Discussion 8.1: Indicators of Innovation
Discussion 8.1: Indicators of Innovation
For your work area:
- Give two examples of significant innovations that could be made.
Increased use of telehealth and enhancement of real-time telemetry monitoring are two significant innovations that could be made within the hospital setting.
- Identify the factors that are driving the need for these innovations.
Increased use of telehealth needs is a result of the backlog from people who have not attended to their regular check-ups, remain behind with an increased risk for adverse events that would increase and prolong inpatient hospital admissions.
Real time telemetry monitoring factors are the increased patient acuity increase with access to records that could substantiate physician outreach by RNs for advisement and consultations.
- Explain how the factors that are driving your identified innovations are related to any of the following indicators of innovation: Unexpected success, Failure, Change, Incongruity between what is and what should be, Process needs, Demographic changes, Changes in perception, mood, meaning, and/or new knowledge
Telehealth innovation is needed as our system has moved further for process needs to digital records. There are demographic changes with expected immediacy for information and acceptance of telehealth records by patients and family. Recent COVID-19 pandemic resulted in the awareness of lack of in person access to physicians which remains limited. There is also the change for more relaxed regulatory standards that has aided acceptance to use telehealth to access physicians for outpatient needs while inpatient.
Telemetry (cardiac) monitoring innovation in real time would result in successful awareness for patient needs. The failure by having a central monitoring station overseeing multiple patients is not enough currently with spot checks for strip recordings combined with high patient loads by floor RNs that result in slowed response rates for critical arrhythmias. The demographic changes of older aged populations and higher patient acuity loads placed on mixed use floors, some with and some without remote telemetry monitoring are another point in favor of more real time telemetry monitoring that would be available to the RNs. There is an expected perception that when a patient is inpatient, the care will be total and complete for the patient. This would drive a purposeful change for enhanced real time telemetry monitoring available to the RNs.
Waxman KT DNP MBA RN CNL CENP, (2018). Financial and Business Management for the Doctor of Nursing Practice, 2nd edition. Springer Publishing Company, New York. Pages 327-343
One innovation that can be made is a better communication system for patients who have arrived in the clinic. The incongruity between what is and what should be, and process needs are major driving factors behind this need (Waxman, 2018). There is a metric for cycle time that the clinic is judged upon. The time from when the patient enters the clinic to the time they leave. This time should be at 30 minutes to optimize provider schedules. Provider schedules need to be optimized to maximize reimbursements through patient visits. This directly impacts the revenue earned by the clinic. Often, the providers in the clinics are unaware of patient arrivals due to the lack of communication from the front desk and MA staff. A new notes and color system indicating which part of the process the patient is in can help alleviate unnecessary downtime and increase the number of patients a provider can see. This can increase the population served by the clinic. To best achieve this initiative, we can build upon the software or technology we already use. There are color tabs next to each patient and a notes section for free text. Each of these can be used to signal when a patient has completed the different parts of the office visit.
Another innovation would be to utilize a hybrid schedule of telehealth, video visits, and in-clinic scheduling. Prior to the pandemic, we had not been able to implement a telehealth visit model. This is an example of unexpected success. We implemented this measure to ensure patient needs were being met during the pandemic and helped us to reach patients for routine and sick visits. Currently, we have telehealth/video days or blocks and in-clinic blocks. There are a significant number of no-show appointments during each block. This type of underutilization of providing scheduling costs the facility in terms of non-productive hours. By creating a hybrid schedule the provider can make calls in downtimes, during no-show appointments, or in smaller blocks throughout the day. Since the onset of the pandemic, telehealth has been an incredibly useful tool for primary care.
