Fred is the president of a large multihospital healthcare system that is nationally recognized as one of the most successful vertically integrated healthcare systems in the nation. The organization was recently designated as one of the first providers in a statewide accountable care contract because of its organizational structure, which supports community-wide point-of-service care, holds exemplar quality standards, and is a positive workplace for healthcare providers.
Even though he holds a lofty position in the organization, Fred often interacts with individuals at all levels of the organization. He makes a point of visiting each of the hospital campuses and talking with gardeners, nurses, dietary aides, physicians, and, of course, patients and their families. Fred is committed to excellence in patient care and strongly believes that an empowered and engaged workforce is the best way to achieve that goal. Even though the healthcare system is widely recognized for excellence, Fred is uncomfortable simply resting on the status quo. He realizes that the competitive forces in the region and in health care and sweeping changes in how health care is provided and reimbursed threatens the status quo.
He meets with his senior executive team and tells them, “We can’t sit still and wait for the future to happen. We must invent the future and write the scriipt for how we will interact with the forces that can either make or break us as a healthcare system. If we are truthful with ourselves, none of us really thrive in a constantly changing environment, and we often long for stability. Unfortunately, we do not live in a stable environment. We are seeing major changes in healthcare reimbursement, challenges with serving the community as it changes ethnically and economically, threats from a union environment that demands more than our organization can offer, and a constantly deteriorating physical plant that needs replacement or refurbishment. We are compelled to accelerate new and creative thinking to proactively address some of these challenges.”
He goes on to tell the team that he is not comfortable with slow, incremental changes, and he challenges them to consider ways that the organization’s leaders can incentivize innovation from the point of service all the way to the top of the organization. He informs them that he recently attended a national meeting of presidents of healthcare systems and that innovation was the most discussed and hotly debated topic at the meeting. It seemed as if all of the healthcare leaders were feeling the need to reinvent their organizations to position them for the new accountable care act and the consequences of other national issues, such as the potential for terrorist acts in their communities, natural disasters, growth of diverse immigrant populations, and the impact of an aging population that experiences many chronic and acute illnesses.
Fred recommends that a comprehensive strategy be developed to create a culture of innovation and instill excitement about developing new and more economical ways to meet patient needs while still supporting the enhancement of professionalism among caregivers. Fred states that this is not a new budget-cutting initiative to meet the financial bottom line, but rather a willingness to invest in new, innovative ideas that can revolutionize how care is provided in primary care settings, hospital settings, and the home environment after discharge. He wants the executive team to consider how the organization’s leaders can partner with physician groups, community leaders, the organization’s nursing leaders, and clinical directors to instill and incentivize a culture of innovation.
Later, Fred meets with all of the CNOs from the system’s hospitals and informs them of his new vision for a culture of innovation. He states that he believes that nursing is a key stakeholder in creating innovations at the bedside and that he is willing to support key innovations in their testing phase and in implementing the changes.
The CNOs discuss Fred’s vision and the need for innovative thinking. They are convinced that advancing the nurses’ knowledge and expertise in evidence-based practice will be an important step in creating a culture of excellence and innovation. The CNOs ask the respective leaders in research and professional development to develop a plan to advance evidence-based practice at all of the hospitals. They also discussed the notion of having an annual nursing innovation conference that would recognize nurses who have developed innovations in care, education, or leadership and disseminate that knowledge to the entire healthcare system. They discussed a plan to financially reward the top innovation, which would be chosen by the executive team with clinical nurse representation and evaluated on financial, outcomes, and alignment with the healthcare system’s mission, vision, values, and behavioral standards. They agree to ask Fred for an innovation development budget that would finance an evidence-based practice institute and an annual innovation conference with financial prizes of $2,500 for the first-place winner, $1,500 for the second-place winner, and $1,000 for the third-place winner.
The evidence-based practice institute would use an established framework for the project development and a mentor–mentee format. The mentors would be the CNSs for research nurses initially, but it is anticipated that in the future mentors could be past graduates of the evidence-based practice institute. The mentees would be recommended by their unit managers and given 8 hours of pay per month to attend the evidence-based practice institute didactic classes and 4 hours of paid time to work on their evidence-based innovation projects. The institute would be conducted once a year with an annual evidence-based conference to recognize the new graduates and to disseminate the findings from their projects. The cost of the institute would also include expenses to have a nationally known nursing leader as a keynote speaker and to display poster presentations of the various projects, with podium presentations from those that meet the criteria and have the greatest impact on unit changes and patient outcomes.
The CNOs also lead the design and development of the annual innovation conference, but they decide to make this annual conference interdisciplinary and invite physicians and other discipline representatives to help plan the annual conference. Using the evidence-based practice institute as a model, they plan for a nationally recognized healthcare leader to be a keynote speaker on the topic of innovation and then for the rest of the day to be filled with presentations from the healthcare system’s employees and physicians who developed innovations to improve the workplace environment, patient outcomes, or workflow processes.
The CNOs are excited to present their proposals and prospective budgets to Fred and the senior executive team for consideration. They had one other proposal that they felt would advance the culture of innovation, and they realized that they would need Fred’s help to initiate plan. The CNOs recommended that the healthcare system partner with major businesses in the region to expose leaders of all disciplines in the system to the research and development process and to engage business leaders in advancing innovations in health care. Several major healthcare vendors had corporate offices and production plans in the region, and they would be perfect partners to design, build, and finance innovations in the physical plant, medical equipment, information technology systems, and workforce planning and resource procurement. Fred and the senior executive team are really interested in the three proposals and particularly like the notion of partnering with regional businesses to advance innovations in the healthcare setting. They also embrace the idea of advancing the knowledge and expertise of clinical nurses in evidence-based practice and the healthcare system’s leaders in the R&D process in regional businesses. The annual innovation conference that was planned to be interdisciplinary is also well received, and the senior executive team commit themselves to support these initiatives and to allocate funding to ensure their success.
Questions
How do you think the three initiatives will facilitate the development of a culture of innovation in the healthcare system?
What types of incentives do you think would be necessary to encourage and facilitate innovation among clinical nurses or other clinical leaders in the healthcare setting?
How effective do you think the initiative to expose the system’s leaders in the research and development of regional businesses will be in developing a culture of innovation?
What effect will advance nurses’ knowledge and competence in evidence-based practice on innovations at the clinical level?
What purpose do the annual conferences for the evidence-based practice institute and the innovation conference serve in promoting a culture of innovation?
Your responses should include the following:
(1) identify the stakeholders in each case;
(2) describe the case situation from the perspective of each stakeholder;
(3) apply the chapter’s content as a framework for analyzing the case; and
(4) determine a course of action to resolve the case, recognizing that there is not one correct answer or best way to resolve each case.
Cite all APA resources on a reference page.
