University of Pennsylvania, Nursing Director of Innovation

The University of Pennsylvania is known worldwide for its well-funded research programs and innovation initiatives. The university is home to several innovation programs, including the Penn Center for Innovation and the Penn Medicine Center for Healthcare Innovation, as well as an ecosystem that serves innovators and entrepreneurs around the world. Several years ago, in keeping with the innovation strategic priorities of the University, the School of Nursing embarked on a journey to bring a focus of innovation to the School.

Initially, the Associate Dean for Research & Innovation worked with school leadership and its Board of Overseers to develop a strategic vision for the innovation space and to frame what innovation meant at Penn Nursing. With this strategic vision as a foundation, Penn Nursing created and funded a Faculty Innovation Fellow who spent a year in residence at the Penn Medicine Center for Healthcare Innovation and supported student internships in this same center. Over the past 5 years, these efforts led to a cadre of faculty and students becoming engaged and committed to further developing innovation in their research, practice, and education.

A new position was created to ensure that innovation was infused in the research, practice, and teaching mission. Initially, as a part-time innovation specialist, within 18 months it was elevated to a full-time Director of Innovation position that represented the School across campus. The role established and solidified partnerships between the school of nursing and other academic units, as well as innovation entities outside of the university while amplifying nurses as leaders in health and healthcare innovation globally. The initiatives from the office of the Director of Innovation are already driving the education of the nursing profession to elevate nurses as innovators. In partnership with the Rita and Alex Hillman Foundation, the office developed an open source on-line curriculum and a national platform by which nurse innovators could share their knowledge and expertise. This unique suite of materials, the Design Thinking for Health platform (www.designthinkingforhealth.org), is available free of charge to all nurses, nursing programs, and healthcare innovators. Funding for programmatic initiatives is augmented with gifts, endowments, and foundation grants.

One of the biggest initiatives undertaken has been the engagement of students. Engagement of students is happening through a number of initiatives including the interprofessional Innovation in Health: Foundations of Design Thinking course, as well as through initiatives such as the Penn Nursing Innovation Accelerator program.

Over 5 years, key lessons learned from the Penn Nursing team are (a) the importance of creating a strategic plan and aligning resources to assure goals can be accomplished; (b) start with a focused initiative and build a strong foundation; and (c) capitalize on the School's board of overseers (i.e external advisors) as fully engaged partners in informing and accomplishing an innovation vision. Penn Nursing's future goals are to (a) focus on student driven activities to enhance participation in innovation-based programming; (b) expand faculty and student reach nationally and internationally through partnerships and educational platforms; (c) engage social media to increase awareness; and (d) continue to capitalize on a robust research portfolio and strong practice partners to ensure evidence based products and processes can be further developed to support spread and scale. The Penn Nursing Innovation program is a great model for research-intensive institutions looking to embrace a culture of innovation. https://www.nursing.upenn.edu/research/innovation/

 Duke University School of Nursing Health Innovation Lab

For the past 3 years, the Duke University School of Nursing (DUSON) Health Innovation Lab has served as an accelerator to translate innovative ideas, processes and technologies into clinical practice. The Director of the Center is a digital health scientist who saw an opportunity to give life to innovative clinician ideas. The lab provides an infrastructure and physical space for entrepreneurship, product development and testing, and modeling new care delivery processes. The lab is a space that sits within a larger 20,000 square foot simulated clinical environment.

The team has created a strong partnership with the Duke Health System and Schools of Engineering and Medicine to create opportunities for engineering and nursing students to work alongside innovative clinicians and research scientists. A 3-year internal grant from DUSON was awarded to launch the lab. Their key to creating a space for the lab was receiving a National Science Foundation (NSF) grant in collaboration with engineering faculty for a robotics project. After this, DUSON took note of the innovative work and wanted to support the lab in a much bigger way by giving them physical space in their new building. Today, they are primarily funded on grants and receive some support from the Duke Health System. One of the biggest challenges for the lab aside from raising money to support it, has been getting protected time to develop it. Because most models of innovation take time to see a return on investment it can sometimes be hard to justify the required protected time for faculty to build innovative projects.

One of the lessons learned early in the process was to invest in people and negotiate for staff assistance early. It takes a team to launch a successful center and staff assistance to support the day-to-day scheduling and administrative requirements can be the key to doing so quickly and efficiently. The future of the DUSON Lab is to build upon interprofessional educational opportunities, primarily with the schools of engineering and medicine and seek additional partners to maximize their ability to bring clinical innovations to life. Currently they offer co-listed courses to engage in interprofessional educational opportunities that often lead to novel ideas coming into the lab for development. For example, every semester, clinical challenges are ‘pitched’ to engineering students in the hopes of garnering interest and building news teams. Many clinicians who have brought their ideas to the lab have found their partners this way. The DUSON Health Innovation Lab is a great example of how bringing together clinicians and engineers for the sake of education, can lead to the development of successful innovation-based partnerships simply through conversation and discussion. https://nursing.duke.edu/tags/health-innovation-lab

