I’ve seen it, you’ve seen it — the pace of change has ramped up exponentially. The leaps to new ideas that drive the need for new behaviors are happening all around us. Whether it’s a new app or a new way to learn, we have to adapt to the “new” almost every day.

What’s the implication for nursing? You can’t do today’s job with yesterday’s skills and tools. Innovation is more important than ever for the profession and the patient, so mastering innovation competencies should be a top priority. But we’re all so busy. How can we get started on the path to innovation at the bedside? It starts with understanding that health care is a constantly changing and complex system, so nurses and nursing leaders need different behaviors than those learned in the past.

The traditional skills for planning, controlling, and managing care are no longer adequate to move us along a trajectory that leads to better patient, staff, and system outcomes. These methods may have worked in the past, predictable, stable system, but today’s system is ever-changing and unstable. Expectations to address issues of quality, safety, errors, and resource use are increasingly urgent, which means we need a new understanding of change along with the use of innovation as a tool to address that change.

Teamwork is an innovation skill

We already know that building effective teams is important to patient safety, but I’m seeing more and more research establishing teamwork as an innovation skill. Teams that can develop, test, and share ideas build environments where creativity flourishes.

Magnet® designated hospitals seem to be particularly adept at understanding this reality, and I’m constantly learning from them about how they do it! Characteristics include shared governance structures, team diversity, proactive leadership, and an openness to risk taking. In addition, the role of the devil’s advocate, the ultimate innovation killer, doesn’t seem to flourish in creative organizations.

Creativity at work: Using Tinker Toys to enhance skills

So how do we build a team that innovates? One way is through creative workshops that show how gaps in innovation, knowledge, communication, and planning can occur in healthcare organizations. For example, consider a session where teams of nurses are assigned to duplicate a Tinker Toy figure using a similar box of Tinker Toys. Groups are given 90 seconds to send one person to inspect the built figure in a separate room, and then 5 minutes to report back and replicate the model with their group. The process is repeated for each group member. Trying to replicate the figure highlights skills essential to both innovation and patient care: collaboration, communication, and reflection.

The Tinker Toy activity simulates an experience nurses encounter frequently: continual and rapid bombardment with information they are expected to integrate the context of a given situation while making decisions to achieve optimal outcomes. In this simulation, an outcome is being driven by an ambiguous process using incomplete information, just like what too often happens with organizational innovation. Whether at the bedside or in the boardroom, driving towards the goals of clinical quality and patient safety requires the same skills as building a Tinker Toy — design thinking, communication, integration of new knowledge, and course correction.

Rules for the road ahead

Here are some other rules for the road to innovation.

• Tap into the power of the debrief. Playful or serious reflection after interventions or actions is essential to understand what did or did not occur. Aviation and the military understand the power of the debrief, but not health care. Nursing can lead the way.
• Accept the incomplete reality. Moving forward with incomplete or limited information is a reality of life. The need to be proactive and adaptive rather than simply reactive is a core competency we all must build. As Voltaire said, “Don’t let the perfect be the enemy of the good.”
• Get unstuck. Knowing where you’re stuck is often not easy to identify. Assistance from others, especially team members and trusted colleagues, can help move the needle.
• Have courage. Innovation requires risk and risk takes courage. Innovation challenges the status quo and can be met with resistance. A team can provide a safe harbor for all ideas, especially since not every idea will succeed. Nurses have mastered the art of courage to provide consistently safe effective patient care, so we’re already well positioned to foster innovation.

The future of health care is largely undefined, with rapidly changing models driven by government entities and private payers. Maintaining the status quo is not an option. The good news is that nurses know best what’s needed to devise new and better ways to improve care; after all, we’ve been problem solving for decades. Now is the time to get creative on a grand scale.

Lillee Gelinas, MSN, RN, FAAN

Editor-in-Chief