Inspiring Nurses to Become Innovators

Carol Pehotsky:

Innovation, not just a buzzword, something that we're constantly hearing, constantly exposed to in every facet of our life. It's seemingly unendless. And yet, we know that it must be part of our practice as nurses. Where does the nurse insert themselves to make sure that we're part of that innovation, to make sure that the needs of us as caregivers and the needs of our patients are heard and being met through innovation? I'm joined today by Dr. Nancy Albert to talk more about nursing innovation and where we can bring that to life in our practice.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing. Welcome back, everyone. Over the course of the past three years, we've had a couple different episodes on innovation.

We've heard about the process of innovation, and we've talked to some innovators themselves. Today, I'm so excited to welcome back to the show, Dr. Nancy Albert. Nancy is Associate Chief Nursing Officer and Executive Director of the Office of Nursing Research and Innovation, to talk a little bit more about innovation from her perspective and how we as nurses and leaders can all be supporting and encouraging each other to innovate practice. Welcome back.

Dr. Nancy Albert:

Thank you for having me.

Carol Pehotsky:

So, innovation could mean a million things. To center us today, how do you define innovation in nursing? Is it technology? Is it change? Is it devices? What does that look like in day-to-day practice?

Dr. Nancy Albert:

So, I want to take a step back before saying in nursing, because really, the definition of innovation is uniquely similar no matter what the field is. And that definition is that you have two components. You have novelty, something new, something never seen before or done before, and you need to have value. You could have something that's very novel, but nobody cares. It's not an innovation. It's an innovative idea that's not going to work. You can have something that's not new, but it's valuable, but you can't call it an innovation because it doesn't have that unique newness to it. So, everything's got to have novelty and value. And then in nursing, that's a big issue that people don't understand what innovation is. Typically, nurses think of innovation as a new widget, gadget, device, piece of machinery or equipment, something they're getting trained and in-serviced on.

Which tends to be something they could hold in their hand or touch and play with dials. But innovation is so much more. Innovation could be a playbook. It could be a tool that you're using to get answers to questions and then you publish your findings and somebody wants to purchase your tool. If it's valid and reliable, it's an innovation, right? It could be all kinds of things. Innovation could be new sensors that are coming out, some of which are going into our bodies coming down the road, but it's all around us. It's anything. I'll never forget one of our past CEOs had two daughters and one of the daughters put little clips in their hair to keep their hair out of their eyes. And that physician was a surgeon and he took a similar clip and created something to prevent atrial fibrillation.

All because he saw something his daughters were using. Again, sometimes it's taking something that may already be available, but using it for a completely different purpose. It's no longer a commodity you buy at the drugstore. It's a medical device now, and of course it went through some tweaking and refinement to get there. So, really, innovation could be anything that's novel or has value, and value is to the eyes of the beholder.

Carol Pehotsky:

Wow. <Laugh> And so, it's easy to get lost in the intoxicating possibilities of what that

Dr. Nancy Albert:

Could be.

Carol Pehotsky:

Bedside nurses spend more time with patients than anyone, really, under the backdrop of what do we have, what do we need, what could be novel and value? How does that frontline perspective help and position a nurse to identify those opportunities?

Dr. Nancy Albert:

The frontline nurse should constantly be saying to themselves in their head, or maybe 2020 as they're driving home, it could be after the fact, “What could I have done differently today? What do I need? What are the issues I'm seeing day in and day out? This happened again. What are the problems that we can't seem to solve?” And I don't mean things like staffing. I mean things in day-to-day, unique patient care. I'll give you a quick example. I was working with a nurse who had a cool innovation. And when we first met, she said to me, "You know Nancy. A couple years ago I was opening little ampule.” She worked in an ICU and she said, “I would cut my hand on the glass all the time.”

