Using the Innovations Exchange To Develop Health Professional Competencies
Using the Innovations Exchange To Develop Health Professional Competencies
On September 18, 2013, the Innovations Exchange held a Web event titled Using the Innovations Exchange To Develop Health Professional Competencies.
This event featured an in-depth dialogue about how the Innovations Exchange's rich collection of novel health care practices and tools is being used to develop competencies for nurses and interdisciplinary teams. The Innovations Exchange is relevant for all levels of inter-professional education including baccalaureate level, graduate level education, and professional development, and can help to address a variety of practical and theoretical goals, including the following:
- Familiarizing health care professionals with concrete approaches to transforming health care delivery in accordance with the goals of the Institute of Medicine, the National Quality Strategy and the Affordable Care Act
- Using case studies of innovation practices to examine how health care organizations adopt and adapt service delivery and policy innovations to solve local problems
- Using case studies of innovations as part of a curriculum focused on improvement and implementation science
Judi Consalvo, Program Analyst, Center for Outcomes and Evidence, Agency for Healthcare Research and Quality
Judi Consalvo serves as a Program Analyst in the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality (AHRQ). She is the project lead for the AHRQ Health Care Innovations Exchange and has been affiliated with this program since its inception. Ms. Consalvo also serves as a grant project officer and a conference grant reviewer.Presenters:
Kathleen R. Stevens, RN, EdD, FAAN, Professor and Director, Academic Center for Evidence-Based Practice, University of Texas Health Science Center, San Antonio, TX
Kathleen Stevens is professor at the University of Texas Health Science Center San Antonio and an Editorial Board emeritus for the AHRQ Health Care Innovations Exchange. She is director of the Academic Center for Evidence-based Practice (ACE) and the inter-professional Improvement Science Research Network, which advance evidence-based quality improvement. Dr. Stevens contributes to EBP theory, competencies, measurement, and research, emphasizing organizational change for quality improvement and patient safety. For this work, she was named the STTI Episteme Laureate and inducted into the International Nurse Researcher Hall of Fame and American Academy of Nursing. Dr. Stevens has served as elected officer on the Board of Governors of the National League for Nursing and Sigma Theta Tau International.Judith Kunisch, BSN, MBA, Lecturer, Yale School of Nursing, New Haven, CT
Judy Kunisch is a senior nurse executive with over 20 years of experience building and implementing innovative solutions to improve medical quality and manage medical costs, and currently serves as an Expert Panel member for the AHRQ Health Care Innovations Exchange.
Ms. Kunisch has introduced new clinical and nursing business models including a disease management program for prevention of preterm birth and a regional managed care company, VNA Managed Care, Inc. As a former Fortune 100 insurance company Vice-President, she was responsible for medical programs and managed care services in 50 states. She also provides consulting services for a variety of health care providers and payers and is an internal consultant to Yale School of Nursing.
Using the Webcast Console and Submitting Questions
Image of attendee console with an arrow pointing to the box to type in questions and another arrow pointing to the Q&A widget.
What is the Health CareInnovations Exchange?
- Publicly accessible, searchable database of health policy and service delivery innovations
- Searchable QualityTools
- Successes and attempts
- Innovators' stories and lessons learned
- Expert commentaries
- Learning and networking opportunities
- New content posted to the Web site every two weeks
- Sign up at http://www.innovations.ahrq.gov
Innovations Exchange Web Event Series
Archived Event Materials
- Available within two weeks under Events & Podcasts http://www.innovations.ahrq.gov
Examples of Past Events
- May 9, 2013 A Close Look at Care Coordination within Patient-Centered Medical Homes
- April 9, 2013 Promoting the Spread of Health Care Innovations
Kathleen Stevens, RN, EdD, FAAN
Professor and Director
Academic Center for Evidence-Based Practice
Improvement Science Research Network
University of Texas Health Science Center San Antonio
Image of a flow chart. Top boxes states “what are we trying to accomplish”, middle box states “how will we know that a change is an improvement”, bottom box states “what changes can we make that will result in improvement?” An arrow then points from these boxes to a circle divided into 4 parts labeled “act, plan study, and do”. There are arrows point clockwise around circle and another arrow that points from the circle back up to the boxes.
Catalysts for Innovation
Under the bullet, “Recommendations and Initiatives” there are images of logos for Center Medicare and Medicaid Innovation logo, American Association of Critical-Care Nurses, QSEN Institute, and AAMC. Additional images include CAPTE's Evaluative Criteria: PT Programs, image of a book titled, The Future of Nursing, Leading Change, Advancing Health, and an image of four people's silhouettes.
Catalysts for Innovation
Patient Protection and Affordable Care Act: Title V Health Care Workforce
“…to improve access to and the delivery of health care services for all individuals, particularly low income, underserved, uninsured, minority, health disparity, and rural populations by…
- enhancing health care workforce education and training…
- providing support to the existing health care workforce …”
Image of a circle with a star in it. The points of the start are labeled, “process, outcome evaluation”, “discovery research”, “evidence summary”, “translation to guidelines”, and “practice integration”. Practice integration is circled. The image is taken from the Academic Center for Evidence-based Practice (ACE) Star Model of Knowledge Transformation.
Image of square watermelons.
What They Did; Did It Work?
- Every title includes the innovation and the outcomes
- Example 1: Patient- and Family-Activated Response Team Averts Potential Problems and Generates High Levels of Patient, Family, and Staff Satisfaction
What They Did; Did It Work?
- Every title includes the innovation and the outcomes
- Example 2: Team-Developed Care Plan and Ongoing Care Management by Social Workers and Nurse Practitioners Results in Better Outcomes and Fewer Emergency Department Visits for Low-Income Seniors
Image of Innovations Exchange profile titled: Intensive Care Units Participating in Hospital Collaborative Implement Multiple Improvement Strategies, Leading to Fewer Deaths and Lower Costs. This profile is available at http://www.innovations.ahrq.gov/node/4671.
