Creativity is thinking up new things.

Innovation is doing new things.

Theodore Levitt, Economist

Dr.Mala Thayumanavan
General Manager-HCG Group
 1.5 RN/1000
population versus 2.5
(0.15 million versus Older population
2.5 million RN) Manpower High in India-8.3%
shortage
Cost Life expectancy
in India-68.7%
Litigation
/Insufficient public Ageing/sicker
funds/Medical Challenges population/
Insurance/ Financial chronic illness
viability NCD 53% of
disease burden
in India
Primary Care Healthcare
Shortage disparities
 Public spending on health-lowest in the world
 90% ‘Out-of-pocket’ on medical expenditure
 39 million pushed into poverty from ill health yearly
 32% Indians refuse treatment due to high cost.
 35% Indians take loans and sell assets for treatment.
 3 times increase in cost of hospitalization in 15 years.
 Patients-discerning and demanding.
 More access to information and
a wider array of choice.
• Comparison of services
• Switching to other hospitals
 Changing needs of the consumers
 New definitions of quality of care
 Cost consciousness
 Patients want to know the quality of care provided
 Patient shouldn’t be thought of as a patient, but as a
consumer. Today’s health care through patients’ eye
If you always do what you always did………
You will always get what you always got

Effective nursing leadership is central to the success

Clinical leadership as the key to promoting high-quality
clinical care and transforming services to achieve greater
levels of excellence
Jonas, McCay and Keogh
Clinical leaders are the health professionals best placed
to lead change in practice and suggest innovations that
impact positively on clinical quality.
 Clinical leaders are found at the bed side
 Clinical leaders can be at any level where clinical staff operate.

 Clinical leaders is ‘...one who possesses clinical expertise in

a specialty practice area and who use interpersonal skills to
enable nurses to deliver quality patient care.
Harper, 1995
 Clinical leader is: ‘...a nurse directly involved in providing
clinical care that continuously improves care through
influencing others.’
Cook, 2001
 Clinical Directly
Competence Expertise involved in
patient care
Emotional Influencing
stability others
Confidence IPR skills
Vision Approachable
Characteristics
Team Effective
building communications
Driven by values and
beliefs-Congruent Role model
leader Quality Motivators
Promote Empower Nursing
values people Care
Leaders become great, not because of their power, but
because their ability to empower others. John Maxwell
“Innovation” is a new method and practice device.

“Innovation” is the process of developing new approaches,

technologies and ways of working.
International Council Nurses

Innovation is the process of turning good idea into something

that can be used, something that is implementable and
achievable and hopefully will bring about better patient care
 Quality-safe,
effective, patient
centered, timely,
efficient & equitable
 Improve quality of care Top line
 Growing demands in health services
 Global workforce shortage
 Resource constraints
 Increase advances in the healthcare field
 Increasing cost
 Cost control/cost effectiveness
 Patient safety and optimal patient outcome
 Staff satisfaction and retention Bottom line
“Innovation drive competitive advantage”
“Innovation helps nursing make money and save money.”
Quality patient care Satisfaction/delight Patient Loyalty Promotors
1 in 10 admissions leads to adverse event and 1 in 300 in
death.

For every 100 admissions,14 adverse events in high-income

countries and 13 in low- and middle-income countries.

 7 common adverse outcomes- injuries due to

medications errors, CAUTI, CLABSI, VAP, DVT, falls and
pressure ulcer.

At any given time, 1.4 million people worldwide suffer from
HAI
India is recording 5.2 million injuries due to medical errors and
adverse events.
1 in 1 million-traveler harmed in an 1in 300 -patient harmed while
aircraft given health care

Medical Errors top 10 killers-WHO Report 2013 11

 5Ps
• Pain
 Patient falls reduced by 33% • Position
 Hospital-acquired pressure ulcer reduced by 56% • Placement
• Potty
 Call bells reduced by 40-50% • Peace

 Cost saving-cost towards fall management

 Better patient care
 Overall patient satisfaction has increased by 12%
 Medico legal cases reduced
 20% reduction in the distance walked each day by the
nursing staff.
Hourly rounding by Nursing and Supporting staff
Challenges- RN forget to do, No time,
Patient signature in hourly rounding register

Nurses are unhappy about taking patient signature

Outcomes
 Increased mobility in vented patients from zero to 100
percent
 Reduced average ICU LOS for vented patients 1.0 day
 Reduced average ICU LOS for surgical patients 0.7 day
 Reduced mechanical vent days 14 days (from 81 to 67)
 Six-month cost savings of $620,981
 Medication safety-do not disturb apron
 Fond farewell
 Tender loving care-birthday, anniversary, etc…
 Morning huddle rounds/interdisciplinary rounds
 Cost saving-WOW/CREW-consumables basket in OT,
low value consumables for scheme patients, etc..
 Discharge bundle care
 ISBAR-hand off communication
 Early warning score-MET/RRT
 Tender care for nurses
 Addressing
problem
anticipating
them
Divergent
* Communicate
• Encourage, thinking
* Do not double check
Risk Taking
Autonomy/  No blame
 Educate
Freedom • Reward
• Cost analysis
Avoid developing
habits of inertia or
overconfidence
Agility/ Failure
Tolerance
“Being willing to tolerate
Flexibility and learn from failure is
the foundation of the
innovation”
Employee feedback

