What does the next wave of nursing innovation look like?

Healthcare leaders have been focused on redesigning care models to improve quality, value and patient outcomes for many years. The COVID-19 pandemic drove unprecedented innovation in healthcare delivery, driven by urgent need, in which nurses played a central role. Now, in this new era of healthcare, many health systems are looking to understand the impact of new care delivery solutions that provide better support for nurses while simultaneously improving patient care.

Disrupting the status quo is the focus of a new network created in collaboration among the Institute for Healthcare Improvement (IHI), and the Johnson & Johnson Center for Health Worker Innovation, called the Transforming Healthcare through Innovative Nurse-Led Care Delivery Learning and Action Network.

Across three phases and 22 months, five healthcare systems will conduct small pilot tests in three key focus areas identified by IHI related to innovative, nurse-led acute care delivery solutions: innovative technology that improves efficiencies for staff, like robots or wearable vital sign monitors, virtual care delivery, and utilization of interprofessional support, teams, and resources. The goal is to gather insights that can be shared more broadly, to inform how other health systems might mirror these new care delivery solutions.

“Leaders are investing time, energy and resources into delivering care differently at a new level,” said Debbie Zimmerman, who is serving as an advisor to the project and is president-elect of the AONL Board of Directors “It’s different ways of thinking and an openness that I haven’t seen in my 40 years of healthcare.”

Throughout the pilots, the learning and action network will also leverage IHI’s unique approach to implementing, testing and assessing change and impact.

The “science of improvement” spurs innovation through rapid cycle testing models. Instead of testing complex approaches over long periods of time, pilot health systems will implement small changes over very short periods – days or weeks – to generate learnings faster and more efficiently.

“We apply improvement methods to generate learning about what changes, in which contexts, produce improvements,” said Patricia A. McGaffigan, RN, MS, CPPS, Vice President, Institute for Healthcare Improvement. “What makes a change successful? What gets in the way of a change being successful? How can we architect the conditions and the ecosystem under which that change can be translated into meaningful results?”

In Phase 1, IHI identified promising clinical and evidence-based innovative care delivery solutions based on expert interviews and literature reviews. Phase 2 began in August 2023 with the selection of five healthcare organizations, who will participate in a learning and action prototyping network, in which they will begin rapid testing, implementing small tests of change, collecting data and sharing learnings. In the summer of 2024, results will be evaluated and synthesized, culminating in a Phase 3 toolkit created by IHI to summarize learnings and provide implementation guidance for other health system organizations to use.

“Johnson & Johnson and IHI and share a commitment to nursing and a belief that nurses are uniquely positioned to understand current points of pain in healthcare delivery and develop new solutions that support the nursing workforce as well as patients,” said Lynda Benton, Senior Director, Global Community Impact Strategic Initiatives, Johnson & Johnson. “We are excited to support this research and look forward to the learnings, so that these solutions can be shared and then better scaled across the workforce. It has the potential to be a win for nurses, patients and health systems alike.

From San Diego to rural Pennsylvania, from hospitals providing care for veterans to those caring for children, the selected nursing teams represent a diversity of organization types, locations, size, populations served and healthcare expertise. Each of the projects are designed to systematically improve and scale transformative change through an iterative process, as testing phases progress and results are continually evaluated.

Boston Children’s Hospital is an urban academic health system and a leader in both child health as well as nursing science and professional practice. Laura J. Wood, DNP, RN, NEA-BC, FAAN, EVP, patient care operations and system chief nursing officer, serves as the project executive sponsor together with co-leads Aaron Farber-Chen, MSN, RN, FNP-BC, senior manager, clinical innovation and digital health accelerator and Kate Donovan, PhD, Clinical Director of Innovation for Nursing. The team is building upon a prior pilot effort focused on the use of a remote resource nurse to further engage onsite staff and identify areas for improvement. While initially focused on nurse-to-nurse support, the team also plans to test the use of resource nurses to support patient-facing workflows related to admission, discharge, and direct observation roles in medical, surgical, and behavioral health settings. With more nurses looking for remote work opportunities, Donovan said the program reinforces the need to support and empower clinical teams.