Image of Innovations Exchange profile titled: Intensive Care Units Participating in Hospital Collaborative Implement Multiple Improvement Strategies, Leading to Fewer Deaths and Lower Costs. Key areas of the profiled are circled such as the comments tab, evidence rating, and related QualityTools. This profile is available at http://www.innovations.ahrq.gov/profiles/intensive-care-units-participating-hospital-collaborative-implement-multiple-improvement.
- Intensive care unit patients have life-threatening problems and complex care needs
- Require a combination of many treatments and services to achieve timely recovery and discharge
- Susceptible to preventable complications (i.e. ventilator-associated pneumonia, deep vein thrombosis, and catheter-associated bloodstream infections), which lead to suboptimal clinical outcomes and prolonged length of stay
- Tools to improve communication and checklists to guide adherence to evidence-based interventions are known to improve outcomes, yet many hospitals have not adopted these initiatives
- Created an improvement team
- Established multiple initiatives designed to improve care including a comprehensive unit-based safety program (CUSP) to enhance the culture of patient safety and tools to expedite the translation of evidence into practice
- Used evidence-based processes to reduce catheter-related bloodstream infections
- Integrated proven interventions to reduce complications associated with mechanical ventilation
- Adopted tools and tactics
Did It Work?
- Improved the culture of safety among participating ICUs
- Prevented catheter-associated bloodstream infections
- 1,800 lives saved
- 140,000 hospital days avoided
- $270 million in savings in 5 years
- Evidence rating: moderate
- Pre- and post-implementation comparisons of safety culture survey results and catheter-related bloodstream infections
- Predictive model that estimated the number of lives, dollars, and hospital days saved over a 5-year period
Image of quality tool titled: On the CUSP: Stop Blood Stream Infections – Resources. The words Quality Tool are circled. This profile is available at http://www.innovations.ahrq.gov/node/5865.
Image of Innovations Exchange profile titled: Pharmacists Monitor Hypertensive Patients and Make Recommendations to Physicians, Leading to Better Blood Pressure Control and Increased Physician Adherence to Established Guidelines. http://www.innovations.ahrq.gov/node/4731.
What They Did
- Assessed the causes of the patient's poor blood pressure control
- Developed a guideline-based treatment plan
- Monitored patients' treatment response at regular intervals
- Made recommendations as necessary to the treating physician for medication adjustments designed to achieve good blood pressure control
Did It Work?
- Improved blood pressure control, even in hard-to-treat patients with diabetes
- Increased physician adherence to established treatment guidelines for hypertension
- Evidence rating: strong
- Prospective, cluster randomized controlled trial at six community-based family medicine residency programs
- Measured pre- and post-implementation blood pressure levels, degree of adherence to established treatment guidelines, and self-reported patient adherence to the prescribed regimen
Will It Work Here?
A Decisionmaker'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
Innovation is the one competence needed in the future…
…early adoption is the second
Judith Kunisch, BSN, MBA
Yale School of Nursing
Using the Innovations Exchange as an Effective Practical Teaching Tool: A Case Study
Background and Goal
- Health care professional study includes course work related to quality and safety and the business of healthcare
- Innovations Exchange provides teaching opportunities for all levels of study
- Nursing undergraduates
- Masters level – MSN, MBA, MPA, MPH
- Doctoral level – DNP
- Learning activities/assignments vary with the level of study and focus of the course
Examples of Learning Activities
- Quality and safety: nursing undergraduates, masters level
- Innovation business plans: masters and doctoral level
Masters Example: Leadership Practice
- Advanced practice students
- Semester course; 100 students
- Practice competency in leadership/quality and safety
- American Association of Colleges of Nursing (AACN) Masters Essentials
- Quality and Safety Education for Nurses
Masters Example (continued)
- Two part assignment: presentation, written memo
- Innovations Exchange provides “contexts of care”
- Innovation adoption guide
- Profiles and quality tools organized by subject areas
The Assignment: Presentation
- Working in pairs
- Small group presentation (leadership communication)
- Single PowerPoint slide, 5-7 minute presentation, 5 minute question and answer
- Single slide tells a visual story; useful in other settings
The Assignment: Written Memo
- 5-6 paragraph written memo to senior leader
- Practice writing (leadership communication)
- Translate the components of patient safety and risk management to a current topic in quality improvement
- Comment on the value of the innovation or tool
- Incorporate other relevant articles and references
Active “Hands On” Learning
- Student centered: learn to use the site, evaluate and analyze innovations/tools
- Result: students will not forget the Innovations Exchange; updated and reliable
- Without the assignment, teaching options include:
- Show them: passive learning, no motivation to use it
- Tell them: passive learning, no motivation to look at it
- “Wait until I am in practice and need to use it” or “Maybe I will do this someday”
Example: Student Slide
Image of example student slide for the profile Automated Phone Counseling Helps Parents of Overweight Children Model and Encourage Appropriate Behaviors, Leading to Meaningful Reduction in BMI. Slide includes a short description of the problem, program description/design, results, and evaluation with an image of a child surrounded by chips, soda and other fast food. This profile is available at http://www.innovations.ahrq.gov/node/4617.
- Students understand AHRQ selection criteria for innovations and quality tools
- Each innovation or quality tool selection is relevant to student's area of interest and practice
- Student employs critical analysis of a specific innovation or tool
- Students practice professional communication with a presentation and written memo
Image of example student slide for the profile Online Access to Low-Dose Birth Control Reduces Barriers to Reproductive Health. Slide includes a program description, program elements, tips for adoption and results. This profile is available at http://www.innovations.ahrq.gov/node/4667.
Image of example student slide for the profile Group Visits for Chronic Conditions. Slide includes a description of the problem, innovation, group appointment elements, and a graph of the results. This profile is available at http://www.innovations.ahrq.gov/node/4422.
Example: Student SlideImage of example student slide for the profile Peer-to-Peer Website Facilitates Partner Notification of STDs. Slide includes a description of the tool and the website. It also includes CDC estimates for the prevalence of STDs and an image from the website. This profile is available at http://www.innovations.ahrq.gov/node/5740.