The regulation around reimbursement for these visits concerning FQHCs has been relaxed and our clinic should be able to capitalize on the extra touchpoints with our patients. This can benefit the patient demographic by allowing patients who cannot miss working the opportunity for a follow-up with their PCP. The medical assistants can start triaging and calling patients first thing in the morning to prepare the patients for the provider calls. Technology can assist with these visits by also allowing the video visit component if a patient has something that requires the provider to visually see the patient. This hybrid model can also help us shift towards being in the clinics to see the patients who require in-person visits, while still delivering quality care to those who can’t make it in.
Waxman, K.T. (2018). Financial and business management for the Doctor of Nursing practice (2nd ed.). Springer Publishing Company. ISBN 13: 9780826122063
Discussion 8.1
In the ICU that I currently work in, we receive many patients that go through alcohol withdrawals. There is adequate evidence-based research available that describes the best ways to treat and help patients going through withdrawals. The two largest issues that rise when helping these withdrawal patients is their electrolyte imbalances and behavior. Two innovations that could be made should relate to treating the electrolyte imbalances and behavioral issues. Many alcohol withdrawal patients come in with a very low potassium, low magnesium, and other electrolyte imbalances which can disrupt organ function. The majority of alcohol withdrawal patients I encounter tend to be aggressive, loud, and dangerous towards clinical staff. These are safety issues that require innovations in order to help the patient and staff. Factors that drive the need for these innovations include the incongruity, process needs, and a change in new scientific knowledge.
The incongruity involves what is happening and what should be happening (Waxman, 2018). Oftentimes, looking at the customer, or in our cases, the patient is what will help us most. The alcohol withdrawal patients are withdrawing from a substance that they have been relying upon and generally, the patient will ask for more during their stay at the ICU. There has been evidence-based research discussing the benefits of giving alcohol withdrawal patients small amounts of alcohol during their hospital stay to help manage behavioral issues instead of giving high amounts and high doses of benzodiazepines or antipsychotics. The patient’s behavioral issues impact the healthcare team’s ability to assess and treat the electrolyte imbalances because we are unable to draw labs, acquire IV access, or give oral medications. Intubating an alcohol withdrawal patient because of behavioral reasons is unethical and is avoided in most hospitals but under some circumstances, it is the safest for the patient and staff.
Process needs involve identifying the weak points of a team’s approach to particular situations (Waxman, 2018). In my hospital, each intensivist or hospitalist has their own way of managing an alcohol withdrawal patient. Some treatment options work better than others and the process needs aspect involves eliminating or reducing the points that do not work (Waxman, 2018). If the healthcare team was to come together to design a protocol for managing these patients with evidence-based research, then there would be more consistency between healthcare team members and patients.
The change in new knowledge indicator discusses finding better ways of doing tasks and improving the processes (Waxman, 2018). Like mentioned earlier, giving patients small amounts of alcohol is a solution that could help manage the main issues of alcohol withdrawal, electrolyte imbalances and behavior.
Reference
Waxman, K.T. (2018). Financial and Business Management for the Doctor of Nursing Practice. Springer Publishing Company.
Discussion 8.1: Indicators of Innovation
Two examples of significant innovations that could be made in the emergency department that I currently work in include having access to point of care troponin lab values and triaging of ambulances/ambulance services. The first innovation that I mentioned involves having access in the emergency department to a machine that can give us lab values within a few moments, rather than having to send the tubes of blood to the lab and wait for them to result. We have a few lab values that we have access to running point of care testing in the ER setting, but not troponin. Since a troponin is a common cardiac marker that we routinely draw in the emergency department setting, it would be a great tool to have point of care access to this lab value on a routine basis. The second innovation that I mentioned involves triaging of ambulance services. This involves a triage nurse seeing an ambulance patient, if they are alert, responsive, and oriented, triaging them, and then if fitting, they sit in the waiting room and wait for a room to become available. Another great innovation would be the triaging of ambulance services. If a medic responds to a call and determines that this patient is not emergent, has access to transportation to seek help for their complaint, and is alert, responsive, and oriented, then they would not be an emergent transfer.
