’s no way I can pull this off. Well, we shall see because I’m totally going for it next year. Now, I just need some venture capital or an angel investor. Seriously. Business plan development here I come!

Are any of your goals scaring you? If not, you might be aiming too low.

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