Example Student Memos: Selected Phrases
- “As an advanced practice nursing student of family psychiatry, I am particularly interested in interventions that aim to address the gaps in systems of care for youth with mental health illnesses ….”
- “… strength of this intervention is the emphasis on care coordination to bridge the experience from treatment discharge to community reentry….”
- “…. a tool with comprehensive information is important for treating every patient, but it is particularly important in Pediatrics …”
- “If I was going to change anything at all, I would expand it to be a global pediatric cancer tool because it is so helpful….”
- “Thank you for your time and for your dedication to quality improvement in healthcare.”
- Slide is easy to read; accompanies the oral presentation
- Not graded on public speaking ability – this is practice!
- Set up professionally
- Student opinion is reasonable and relevant to practice
- Overall writing demonstrates an understanding of the innovation or tool and its relationship to practice
- Student compares it with other tools or innovations he/she has observed or used in practice
Image of attendee console with an arrow point to the Q&A widget.
The Innovations Exchange
More information on Yale's School of Nursing assignment:
Visit our AHRQ Health Care Innovations Exchange:
Follow us on Twitter: @AHRQIX
Send us email:
Judi Consalvo: Good afternoon. On behalf of the Agency for Healthcare Research and Quality I’d like to welcome you to our event entitled Using the Innovations Exchange to Develop Health Professional Competencies. My name is Judi Consalvo and I’m with AHRQ’s Center for Outcomes and Evidence.
We’re very excited about today’s topic and glad to see that you share our enthusiasm. We have 614 registered for this event today.
Before we begin I would like to introduce you to our webcast console. The console can be resized to fit your entire browser window. All the components on the console can be resized, moved and minimized into the menu dock at the bottom of the console. If the slides are too small, click on the lower right-hand corner of the slide window and drag your mouse down to make it larger.
Twitter functionality is available in the console for today’s webcast. Feel free to participate using the hashtag #AHRQIX.
We’re pleased to offer closed captioning on this web seminar. To access the closed captioning, please click on the link called Closed Captioning. That’s on the lower right hand of your screen view. After you click the link a new window will display the captioning.
I would also like to remind you that if you experience any technical problems you may click on the question mark button at the bottom of the screen to access the Help Guide or click on the Q&A button at the bottom of your screen to contact us with your question. Our technical staff will work with you to resolve any issues.
The last 15 minutes of this web seminar is reserved for a discussion based on questions that you submit. You can submit questions at any time during the presentation. Simply click on the Q&A button at the bottom of your screen, then type your question into the Q&A box and select Submit. We welcome your questions and comments on the upcoming presentation and we look forward to an engaging dialogue that will promote the spread of healthcare innovations.
Today’s slides are available by clicking on the widget at the bottom of your screen that says Download Slides. This will generate a PDF version of the presentation that you can download and save as desired.
The web event series is sponsored by AHRQ’s Health Care Innovations Exchange. For those of you who are new to the Innovations Exchange I’ll take just a minute to give you an overview. AHRQ created the Exchange to speed the implementation of new and better ways of delivering health care. The Exchange offers busy health professionals and researchers a variety of opportunities to share, learn about, and ultimately adopt evidence-based innovations and tools that are suitable for a range of health care settings and populations.
The Innovations Exchange website includes a searchable database of quality tools and service delivery and policy innovations, and it also contains both successes and attempts, innovators’ stories and lessons learned, and expert commentaries. To assist you implementing these innovations AHRQ also supports learning and networking opportunities such as web seminars, tweet chats and podcasts. We post new content to the web site every two weeks on a range of topics and hope that you will sign up to stay connected with us, if you have not already done so. The web site also holds an archive of our past web events, podcasts and tweet chats. The slides show you a couple of examples of events that are in our archive. We invite you to take a look and download materials that may be useful to you in your practice.
So let’s turn to our agenda for today. It is my pleasure to introduce our first presenter, Dr. Kathleen Stevens. Dr. Stevens is currently a professor at the University of Texas Health Science Center, San Antonio, and Editorial Board Emeritus for the AHRQ Health Care Innovations Exchange. She is Director of the Academic Center for Evidenced-Based Practice, the interprofessional improvement science research network which advances evidence-based quality improvement. Dr. Stevens contributes to evidence-based practice theory, competencies, measurement and research, emphasizing organizational change for quality improvement and patient safety. For this work she has received several honors, including being inducted into the International Nurse Researcher Hall of Fame.
I’m pleased to now turn it over to Kathleen. Kathleen?
Kathleen Stevens: Thank you so much, Judi. It’s been an exciting experience to be part of developing the Health Care Innovations Exchange and a privilege to do so because the thought is if the challenge is to leverage the Innovations Exchange as a resource in teaching health competencies, the two topics that are important to faculty as we develop those health professional competencies are what are the catalysts for the innovations in healthcare and the second is what are the key features of the innovation profiles contained in the Innovations Exchange so that we can use them.
First, there are a few catalysts I wish to mention. On great catalyst is the catalyst for innovation that’s driven with the paradigm shift of thinking that improving our work is our work. It’s a major shift in the way that we approach our clinical work. One mantra for today’s health professionals is this in looking at the processes and the flow of our work if health care is to be transformed all who are involved must contribute to improving the work, the workflow, the work environment, the work climate. Frontline, mid-management and executive level clinicians, we’re all called on to improve our work. Such is the focus of the Innovations Exchange.
Embedded it improvement is change. Improvement requires change; however, we keep in mind that not all change leads to improvement so we want to put a fine point on that target. The ability to develop, test and implement innovation is essential for any individual, group or organization that wants to continuously improve.