Role Filling
Role Modeling
Employee Engagement
Education
Protected Time
Technological Support
Rewards
Budgeting
Leadership
 Resistance-disagreement, covert resistance,
non-cooperation, procrastination, arguing,
rationalizing, sabotage.
 Coping-problem solving and overcoming
barriers
 Responding-choice is made to act & being
responsible.
 Choosing-Embracing the change, a
commitment to larger possibilities.
 Bringing Forth-Creating a solution, putting
vision/values into action, taking a stand.
 Mastery-Being the force for change acting it
out in daily life.
“Change is never painful, but the resistance to change is
painful”
Education and Participation Facilitation and
Communication and Involvement Support

Negotiation Manipulation Explicit and

and and Cooperation implicit
Agreement coercion
 Knowledge-
What? why?
Habits

Habit
Behavior
Skill- Mindset Attitude-
How to want to
Decision
making

Diffusion of innovation
Risk taking & Fall in line Hesitant
pioneering Resistant
Formal communication-
Conference, publication,
internet, TV, newspaper
Informal communication-
Nurse to Nurse and other
health care persons
* Direct application
* Reinvention
* Indirect effects
Communication Channels

I II III IV V
Knowledge Persuasion Decision Implementation confirmation

Prior conditions
• Previous practice Continued adoption
• Felt needs/problems Adoption Later adoption
• Innovativeness
• Norms of the social system Rejection
Discontinued
Characteristics of the Perceived Continued rejection
decision-making unit characteristics of the Active or Passive
•Socioeconomic innovation rejection
characteristics •Relative advantage
•Personality variables •Compatibility
•Communication behavior •Complexity
•Trialability
•Observability
 Innovation in
Healthcare
Quality Cost Safety Efficiency Outcome

How patient Treatment

is seen
Diagnosis
The Patient

Information
Technology

Healthcare
providers
How patient Prevention
is heard
Education

How patient Research

needs are
met Outreach
  Creating a culture of
Influencing innovation and innovation starts
with leader
ideas at the organizational
level.
Acknowledge and reward
innovation Influencing innovation and
Inject creativity with ideas at the personal level.
acquisitions Increase dialogue-debate &
Dedicate time to innovation discussion
Suspend assumptions and
3M-15 percent program judgement
(Post-It note) Actively listen
Google-20 percent time
(Gmail & google earth) Encourage staff to publish
and present their
innovation
 Think tank

Identify innovative team members

Set the ground rules

Generate seeds

Schedule group idea sessions

Encourage individual sessions

Watermelon Squared 26
• No willingness to use change management principles.
• Lack of critical thinking (not stopping to ask the “why” or “why
not” question).
• Poor access to IT skills or educational resources.
• Poor staff support.
• No time/skills/insight into reflection.
• Poor networking skills.
• Poor delegation skills.
• Too busy doing things to notice opportunities for innovation.
• Fear, Uncertainty and Doubt
• A perception that nursing remains a low status profession.

N o innovation and creativity without failure

• Organizational/departmental hierarchy.
• Bureaucracy
• Already there…experts… “You can’t do it that way.”
• Limited autonomy/freedom to be creative.
• Few mentors/role models who have “gone before.”
• Low status of clinical work
• Difficulties with clinical staff being moved into non-
clinical positions.
• Horizontal violence, conflict or bullying.
• Organizational culture.
A Decision maker’s Guide to Adopting Innovations
 Does this innovation fit?
 Should we do it here?
 Can we do it here?
 How can we do it here?

Taking Innovations to Scale

 Resources to assist innovators and adopters
 Spread success stories
 Presentations and reports
• Understanding change management principles
• Organizational culture-open and supportive.
• Capacity to take risks.
• Being there-visibility.
• Going to the source: direct involvement of patients/service users.
• Having clinical support-mentorship/guides/role models.
• Access to IT skills and educational resources.
• Willingness to follow and develop passion (nurture your values
and beliefs)…courage…and strength to challenge/change the
rules.
• Reflection
• Create a bug list.
• Observe…step back and use child’s eye.
• Observe the right people.
• Little innovations matter
• Recognize and acknowledge clinical heroes.
• Best way to have a good idea is to have lots of ideas
• Brainstorm/mind map/reflect/team meetings
• Give permission and time to do.
• Try things out-need to build prototypes/trials
• Allow change to have an opportunity to impact on ideas.
• Share the stories of innovative ideas (at meetings and
conferences).
 Patient Effective Clinical
satisfaction/Delight Leadership

Quality of
Positive Innovation
Nursing Care

Effective
Change
Link between Clinical Leadership and Innovation and Patient satisfaction

Innovation is the one competence needed in the future…--Peter Drucker

…early adoption is the second --Kathleen Stevens

 Encourage nurses to bring their ideas

 building a strong foundation of values (trust and

collaboration) and resources that encourage it

 Peer review to provide an objective viewpoint on

the worth and ROI of novel solutions.

 Create a infrastructure to support innovation

 Clinical leaders need to be recognized, by their organizations and
by themselves, and opportunities for genuine innovation and real
change needs to be supported and fostered.

 From optimizing patient care to improving safety and patient

outcomes or simply creating efficiencies in day-to-day
responsibilities and beyond, nursing innovations drive our
profession forward.

 Innovation in healthcare continues to be a driving force in the

quest to balance cost containment and health care quality.
Innovation is considered to be a critical component of business
productivity and competitive survival
 Knowing is not enough
We must apply
Willing is not enough
We must do
To be successful, providers need to know what patients
want and expect from their health care experience