Dr. Nancy Albert:

And she said, "I used to say to myself, we need something to prevent nurses from cutting themselves on the glass." And she said, "Look what I found." She showed me an ad from an article, she must have torn it out of a journal she was reading, that are ampule little rubber things to prevent you from creating problems with blood on your fingers because of cuts. And she said, "I should have thought about this years ago. So, I'm coming to you now because I've got a new idea." And she had a really good, fascinating idea. It never got implemented at Cleveland Clinic, but I'm here to tell people that it is now a product purchased out there. And when I go into exhibit halls at national meetings, I see it all the time and I want to scream that our team at the time didn't have the mindset to move it forward.

I think innovation could be anything. Just ask yourself, “What's driving me nuts? Why don't I have the tools I need or the systems I need, the processes I need to get from A to Z, and maybe I can create it and be that innovator.”

Carol Pehotsky:

I think for me at least, when we think about inventors or innovators, it conjures the science lab and the cartoons. Which is one version of that, but not the only version. So, I imagine there are other nurses that also wouldn't necessarily think of themselves as inventors or innovators. How do you encourage nurses to really understand that they can be inventors or innovators and tap into that creativity?

Dr. Nancy Albert:

Ye. I think the best way to do that is to have people understand that innovation is for everyone. My mantra is that every single nurse at Cleveland Clinic should and can be an innovator and every nurse around the country can be. So, what are the steps to make that happen? Years ago, when we had our professional practice model, I had to argue with people to make the very first rung include bringing forward an idea for change. You could call it my two cents, you could call it whatever you want, right? And people that were developing the professional ladder thought, oh, that should be at the top. You know, it's all clinical stuff at the bottom. And I said, no, every nurse needs to know what issues are preventing them from delivering care the way they should and coming up with an idea for change.

First, they have to recognize there's a problem or an issue or a need, and then they need to be willing to dive in and take those next steps and say, “Can I solve this? Can I do something different? Can I be the innovator?”

Carol Pehotsky:

We're very fortunate to have your office that's so helpful in that space. So, we get that nurse that has that moment that says, “I think I have something here. That might feel like a big next step to take. What is that first step and what does that journey look like for that nurse?

Dr. Nancy Albert:

I would say that in many cases when nurses come to me, they already have an idea in place. But if they don't have an idea in place, the very first step is to talk about the need or the issue. And it may be that when you talk about it, you don't talk about it as an island. Maybe you need to bring in an engineer or somebody in housekeeping or in dietary, depending on what the need is. It may take a team to look at it from different perspectives and figure out the best way to solve the problem. So, really innovation is either solving a problem or fixing a need that we have out there. And if you bring in other people that may help get the creative juices flowing, sometimes it's easy for us to go online and look to see what's already out there.

And that's great because we need to know what's not innovative anymore because it's already available.

Carol Pehotsky:

Right.

Dr. Nancy Albert:

Right. But then some people have a hard time getting past it. They say, "Well, it's already done. I can't do anything more." We need to get people to understand that innovation is and can happen and that they could be the catalyst for it, especially if what's available doesn't really work. It's not great. It's just okay. We want to get to something better.

Carol Pehotsky:

Yes. It reminds me of a conversation you and I had where it is 2026. Surely there is a solution for X.

Dr. Nancy Albert:

Yes.

Carol Pehotsky:

And you said, "Gosh, I don't know, Carol." And we went out there and there is a solution, but it might not be the right solution. And, and thankfully, we've had nurses stepping forward with some ideas around how to fix that. So, it can be just as simple as a question that says, “why are we still doing this?”

Dr. Nancy Albert:

Right. And usually somebody gets sick of the problem enough that they start thinking about how they could do a workaround. That's why we have so many workarounds in nursing. Some of those workarounds are probably innovations, but people just need to share it with us so we could bring it forward in a more formal way. And maybe eventually a company could create the gadget or widget, or we could write up the process and share it with the world.

Carol Pehotsky:

The last episode we talked about processes around evidence-based practice. And there's definitely a process for bringing innovation forward. We talked about the process of define the question, does the evidence exist? Do I implement? What does that look like? What does that process look like for innovation?