“It really allows us to see the benefits of using a remote resource nurse,” she said. “A few years ago, we tended to focus on the patient and family experience, and we’re realizing that none of that can happen unless we're taking good care of our teams as well.”

Suburban Washington, DC health system Inova Fairfax is exploring ways to implement more innovative technology and reduce nurses’ administrative burden by integrating existing technologies and enabling greater data collection.

The team at Inova Fairfax

“We really have accelerated our nursing innovation work. We see this as an opportunity to expand on that and we want to help start to build some structure around it,” says Maggie Cunningham, BSN, MSN, DNP, RN-BC, NEA-BC, CPHIMS, Vice President and Chief Nursing Informatics Officer Inova Health System. “As we continue, we’re going to start discovering new areas of innovation that we haven’t yet tapped into. We’re excited by that, and we think this is a platform that’s going to allow us to do a lot.”

Senior Vice President and Chief Nursing Officer Betty Jo Rocchio, MS, BSN, CRNA, CENP, and her team at Missouri-based Mercy are leveraging technology to not only change care delivery at the bedside, but also fill the growing gaps in the nursing pipeline.

Using the real-world perspective of the staff medical-surgical nurses at Mercy, Rocchio and team are working towards reducing friction in bedside practice so nurses can build better connections with patients. The innovation unit has started by quantifying the day-to-day tasks of a med-surg nurse, showing the heavy cognitive workload of a task-driven care model. Next, Mercy will implement tech solutions, like an electronic white board that keeps patient goals, medication schedules and other pertinent information immediately accessible, to test the reduction in administrative responsibilities.

“We're putting the rigor towards evidence-based practice and measurable outcomes,” Rocchio said. “But what will mean the most to me is hearing nurses say, ‘I love my job, and I want to work on this unit.’”

Though nurse scientist Ana-Maria Gallo only joined VA San Diego six months ago, her goal is further integrating evidence-based practice, quality, improvement, and research into the facility culture to create a better environment for nurses and caregivers.

The San Diego team is still evaluating which technology solutions to test, but is focused on impacting recruitment, retention and the satisfaction of nurses, Gallo said.

Gallo and her team also hope to take advantage of the peer learning aspect of the pilots, especially as the VA San Diego serves a unique population of veterans.

WellSpan Health is a clinically integrated network of more than 2,500 physicians and advanced practice providers, more than 200 ambulatory sites, 8 hospitals, home care and a behavioral health organization in a mostly rural setting across South Central Pennsylvania. With a focus on virtual nursing, WellSpan’s goal for the pilot is to mitigate the impact of the nursing shortage as part of its workforce transformation strategy.

“Using innovation to solve some of our most complex problems is a top priority at WellSpan, and we’re also dedicated to being a learning organization,” said Kasey Paulus, MBA, RN, CENP, Senior Vice President and Chief Nursing Executive. “The opportunity to connect with other thought leaders who are innovating around nursing care delivery models was a really exciting opportunity for us.”

The virtual nursing staff are all from the pilot unit, so they are already attuned to patients and system workflows. Virtual nurses will focus on admissions, discharges, and patient education, areas that WellSpan has determined will bring the greatest value to the patient experience and employee engagement.

The goal of the Transforming Healthcare through Innovative Nurse-Led Care Delivery Learning and Action Network is not only to impact nurse satisfaction and care delivery in five systems, but to ensure that nurses are able to thrive in the driver’s seat of innovation, and capture and disseminate the learnings broadly.

Nurse leader Kathy Howell, MBA, BSN, RN, NEA-BC, chief nursing executive for UCHealth, serves as a advisor for the project. Her role is to advise, problem-solve, and encourage creative thinking among the five nursing teams to take their learnings and solutions to the next level.

“It’s all about scaling,” she said. “It takes a lot of blocking and tackling, selling the dream at each scale, going back to the why, and then managing it from a long-term perspective. That’s when you get arms around it, and that's when the work begins.”

Johnson & Johnson is committed to supporting a thriving healthcare workforce worldwide through the Center for Health Worker Innovation and is proud to continue its 125+-year commitment to champion nurses and the nursing profession.