This point is driven into recommendations and the institutionalization of innovation and quality improvement in health providers’ education by a number of entities. Innovations for improvement have been promoted by the following catalysts and initiatives and institutions. For example, the Center for Medicare and Medicaid has a Center for Innovation. The American Association of Critical Care Nurses has innovated creating health work environments. The American Association of Medical Colleges has a research on care community that is the home for academic medicine leaders and their teams who are committed to using clinical effectiveness research and implementation science. Catalysts for innovation is further spurred by the American Physical Therapy guidelines for curricula and the Institute of Medicine Future of Nursing Report, which calls in this case for nurses to lead and manage collaborative efforts with other members of the healthcare team to conduct research and to redesign and improve practice environments and health systems.
To be impactful, clinicians will lead with evidence of what works in improvements. Innovations that have been tested provide the groundwork for such practice-based evidence. To be impactful, healthcare professionals will lead with evidence of what works, these tested innovations.
The health reform law also has been a catalyst for innovation. Title V focuses on health care workforce; specifically, the ACA calls for an increased emphasis on the education and training of the health care workforce to improve care through innovation. Note the health disparities focus within the workforce section as well.
So improvement, change, innovation, these are all part of our everyday conversations in health care. Evidence-based practice is an undergirding structure for the improvements and the changes and the educational reform to prepare workforces of the future.
One approach for examining this dynamic landscape is to consider how improvement based on evidence occurs. One model is helpful as we organize our thoughts about evidence-based quality improvement. The ACE Star Model of Knowledge Transformation places innovation in this cycle of evidence-based improvement. The model distinguishes various stages of knowledge transformation that’s required to integrate best evidence into common practice. Point one you’ll see is discovery research. Point two is the evidence summary. Point three is translation to guidelines. These three stages are repackaging of the knowledge. At point four, practice integration; evidence-based improvement implies change, which calls for innovation.
As a matter of fact, an innovation leader, Paul Plsek, quoted if you continue to do what you’ve always done you’ll get the results you’ve always gotten. Improvement, innovation, change, with such high demands to use evidence to improve, a number of useful resources have been developed, many of which are offered through the AHRQ. Organized by the various stages of knowledge transformation, we see several of these valuable resources.
On point one, there’s our familiar bibliographic databases, MEDLINE and CINAHL, the research articles that we find in the journals.
On point two, evidence summaries are produced through AHRQ Evidence-Based Practice Centers and other entities such as the Cochran Collaboration to create evidence synthesis of all that’s known about a particular topic.
On point three in this continued evolution of knowledge, clinical practice guidelines are based on the best available evidence and the guidelines are recommendations to clinicians. These are provided through the National Guideline Clearinghouse by AHRQ and through the U.S.Preventive Services Task Force.
Now as we jump to point five we see National Quality Measures Clearinghouse, again supported by AHRQ, to benchmark that movement toward this national quality of care.
The Innovations Exchange is part of an array of other important AHRQ resources for improving and transforming healthcare. Look at point four. Point four is until the AHRQ Innovations Exchange was developed, there truly wasn’t a national resource to assist clinicians in integrating improvement into practice until AHRQ began to say here is how others began to do it and created this wonderful learning and sharing environment.
So why exchange innovations? Thinking outside the box, the problem was recognized in the Japanese grocery stores in that they were very small grocery stores and so the solution to the problem of round watermelons that took up many, many more square inches than necessary was seen as one that could help everyone the deliverers, the growers, the grocery store, even as you brought it home and placed it in your refrigerator. The solution of the round watermelon wasn’t nearly as difficult to solve for those who didn’t assume the problem wasn’t impossible; they moved forward. Some took a false start. Was genetic engineering the solution or the solution turned out actually to be placing the watermelon at a young stage into a box. It turns out that all you need to do is to place this watermelon as they’re growing in a box and it’ll take on the shape of the box. This made grocery stores happy and had the added benefit that it was much easier and cost effective to ship the watermelons. Consumers loved them because it took up less space in their refrigerator.
So there are a few lessons in watermelons squared. First, think inside the box as well as outside the box and don’t assume; the major problem was that most of the people had always seen round watermelons. The next one is to question habits, question your habits. If you can make an effort to question the way you do things currently on a consistent basis you open up the learning opportunity. The next lesson is to be creative. Be creative in looking for a solution. Look in many different places. And then to look for a better way; the square watermelon question was simply seeing a better and more convenient way to do something and the question is, “Is there a better way I could be doing this?” Impossibilities often aren’t. If you begin with the notion that something’s impossible then you might not make a solution, and so we moved to innovations in healthcare processes and wonderful examples from innovators that will spur our own thinking.
The Innovations Exchange was indeed designed with the busy clinician in mind. One feature of the Innovations Exchange is that the titles tell the story. The title answers the question what they did and did it work. In the next slide – thank you – we begin to see how this takes shape. From the title alone the clinician can decide if this is an innovation that could potentially meet their improvement need. Every title includes a statement about the innovation and the outcomes.
In this first example of an innovation profile, the underlying text in the slide specifies the innovation for process improvement. Well, let’s go back. The example in the italicized part of the title is Patient and Family Activated Response Team, so that’s the innovation. Included in the title are the results and in this slide the results are averts potential problems and generates high levels of patient, family and staff satisfaction. A long title, I know, but very much shorter to get the whole feel of the innovation to see if you want to move on further.
Let’s look at a second example on the next slide. Again, every title includes the innovation and the outcomes. In this case the innovation that they used was team-developed care plan and ongoing care management by social workers and nurse practitioners and the results are this. These result in better outcomes and fewer emergency department visits for low income seniors.
The titles are a quick way to match the adopter needs with potential innovation solutions so, once you have titles that you’re looking at in the Innovations Exchange let’s look next at what the actual innovation looks like. Very tiny, this is a screenshot of another Innovations Exchange profile. It’s too small to read here but it’s important to understand the layout. Here’s the full story in the title – remember the two parts – Intensive Care Units Participating in Hospital Collaborative Implement Multiple Improvement Strategies, Leading To Fewer Deaths and Lower Costs. So there’s your elevator speech right on the spot. Note the snapshot. This is a structured abstract. You will see the same categories on every single abstract within the Innovations Exchange, with standard subheadings that are used in every innovation profile. There’s a summary, the evidence rating, the developing organization, when it was implemented and the patient population.