Dr. Nancy Albert:

The process for innovation is a little different, but also a little similar. You need to understand the background and foreground of the problem issue or need so you could understand what's important because you don't want to innovate something that's going to fix one problem but cause 10 new problems, right? You want to make sure that you understand the bigger picture. But once you have an idea, I tell people to get out a piece of paper and draw it. Doesn't matter if you're not an artist, doesn't matter if it's one dimensional instead of three dimensional. Draw what you want. If it's a process, draw the steps of the process. Maybe it's more text and words, but if it's something that you're trying to create or fix and you see it as a 3D, draw it as best as you can and then come and share it with us because then we can help with the next steps.

In most cases, we say the first idea is not the last idea. We tell people all the time that failure leads to success and you almost have to fail to get down that road. So, think of failure as a step towards success. If you have to throw away the paper and start again, that's okay. It may be that it's too complicated the first time or it's too simple or you forgot to think about X, Y, and Z. You got A, B, and C, but you forgot X, Y, and Z. So now you have to add those layers on or take extra complications away to finally get to the end game.

Carol Pehotsky:

That's got to be hard though too. You think about having your little prototype baby or paper baby that you've spent a lot of time thinking about. How do you work nurses through it's okay to iterate on that?

Dr. Nancy Albert:

I call it refinement. Iteration is a good word as well. And I tell people upfront that this idea that you're trying to bring forward, which you see now may not be what we deal with at the end game, but we're here to help try to advance you so you can get to the end game and so that it's truly novel. Because remember, a lot of times people have incremental innovation or incremental changes. It's kind of like the smartphone. We've had a smartphone for a while, but maybe when the smartphone first came out, it was more of a phone and now it's your email and it's your movies and it's your music and everything else. And so those are all incremental changes. It may be that something's already out there, but this is an incremental change, and we need to make it novel enough so that somebody out there will be interested in commercializing it.

So sometimes you have to have failure before you get to success. Patience is a really important virtue. <Laugh> And determination, I would say, when you're trying to innovate.

Carol Pehotsky:

With that, you'd mentioned some innovations are too simple and maybe more complex, but some of them are relatively simple. Why is it so important to not overlook those small opportunities for innovation?

Dr. Nancy Albert:

I think it's really important not to overlook the small opportunities because we need to grow in nursing and we don't want somebody to develop something and force us to use it. We want to be our own masters of change and our own masters of what works best. Nurses are with patients twenty-four-seven. We say that all the time, right? We're the ones who really understand the issue and we could be the best people to come up with the solutions. Again, because it's an iterative process, sometimes it takes a team, a small village, to come together to say, "Add this on. Take that away. Make it on this side instead of that side. You know, turn things around, maybe a different color, a different shape, a different look, all to get to that end game." And so just being creative in your mindset.

There are people out there who say, "I'm not creative. I'm probably not really a good innovator." I would say that there are roles for nurses everywhere through the innovation process. Maybe you're the leader who helps facilitate bringing something in. Maybe you're the doer who helps implement it to say, "Yes, it's working just like you expected." There are different work roles for people in innovation in addition to the innovator themselves.

Carol Pehotsky:

I think it's a great point because it opens the nurse to, you don't have to have the idea just to be part of the process. You might be the person that says, "I tried this. Here's what went well and here's what didn't." You're still part of that process and that feedback and a very important part.

Dr. Nancy Albert:

Yes. That's why we do ideation sessions and you hear about them. Hackathons, ideation sessions. Those are all terms that we use now. It's an exciting way for people to come together from different fields possibly, or at least different roles within the field to innovate and ideate. People talk about what the issues are, get the teams together at different tables who all share the same issue or problem, and then think about how we can solve that problem in a way that has never been solved before. You may write down 50 ideas and it may be idea number 51 that is the magic one, right? <Laugh> But you have to go through that process because usually when we first think of ideas for change or innovations, we think of what's common to us with the first thing that comes into your head.