There are many factors driving the need for these innovations. COVID-19 and staffing shortages have put a strain on our healthcare system, as everyone here knows, and especially in emergency departments. Having access to important lab values at the tips of your fingers in only a moment’s time can help a nurse provide better care to patients in the department. Patients who are in a true emergency situation having access to an ambulance when needed is also a priority, rather than waiting an unnecessary amount of time because of non urgent calls busying the system.
According to Drucker, there are numerous indicators that can drive innovation. The main indicator driving the need for point of care troponin lab values in the emergency department setting involves failure and a change in process needs. I cannot name the amount of times that I send lab work to the lab to be run and they are either lost, hemolyzed, or something happens in the process where the lab values never result in the computer. This causes delayed treatment for patients when their lab values do not result in a timely manner. When I run a point of care lab value, I am able to do the test myself, so I know what the result is, that the lab has been completed, and am able to communicate this result to the provider. The main indicator driving the need for triaging of ambulance services involves addressing a change in process needs and changes in perception.
The common perception for many of the local community is that if they do not want to wait in the waiting room of the emergency department, then they will just go home and call an ambulance so that they will get put back in a room right away. This is a huge perception that has only gotten worse due the current pandemic and stressors on healthcare systems. This perception needs to be addressed and corrected. When a non urgent patient comes in through an ambulance, they need to be triaged and put into the waiting room if deemed necessary by the triage nurse. If every non urgent patient who calls an ambulance has to wait for a period of time in the waiting room, just as if they would have walked through the front door with the same complaint, then we can help to adjust this process change and perception change. In the department I currently work in, ambulance patients often get assigned a room right away and then are triaged by the nurse that is assigned to that room. Sometimes these ambulance patients are not urgent by any means or have no real complaint and could easily be triaged and wait in the waiting room along with everyone else. Overall, I think that both of these innovations could help change the care that I can provide as an emergency department nurse to my patients.
The lecture mainly involved the discussion on different indicators of innovation considered in healthcare management. These indicators are often used to signal the appropriate approaches that can be undertaken to ensure that healthcare organizations remain relevant in the dynamic healthcare industry. Process needs, demographic changes, shifts in perceptions, mood, and meaning are some of the examples of indicators of innovations covered in the lecture (Waxman & Barter, 2018). Any process needs in a healthcare organization could trigger innovations or changes geared toward improving different processes. On the other hand, the demographic shift may determine approaches or processes that could lead to innovative thinking.
Chapter 14 of the lecture notes discusses important aspects of entrepreneurship and how it can foster innovation within businesses or healthcare organizations. It also provides a business acumen overview which can help individuals understand some of the essential aspects of running a successful healthcare organization through innovations. Some examples of significant innovations that could be derived from this chapter include creating a more effective process for ideation and development and improving team communication and collaboration. Additionally, implementing the concepts shared in this chapter could lead to improved operational processes.
The factors that are driving these innovations include significant changes in cultures and the demographic composition of the organization. Culture, as a driver of change, in this case, is related to changes in perceptions, mood, meaning, and/or new knowledge (Entrepreneurial Leadership Transcript, n.d). Significant changes in culture are attributed to shifts in perceptions of the people and the acquisition of new knowledge. In such cases, an organization ought to bring innovative changes that would ensure continued success in the overall operational processes. Changes in demographic composition, as a driver of change, are related to demographic changes. In most cases, the demographic composition determines the approaches that ought to be undertaken to ensure overall improvement in the operational processes. Demographic composition/changes may trigger innovative ideas that may, in the end, enhance collaboration and overall improvement in the operational processes.
References
Entrepreneurial Leadership Transcript. (n.d.). Entrepreneurial Leadership Transcript. https://lmscontent.embanet.com/BDU/ECO605/Transcripts/BDU-DNP-ECO605_W08_M01.html.
Waxman, K. T., & Barter, M. (2018). Entrepreneurial leadership: Innovation and business acumen. Financial and business management for the doctor of nursing practice, 327-343.