Now I’ve highlighted some things in this particular slide to help point out a few more features. Note the comments tab. Judy Kunisch will speak to this as a student opportunity later. Also note the evidence rating. In this case it’s moderate for this particular innovation. They tested it and the evidence showed that it was moderate. This is in connection with the evidence-based practice concept of rating the evidence. In the Innovations Exchange the evidence about the certainty of the impact of the innovation is classified as strong, moderate or suggestive. Remember we’re dealing with essentially innovations that have been tried usually in one spot.
Also note another important feature in the Innovations Exchange; right up in the right column there’s an item called Related QualityTool and I’ll get to that in just a minute by showing you an example.
Let’s look a little more closely at the sections of the profile. Returning to the profile titled Intensive Care Unit Participating in Hospital Collaborative Implement Multiple Improvement Strategies, Leading to Fewer Deaths and Lower Costs, after the snapshot the profile is organized into essential headings. The problem addressed, this is an executive summary of the problem. This is your pitch for buy in. If you have this clinical problem, these statements will help you hook the attention of management and articulate very clearly where the evidence is pointing to the extent of the problem. In this case the intensive care unit patients have life-threatening problems and complex care needs. Another part of the problem is that they require a combination of many treatments and services to achieve timely recovery and discharge. They’re susceptible to preventable complications and you see the list there we’re all familiar with them which lead to suboptimal clinical outcomes and prolonged length of stay. The tools to improve communication and checklist to guide adherence to EBP interventions, they’re known to improve outcomes and yet many hospitals haven’t adopted these initiatives. Is this the mirror that you’re looking in? Are some of these pieces true in the problem that you have in your particular clinical agency?
So the hook to move to action are these tools to improve communication and checklists, and this particular group of innovators moved forward and here’s a description of what they did. They created an Improvement Team. Each participating ICU had an Improvement Team that led the implementation of multiple initiatives, including a comprehensive unit-based safety program or what we now know as the CUSP or the CUSP Program, to enhance the culture of patient safety and tools and to expedite translation of evidence into practice. So this was their Improvement Team. Each ICU implements a CUSP, a five-step process that Johns Hopkins developed and now is sharing across AHRQ. The culture of safety and teamwork is measured annually using safety attitudes questionnaires, so there’s the benchmark. The tools can help speed adoption of evidence-based practices and proven interventions to reduce catheter-associated bloodstream infection and complications associated with mechanical ventilations. They adopted these tools and tactics.
Now you’re sold so the problem is big, the solutions are outlined in terms of what they decided to do, and next the question is did it work? The program improved the culture of patient safety among participating ICUs and prevented a significant number of catheter-associated bloodstream infections. It led to more than 1,800 lives saved and more than 140,000 hospital days avoided, at least $270 million in savings over a five-year period.
Then the clincher – how strong is the evidence? In this case the evidence rating indicates how confident we could be in the result should we implement the same innovation. This is moderate for this particular test. Again, the Innovations Exchange ranks evidence. Evidence ratings range from strong, moderate to suggestive and even include innovations that are considered attempts. This evidence rating is moderate because of the design that was used to test the innovation. That is a pre-post test implementation comparison of the culture of patient safety results and the actual occurrence of bloodstream infection. So predictive modeling also helped them estimate the number of lives.
But now back to the screenshot just to move forward in thinking about the related quality tool because so much of our efforts require resources cost, personnel, actual dollars, changes and we want to be able to demonstrate not only the effectiveness in terms of patient outcomes but the return on investment and the way we do that is to look at the impact. In this case the quality tool is affiliated with the CUSP Program. The website provides you with a link to the tool. You see here that the related tool is freely available to you in testing whether or not your implementation was successful.
Let’s quickly look at a second profile to get the feel for how useful these are in clinical change. This particular one is about pharmacists who monitored hypertensive patients and made recommendations to physicians. It led to better blood pressure control and increased physician adherence to established guidelines.
Some of the details of this particular profile are what they did. They assessed causes of poor blood pressure control, guideline-based treatment plan, monitored treatment response and recommendations for the treatment to physicians.
Did it work? The next slide shows that it did improve blood pressure control, even in hard-to treat patients. It increased the adherence and the evidence rating on this is strong because it was a cluster randomized control trial at six community-based family medicine residency programs.
So you see that it’s interprofessional. Many of these innovations require interprofessional intervention and so the question next is will it work here now that you’ve found an innovation that seems to fit the problem and seems to have good evidence.
Once it’s located then you reflect on adopting the innovation. The Innovations Exchange offers the Decision Maker’s Guide to Adopting Innovations, which is available online.
The second really important resource is you have access to the innovator, him or herself. Part of the requirement is that the innovator will talk to you by placing their email and phone numbers right into the profile. This resource bolsters the early adopter’s capacity to put the innovation into motion in their own agency and it completes the cycle almost.
The next slide, we have to remember the consideration of adoption takes into account the scale up and spread issues that are part and parcel of adopting an improvement strategy.
And this next slide, it just reminds us that AHRQ does have a focus on scale up and spread to facilitate movement of an innovation across a single agency and across the nation’s agency, an excellent resource provided on the Innovations Exchange website related to spreading innovation.
So the conclusion in this look at that Innovations Exchange, as Peter Drucker said, innovation is the one competence needed in the future. I might add that early adoption is the second and the Innovations Exchange makes this possible for us.
Thank you. Back to Judi.
Judi Consalvo: Great. Thank you, Kathleen. That was just great.
It is now my pleasure to introduce Judith Kunisch. Ms. Kunisch is a Senior Nurse Executive with over 20 years of experience building and implementing innovative solutions to improve medical quality and manage medical costs, and she currently serves as an expert panel member for the AHRQ Health Care Innovations Exchange. Ms. Kunisch has introduced new clinical and nursing business models, including a disease management program for prevention of pre term birth and a regional care managed care company, Visiting Nurse Association Managed Care, Inc. As a former Fortune 100 insurance company vice president she was responsible for medical programs and managed care services in 50 states. She also provides consulting services for a variety of healthcare providers and payers and is an internal consultant to Yale School of Nursing. Judy?