And that may be too close to reality. And it takes time to get out there. Also, it takes people understanding that it's okay to let people know that you're way out there. <Laugh> Think about the old horse and buggy days and now you have a car. Who would've thought a car would replace a horse and buggy? Totally different. Doesn't look anything like it, uses metal, et cetera. We think about all the things we have now that are innovations, and some of them are totally opposite of what we're doing currently. So, the wilder the innovation, the more likely it is to have that novelty and to actually be something that takes off. Think about alcohol impregnated caps that we put on our IVs to keep the hub clean and keep it free from potential bacteria that could lead to infection.

It was a simple little idea. It solved a huge problem of hospital acquired infection, possibly, or CLABSI, and it spread like wildfire. All because it was a huge problem and somebody said we need to do something differently. So that's where we want our nurses to get to. What are the problems, issues or needs and what can we do differently? And then let's be creative and think of something that will spur us on.

Carol Pehotsky:

And be brave enough to throw out that wild idea sometimes.

Dr. Nancy Albert:

And be brave enough to throw out the wild idea knowing that somebody may say, "Oh, she or he is crazy." <laugh> But we need to also say, "No, this is exactly what we need. You're a perfect person to be creative." We need to almost encourage those people to come forward with their ideas. Also, I've learned that people that have that creative mindset have it for more than one thing. So, they come up with one innovation and then they come up with more. It may not be that they all work, but their mind is constantly going and those are the people we need to tap.

Carol Pehotsky:

We've already talked about some barriers in terms of even just seeing yourself as a potential innovator, really taking that idea and being brave enough to say something about it. What other barriers tend to prevent nurses from pursuing innovation and how can their leaders and organizations help remove those barriers?

Dr. Nancy Albert:

I would say the number one barrier is being risk averse. Think about it. As a nurse, we don't want to make mistakes. We don't want to have errors, right? And so, if you come up with a cool idea and people are thinking that'll never work, or that's too costly, or I'm not even sharing it with my boss because et cetera. We need nurses to think that it's okay to be risk averse when it comes to innovation and creativity, because people won't voice their cool ideas unless they get past that “I'm afraid to tell somebody about this. They'll think I'm nuts. They'll think this is stupid because it's different.” It's novel and people can't see it in their own minds. So that's one of the big ones. Also, innovation does take extra work. You've got to create, then you've got to refine, then you've got to sell it to the leads that are going to help us bring it to life or to commercialize it, et cetera.

That's a piece of it. And then you must have passion, determination and persistence because it takes time and effort. A typical innovative idea, for it to go from that first idea to actually an innovation that's commercialized, is probably your two-or-three-year process.

Carol Pehotsky:

Wow.

Dr. Nancy Albert:

Because it takes time to get industry partners excited about it. Now, if you've got a really good story, it could go quickly, but they're trying to make money, not spend money. <Laugh> And they don't want to just make $50,000. They don't want to just make $500,000. They want to make $5 million or $5 billion, right? So, they're looking for ideas that they think have the biggest chance of making a big hit. And we have to help them to understand how this innovation cannot just be used in one little niche area, but it can be used maybe at home, maybe in babies as well as adults, as well as critically ill, as well as nursing homes. The broader the innovative idea, the faster it is to get from point A to the commercialization process.

Carol Pehotsky:

And organizations really should be thinking about creating that culture of innovation, right?

Dr. Nancy Albert:

Mm-Hmm.

Carol Pehotsky:

Throughout all levels of the organization. What does that require from leadership?

Dr. Nancy Albert:

From leadership, I think it requires a few things. You have to have systems or processes in place that set people up to share their ideas, share their issues, share their needs, share the problems, right? So, whether it's my two cents or whether it's what we call our step forward with your innovative idea, no matter what it is, they need to have a process. And it's got to be simple and easy to use. It can't be 10 pages long. It's got to be quick and easy. And there's got to be somebody on the back end who understands enough about innovation to not say, "Oh, this will never work," and throw it aside. That's part of it. And then we need to make sure you've got people behind the scenes who could work with the nurse or the team, could be a team of nurses and others, to bring it to life.