Judy Kunisch: Thank you, Judi. Hello, everybody. It’s great to have the opportunity to talk about using the Innovations Exchange in the classroom and with all kinds of students at all levels of study, all disciplines.
The other thing that I’d like to say right upfront is that our students are with us for only a short time and we are preparing them to be health care professionals and administrators so using the Innovations Exchange, which is there and readily available to everybody, is an important benefit of an assignment that I’m going to show you about. May I have the next slide, please?
Well, as a piece of background, we know that health care professional study includes both coursework related to quality and safety as well as the business of health care and what I want to talk about is I’m going to give you an example of an assignment which is available on the Innovations Exchange that I used in the classroom for a Master’s level advanced practice nurses however the Innovations Exchange can be used for nursing undergraduates and also students in Master’s programs related to both the allied professionals – physical therapy, occupational therapy, social work as well as at the doctoral level. I’m preparing a business class for a Doctor of Nursing practice students that I’ll be teaching in the wintertime and the Innovations Exchange is a go to spot for me.
So the learning activities and assignments really vary with the level of study and focus but there is something here for everybody. I also want to add in going back to the Affordable Care Act that we can use the Innovations Exchange for our health care workers that are in the workplace. So those of you that might be doing training, your training is at hospitals or in clinics, it’s an excellent resource.
When you go on the first page there is a sorting index that is absolutely superb. That’s one of the important parts, ease of use, and you can type in or look up by subject area so, if you’re doing a training program, you’re looking for innovations related to pediatric health or the elderly, there are subject areas that you click on and it brings up specific innovations and QualityTools for your subject.
The other place that’s important is geographically. You can sort and look at innovations and quality tools by geography so, across the country, however you want to look, that’s a capacity that it has as well. Next slide, please.
So a couple of examples before I take you into the one that I did. For quality and safety learning, nursing undergraduates, health care undergraduates, people at the Master’s level, Kathleen pointed out the innovations comment section and I have had students go in and look up an innovation, look at some related references in the literature and write a comment on the innovation itself. So they click on that tab and they go in and they write a comment. And this eventually gets back to the innovator, so it can be an exchange between the student and the innovator; it also can – innovators are busy people at times and they don’t have time to review the literature so if a student puts an article up there or a comment about something that they’ve seen in the workplace related to the innovation, it can be very helpful to the innovator as well as other people looking at the innovation.
For the Master’s level and Doctoral level we’re using it to write business plans. It’s a scale up and spread opportunity. How do we create sustainability – many of the innovations are started with grant funds; how do you convert them into revenue-producing innovations – is an important task and having students do that is very helpful to them for their own practice.
Just last week I assigned my students to look at a policy update related to accountable care organizations, so you can go in and they typed in accountable care organizations and up came a policy interview with an ACO expert. So this kind of training is extremely important. There’s a wealth of things that you can do on here. Next slide.
So to the subject for today, I’m going to show you an assignment that I give Master’s students. These are advanced practice nurses. The course is titled Context of Care and there are a hundred students in the course. How do you make a course for 100 people hands-on? This assignment does it, I’ve found that if I was confidently lecturing or bringing lecturers in students would zone out, they weren’t particularly interested. It’s hard to do. So this form of active learning has been extremely engaging and the students have really loved it and so have other faculty.
The assignment gives people practice in competencies in both leadership and quality and safety and we need those to meet our obligations as an accredited school meeting the Master’s essentials as well as the QSEN competencies for nurses. Next slide, please.
The assignment is a two-part assignment. It has a presentation component and a written memo and, as I said, the title of the course is Context of Care so the Innovations Exchange is part of that context in which health care providers are giving care. On the Innovations Exchange is an Adoption Guide that potential innovators can look at but I also have the students read the Adoption Guide so they understand and have background as to why an innovation got there. And then, as I mentioned earlier, the excellent capability of sorting the innovation profiles and the quality tools by subject areas is extremely helpful. Next slide.
So I take the 100 students and I divide them into small groups and I give them the assignment. The first part of the assignment is the presentation and I have the students work in pairs. They need to select an innovation and they need to prepare one PowerPoint slide, give a five to seven-minute presentation to their small group, and then allow for five minutes Q&A. The single slide is always controversial because they want to make lots of slides and they’re in an academic setting and that’s what people in academia do, but I tell them that they need to be clear about the message about what the innovation does, what its results are, and tell a visual story. I’m going to show you some examples and you’ll see how creative they’ve gotten.
The other thing I tell them about a single slide is that you can use that as a handout in other settings. We encourage our students to meet with the legislators, their state and local legislators, and you know that legislators are very busy so if they have a single handout to give them it gets looked at as opposed to a package. I also am preparing them to do presentations in their own place of work when they leave school and I’ll tell them you may have 10 minutes on the agenda; if you have too many slides you’re going to get stuck in one place. So the single slide has a lot of reasons for using it and once they get over it it’s very effective. Next slide.
The second part of the assignment is a written memo and, again, these are Master’s students and they need to be able to communicate in writing to senior leaders. So we give them the format for writing a memo, they need to make it five to six paragraphs. It’s a form of leadership communication in which they will translate the components of patient safety and risk management for quality improvement. Kathleen talked about early adoption and oftentimes we tell our students you will be working and you may be the person that has an idea about an innovation for a problem and you need to communicate both in writing to your senior leaders, so this is the way that we do it. Next slide, please.
Both of these activities are active learning activities and they’re student-centered. And as I mentioned, the students learn to use the site and to do critical thinking, evaluate and analyze tools. The result is that when they leave here they will not forget the Innovations Exchange, which Judi told you at the beginning is every two weeks there’s a new set of articles and innovations that are presented. It’s also updated. So it’s a reliable tool for students after they graduate.