Again, it could be a process. It may not be a widget or gadget and may not be anything that needs a 3D printer. It's just your brain power, your knowledge. It's your knowledge worker in that case. But you need to make all the steps in an orderly fashion or make sure it's clear and concise, make sure people can understand the rules, all of those kinds of things. It's helpful when you have people behind the scenes who could work with you, who can ask good questions and help push you to refine it in a way that makes it easy for everybody. So that when we do try to push it out the door and see if we can commercialize it in some way, even to commercialize it by, if it's a process or a tool to put it on a website so people could find it and ask permission to use and maybe purchase it, we want to get to that end game.

There are different steps along the way. And leaders are critical in really allowing people to take the time to bring that innovation forward.

Carol Pehotsky:

We were talking before recording about a consortium you had been at with people in roles like yours from other large

Dr. Nancy Albert:

Organizations

Carol Pehotsky:

And their approach to innovation. What did you take away from that gathering?

Dr. Nancy Albert:

What I took away from it is that every system defines innovation maybe in a similar way. Their definitions may look different, but they all kind of say the same thing. But they carry out the innovation processes totally differently.

Carol Pehotsky:

Really?

Dr. Nancy Albert:

One institution, a large one, actually pays an outside company to come in and help people to develop tools, devices and gadgets. So, they don't have a lot of process innovations or playbook innovations or tool survey kind of innovations. Their innovations are all what you could touch, feel, see, hold in your hands. Another institution has a huge setup that could be taken down and moved around to different parts of their campus. So different hospitals, maybe in the lobby area of one, someplace else. There's a 3D printer that shows up. There are all kinds of supplies and they tell people, "Come in here and just play." And then somebody's there who can help support them and bring innovations forward. We took the mindset of having a creativity session, and it was four hours long. And the first step of it is to identify what problem or issue we want to solve.

Then once we know that upfront, we do our homework and bring it to the table, make sure we have the right people in the room that are intimately involved with that problem, issue or need. And then we explain what the background is, what the foreground is, and we say, "We want you to be creative." And then we use post-it notes and a lot of refinement to get to the point where we can understand the issue and come up with something creative. Usually at those creativity sessions, if you have 20 people there, you probably end up with four or five different ideas. And then you can vote on them and see which one is the best one. Which one should we move forward first? Oh, I can't choose. We need to move forward two different paths. So, there could be lots of different ways to bring innovation to life.

Carol Pehotsky:

Wonderful. I'm going to really challenge you here maybe, especially because of how fast things are changing and innovating. <Laugh> So looking into your magic eight ball, what areas of healthcare do you think are especially ripe for nurse-led innovation for the next two to five to 10 years?

Dr. Nancy Albert:

I would say that all of our colleagues in IT should be listening and should be acting now because we know that informatics is going to change dramatically, not just because of AI, but because of all the sensors, gadgets, widgets, and microchips that are available now that weren't available before. We need to help nurses be able to document quicker, more accurately, easier. We need to have nurses spend less time documenting period, more time at the patient bedside. So, anything related to IT is going to be a huge win down the road. Now working with the different IT companies whose medical records we all purchase may be a different problem to solve because they have their own innovators and they may not welcome outside ideas, but we need to figure out how we can either have something adjunct to it or get them to understand the need. In addition to that, I think that we have so many new drugs out on the market now.

All you have to do is watch TV and see all the drug commercials. Because we've got new technologies available to us, I keep coming back to sensors. There are sensors now that could be inserted in our bodies and give us valuable information about different problems, issues or needs. And so, we need to come up with the innovations around that. So, the sensor is available, we know how it works, but how do we bring it to life in reality? Patients don't want to have to do stuff every day. They want to live their life. They want to pretend the sensor isn't there, but be alerted when there's an issue, right? So it may be that nurses have to come around and start thinking of how we could make the lives of our patients easier based on a new medical procedure, a new surgical procedure, a new device that's available.

Because the device company is just trying to make sure the device works and that the device does what it's supposed to do. But then we need to figure out and see if we can innovate about how everything comes to life around the device.

Carol Pehotsky:

So, we've talked about how personally committed an innovator and inventor is to their idea. And failure is inevitably part of that process. How do we help that innovator stick to it, keep going? How can leaders support them through an incredibly challenging situation?