Without the assignment, you can tell them about it; I’m sure those of you that are listening who teach, you can tell people, you can show people, but generally they might say to themselves when I’m in practice someday I may use this, who knows. This assignment gets hands on and they do it. Next slide.
This is an example of one of our student slides. I’m going to show you a few of them but you can see that they’re extremely creative once they get going and they’re very proud of them when they get done. As you can see on the bottom – it’s hard to see in writing – but the name of this innovation is Automated Phone Counseling Helps Parents of Overweight Children Model and Encourage Appropriate Behaviors, Leading to Meaningful Reduction in Body Mass Index. So the student gave a quick summary of the problem, a description of the innovation, the results and so me evaluation and made it engaging enough and interesting enough that it captured our attention. Next slide.
Our objectives in grading include understanding the selection criteria that AHRQ uses, that the students have selected an innovation or quality tool that’s relevant, that the student uses critical analysis of specific innovations or tools; we work very hard on both the speaking critically, oral communication, as well as the written, and that they’re practicing it and, as I mentioned before, that is very important for students when they’re graduating. Next slide.
Here are a few more examples. This truly is one of my favorite. These two students really organized this so that your eye follows carefully the different elements of the innovation. I think it’s easy to see. I was in the group when they presented it and they did not read the slide; they talked to each of these boxes. It’s very effective. I actually used it myself for a one slide presentation that I did later, I liked it so much. Next slide, please.
In this slide we have data and showing some results, so this group put up a chart that people could quickly look at, get their attention, and then again breaks it down by problems, innovation and then what they did, which were group appointments for this. Students are very creative, as you can see. We’ll have one more slide. Next slide, please.
And this one I always like because you can tell that they’re students and they selected an innovation with a visual that was on the Innovations Exchange for a tool and put that up. So again creative, informative and had the students really have to focus, summarize and hit the elements, which they will in turn be using in practice.
On the next slide are some examples of selected phrases from the student memos. I’m going to let you just quickly look at them. As you know, you can go back and see these. And I will mention that the memos themselves, there are six examples on the Innovations Exchange – there’s a link to that website at the end of this presentation – and you can read them carefully if you like. But you can see that the students were focused in their writing, had an opinion, documented it, and I’m very proud of the work that they’ve done and I have a lot of confidence that they’re going to be able to carry this experience into their practice.
The next slide is my grading criteria. Needless to say, the slide needs to be easy to read and it accompanies the presentation. We all hate presentations where someone reads their slide and you can see that they used the visuals. They are not graded on their public speaking ability, which actually makes them more relaxed; I tell them that at the beginning. The memo, they have to express an opinion and they have to have an understanding and compare it, do some comparative writing.
So that’s it on the assignment. As I mentioned, at the end of this you will see a link to the assignment and I hope you enjoy it. Thank you very much.
Judi Consalvo: Thanks, Judy. That was great. Two wonderful presentations, a lot of information, and I would now like to open the discussion to audience questions. We’ve had a number of questions come in and so we thank you for submitting them and we’ll get to as many as we can in the time that’s remaining.
The first question is a follow-up question for Judy’s presentation. Judy, can you give an example or two of how students who have taken your course have continued to use the Innovations Exchange in their practice?
Judy Kunisch: I’d be happy to do that. First of all, one of our students – our students come from around the country and she was going to Maine and she was going to work in rural health care as an advanced practice nurse she was, because in Maine you can have an independent practice, was going to open her own nurse-managed clinic for adults. Her patient population was for adults.
She selected an innovation on doing eye test screening for adult diabetics and she told us that she was going to introduce that at the beginning of her practice. She felt it was going to be a tool that she could use right away. She also had contacted the innovator and the innovator has been extremely helpful to her in getting materials and beginning to look at a plan for how to introduce it. So that was a really interesting one for me because not everybody is here in Connecticut and they’re going to faraway places.
We had a second student who looked at an inpatient pediatric for children with leukemia a medication management tool and she contacted the innovator because she had received clearance to develop it for other acute illnesses in children. So they were working on not just the subject of leukemia but they were moving it to other illnesses, acute care illnesses.
So that’s two examples where students took the work that they started here and moved it on into practice after graduation.
Judi Consalvo: Good. Okay, thank you. Kathleen, would you like to add to that or talk about some of the steps that you’ve taken?
Kathleen Stevens: I would. Thank you, Judi.
I’m thinking about how do you get these changes, these adoptions to be made, and reflecting on one of the early change gurus from Lippitt and the first step is that everybody has this felt need. I think sometimes we move forward with a great giant felt need in our own minds and yet not everybody’s on that same page with us.
The work being done by Kotter out of change management and reflected in the book Our Iceberg is Melting provides a very nice synopsis of all of his research in terms of stages of change. As a matter of fact, those of you familiar with AHRQ’s Team Steps Program recognize the book and the change process, and I guess there’s four major pieces of that that in my work I keep in mind.
One is to look at that local information. Is the problem sensed? Can you produce data along the same lines? What is your level? Has there been some issue with retained instruments in the OR (operating room)? So that sense of urgency can be created by looking at a local example.
Then moving the people together, the right people – and sometimes it’s surprising who are the right people that need to be at the table – to create what’s called a shared mental model, that shared goal of okay, this is our problem, we embrace it; now what is the solution or solutions that we’re going to try? And I think the champions and practice facilitators are part of moving people from A to B, empowerment in moving yourself to A to B, and then making it stick by having auditable outcomes that are fed back so that people can enjoy the success of their change. So I think that’s at the clinical level as well as probably in curriculum revision and development.
Judi Consalvo: Thank you, Kathleen, and thank you both.
The next question is directed to you, Kathleen. Health care reform is driving a number of changes in the workforce, ranging from defining new roles, such as community workers and physician extenders, to redefining roles to encourage multiple-disciplinary teamwork. You spoke about the need to promote innovative thinking to help prepare the future workforce for the changes needed in health care so, Kathleen, can you provide your perspective on how the educational curricula should change to meet the needs of the current and future health care workforce?