Dr. Nancy Albert:

Yes. You know, failure is part of the process and because it's part of the process, I like to tell innovators in a one-on-one scenario, we want you to fail fast. And what I really mean by that is if it's not going to work, set it aside completely so that you could be creative to come up with a new solution. If you keep going back to the failure, you're not failing fast. You're lingering and that's going to slow you down. It's going to create problems with your passion for the project overall. So, we really want people to fail fast, crumble the paper up, throw it in the garbage, and then start again. It could be the iteration is similar but different enough, but failing fast is really important. And then we need to make sure that leaders need to understand that the person failed, but they didn't really fail.

They're just moving toward a new approach. And leaders need to give encouragement, they need to give support, they need to say, "You'll come up with the right solution. You need to stick with it. This is so important. This is so valuable and I want to see you succeed." And that will give encouragement to people to continue to move forward. In our innovation office, we do the same thing. We have a PR committee, a peer review committee, and they get to review the innovation that somebody brought forward. We get to ask questions of the innovator, and then after the innovator leaves, we discuss it. The whole point is to figure out how we could help that innovator do better, be better and make their innovation more important. And the innovator needs to be open to that because it's not truly a failure, it's growth.

We say to them, "This doesn't mean you did anything wrong. We're just trying to refine it more." I try to use the word refinement often, iteration refinement, and tell people, I tell them up at the beginning, "This is a process. You will fail.” The goal is to fail fast and move on. So don't get stuck in the past. Just say, "Okay, phase two, phase three." It's almost like taking the next take if you're making a movie. <Laugh>

Carol Pehotsky:

Before we call it day, I'm hoping to ask you a couple of fun questions.

Dr. Nancy Albert:

Okay.

Carol Pehotsky:

You know so much and you provide so much value to the nursing community. Outside of nursing, what's one skill you've always wanted to learn?

Dr. Nancy Albert:

One thing in the water and one thing in the sky. Because I am a little bit of a daredevil, but I'm almost a little afraid. I want to learn how to scuba dive. I actually one time sat in a pool with scuba gear on and the person who was teaching me made me sit at the bottom of 10 feet of water at a hotel pool for an hour to get comfortable. But I've never taken those next steps. I really feel like I could not scuba dive today.

Carol Pehotsky:

I'm getting anxious just listening to you.

Dr. Nancy Albert:

<Laugh> Yes. The other one is in the sky. I've always thought maybe I'd like to learn how to skydive. I don't know if I would ever actually do it. Maybe somebody would have to push me out of the plane, but I'm just fascinated with that idea. I did one of those things at one of the amusement parks where you pull the cord and you drop and I remember swearing profusely on the way down, but it was a lot of fun. It was a weird adrenaline rush that you don't normally experience in a good way.

Carol Pehotsky:

You're such a value to our organization, Nancy. When I think about the mentoring and advice that you provide nurses of all comfort levels and all experience levels, it just can't be measured. So, in light of that, what is some great mentoring or advice you've received?

Dr. Nancy Albert:

I love getting mentoring advice because I think it's so important to growth for all of us. Early on, somebody told me to stop writing book chapters because it takes two or three years for a book to come out. So, you write a chapter and before it comes out, it's totally old. She told me to say no to book chapters, give a name of somebody who can write a book chapter so that I could focus on research and innovation and move nursing forward. I just finished a book chapter, and I think about that advice all the time. It was a friend who asked me to write it, and I felt like I had to say yes because I try to hold my friends close, but that was one piece of advice. And then I think the next piece of advice is I try never to say no.

I do sometimes have to because I have to sleep at night, but I think because I was so good at not saying no, it opened doors for me in many different ways to help me become an expert in specific fields that maybe I would have never been as good at because I was at tables with physicians and other thought leaders and it was just amazing to sit there and listen.

Carol Pehotsky:

Wonderful advice. Thank you so much for joining us today.

Dr. Nancy Albert:

Thank you so much for having me.

Carol Pehotsky:

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other. The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.