Kathleen Stevens: You know, I’m really encouraged about the leadership provided on a number of fronts throughout medicine and nursing and physical therapy and other professionals in the team to look at how the IOM redesigned principles are cross the quality chasm are beginning to really be codified in what I call accreditation. Once you go in and expect a program to have this in order to receive accreditation, then it becomes a big motivator, so I’m very excited to see the safe, timely, effective, efficient, equitable and patient-centered principles moving into the preparation of our workforce.
It’s in such great harmony with the AHRQ Health Care Innovations Exchange because some of the first criteria of how to move your innovation that you’ve tried into the Innovations Exchange is that it must be about a care process that addresses safety, timeliness, effectiveness, efficiency, equitability and patient centeredness. So I think that’s one aspect we are beginning to see our educational expectations harmonize with the national paradigms that have been set up.
So we know that the context can pose great challenges and that the first paradigm shift that I offered in a slide was improving our work is our work is almost too simple. It’s almost too simple in that you can say it and it includes this very exciting set of new skills in terms of many of them engineering or microsystems focuses, so how to reengineer the system becomes part of that curriculum change.
Judi Consalvo: Great. Thanks, Kathleen. I think that’s probably helpful to the person who sent that question in.
Judy, is there anything you would like to add to that?
Judy Kunisch: No, I think that was a great answer.
Judi Consalvo: Okay. Good, let’s try to move as quickly as we can to get some of these questions in.
The next question is directed to you, Judy. Curriculum changes in higher education can be difficult to make. Can you talk about the steps that you took to initiate that process?
Judy Kunisch: Well, thank you for the question. Yes, I will talk about the steps.
I think if you all recall when Judi did my introduction that my career has not been as an academic, that I have worked outside of academia and I’m actually a doer and an action person, so the opportunity to teach has been wonderful for me because it’s allowed me to pass on to my students some real life examples of what happens when they’re in the workplace.
So when I decided to do this I became familiar with the Innovations Exchange actually through a conversation with someone at a professional conference over coffee in the morning and what do you do and she told me about it and I went and I started looking at it and I said wow, this is terrific because, unlike a lot of research which sometimes takes years to get published and years to get out to people, the Innovations Exchange is an action-oriented, clearly vetted website where we don’t have to wait as long, and so I just did it.
I looked at my course; I had a piece on quality and safety, I have a piece on leadership, and I said I can’t think of a better way for students to practice and gain an understanding of what real people are doing addressing real problems in the clinical setting and also to practice their communication skills. And I was thinking when Kathleen was talking earlier, this isn’t just about nursing; this is for physical therapists, this is for OTs, this is for social workers, this is for people who are studying health care administration and they come in and they’re learning about how to run an outpatient department or they’ve been given an assignment to look at a certain aspect.
So I did it and then I told people I was doing it and I had faculty actually come to the small groups because we do grade the students on their presentations in the small groups and the faculty came back to me afterwards and said wow, that was really great; that was exciting, the students had fun, clearly the slides are very interesting. So it was more of a take action with something that’s innovative.
Judi Consalvo: Great.
Judy Kunisch: Kathleen, you might want to say something.
Kathleen Stevens: Thank you, Judy, yes. We’ve had some conversations about this in terms of the deferral of who’s at the real point of work and I concede to Judy that coming from the relevance to the clinical setting that is to patients is where you’ll find students and that passion and energy is what turns the head of faculty who are a little bit more hesitant to change.
The tactic that she used is one that I can connect to Rogers, Everett Rogers of Innovation Adoption fame, and he stated that the trialability and testability of an innovation, those two things are key to its larger adoption, and what you did was take the risk out of testing it with students and you stepped forward and you built it and you tried it and then you showcased it and it worked. You paved the way and I think this reduces the risks for others. And I think we should give each other permission to try to different things and see if it works and not be quite as hesitant to try new things, so the trialability and then determine if it’s scalable.
By the way, some innovations don’t work and I think we’ve showcased some of those in the Innovations Exchange because we learn from those as well. If an agency has tried a program and invested resources, energy and thought and yet it didn’t work, that adds to our knowledge as well. So these attempts are worth looking at in addition to the ones that have moderate and strong evidence.
Judi Consalvo: Thanks, Kathleen, for adding that information.
We’re getting down to a limited amount of time; we have several questions but just time for one more so, Kathleen, we’re going to direct this to you and, as we’ve been doing, Judy, you can add some comments if you’d like.
The question is in social worker there is a wide array of content competing for limited space in the curriculum. The type of content that you provided may be relevant for a number of different courses, such as organizational change and an introduction to research. So Kathleen, do you have any examples of continued or higher education settings that have incorporated content from the Innovations Exchange into their existing curriculum?
Kathleen Stevens: Well, a very simple add on with looking at Judy’s example was to have students go in and phrase the comments, to really look at the innovations deeply enough in order to form some opinions and then have them share amongst each other.
I know that coming from innovation and creativity, one thing that I come away from Paul Plsek’s teachings is that creativity is a learnable skill and he demonstrated that in a fairly recent presentation.
So I think that this isn’t a standalone class; it’s something that is part and parcel of our clinical decision making. So the bottom line is that every place you teach students or students have an opportunity to learn what to base their clinical decisions on is a place that you can interject these innovations and using examples from the Exchange.
Judi Consalvo: Judy, would you like to add anything to that on what you see maybe as the pros or cons of creating a course dedicated to innovation versus incorporating some of the Exchange content into existing courses?
Judy Kunisch: I personally think that we do need to have some courses on innovation, both that there is so much opportunity for change in our present healthcare system and that we have begun to develop a science of innovation, and so I am in favor of innovation courses and I do think that they are important and they’re almost our ethical obligation to our students to teach them how to innovate.
Judi Consalvo: Thank you, Judy. I’m afraid we’re running out of time now.
First of all I want to thank our presenters, Judy and Kathleen. That was great. I think you’ve shared a wonderful amount of information to our audience and I hope our audience has enjoyed this.
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