 Cleveland Clinic Health System, Office of Nursing Research, and Innovation

The Office of Nursing Research and Innovation of the Cleveland Clinic Health System provides mentorship and guidance for nurses in all stages of research, from developing questions through developing manuscripts of completed research, and also, in all stages of the innovative process, from ideation to commercialization. A strategic mission of Cleveland Clinic is innovation, but historically most innovations were physician led. In 2006, the chief nursing officer identified an opportunity for nursing to embrace innovation and asked the Director of Nursing Research to attend Commercialization Council meetings and implement creativity sessions. In 2011, nursing innovation became a strategic initiative of the Nursing Institute; the Office name and the director's job title were changed to include innovation. Innovation must be supported by leadership at the highest level to be successful. Since innovation is not often seen as mission critical, leadership must advocate for it, as it can be time intensive and many innovations require funding for the work of developing prototypes and assessing innovation value. Infrastructure support by the chief nursing officer provides an example of the importance of creating structures that support a culture of innovation, not just in words, but in policies, incentives, and actions that support the vision and mission of an institution. Nurses often have trouble taking ownership of their own inventions and following through with next steps because they either lack knowledge or confidence in the innovation process. Therefore, the Director of Nursing Research and Innovation and her team use multiple methods to reframe innovation and make innovation more transparent. They encourage nurse innovators to communicate their ideas and to take the lead from idea generation to implementation. In 2018, the team hired a part time ‘innovation coordinator’ to encourage, support and guide nurses along their journey. Since the Office has employees with expertise in nursing research, some of whom were also innovators, it was a natural “marriage” of teams, especially since, research is sometimes needed to show the value of innovations.

Over time, one lesson learned for the Cleveland Clinic team was that some nurses with great ideas do not want to spend time and effort on cultivating them. To overcome innovation inertia, the Director and her innovation coordinator revised their innovation processes. Idle ideas are now shared with others, cultivated, and brought forward so that clinicians can benefit from their colleagues’ ideas. The Nursing Institute is fortunate in that they collaborate closely with Cleveland Clinic Innovations; the team that receives inventions, reviews them for viability and takes steps toward commercialization. The combined expertise of the Cleveland Clinic Innovations team and nursing innovation leaders help bridge the gap for nurses who are not trained in the language, skills or steps of innovation.

When nurses do not know who to share ideas with or how to make a case of the value of their innovations, they will be less likely to vocalize them initially and advocate for their implementation. An innovation coordinator coaches nurses so that when they submit to the Cleveland Clinic innovations team, innovation details (including drawings) and expected outcomes are developed and the innovator can pitch their idea. Cleveland Clinic Innovations leaders understand the value of promoting nursing innovations and now provide a more advanced level of prototyping support. When research is needed, nursing research personnel mentor the innovator team in grant support, often through internal grant funding.

The Cleveland Clinic Health System, Office of Nursing Research and Innovation is a great example of how nursing innovation can flourish in an institution when resources are maximized and coordinated to ensure that great nurse-conceived ideas are vocalized, mentored and processed toward local implementation, commercialization and gaining a return-on-investment. Mentoring and coaching remain a critical component of building innovation-based capacity and development in nursing. https://my.clevelandclinic.org/departments/nursing/about/specialties/nursing-research

 The Ohio State University College of Nursing Center for Healthcare Innovation and Leadership

Our entry into innovation began with the development of a Master of Healthcare Innovation (MHI) Program in 2012. This development process showcased the need for non-academic support for the ecosystem. In conjunction with the MHI curriculum creation, the CON launched our inaugural Healthcare Innovation and Entrepreneurship Workshop in 2015. This workshop has continued annually as a two-day event focused on providing innovators and entrepreneurs the tools and network they need to be more innovative in their practice or take the entrepreneurial leap.

As these programs grew, so too did the need for a foundation of innovation that has been carefully developed over the past 9years. We recognized that we needed leadership roles that stretched beyond the typical barriers found in traditional academia. Our first step was to create the nation's first Chief Innovation Officer in academic nursing in 2016, who quickly focused on giving nurses and other interprofessional innovators a voice through the Innovation Studio.

Funded by a philanthropic gift, the Innovation Studio started as a moveable makerspace/idea incubator focused on democratizing innovation across campus. The Innovation Studio makes seven-week long tour stops at high traffic locations across campus (lobbies of libraries, hospitals, colleges etc.) At the end of each tour stop, the Innovation Studio hosts a pitch day to learn about the innovations that interprofessional teams have created. The true uniqueness of the Innovation Studio is not that it is moveable or hosts pitch days; what is truly unique about the Innovation Studio is that it provides funding to every team that pitches their idea as long as the teams are made up of two or more Ohio State students, faculty, or staff, and their innovation has to improve the health or wellbeing of at least one person on the planet. Keeping the barriers to entry at a minimum has allowed for a diverse group of teams and ideas to be pitched to the studio since launching in March of 2017. Since then, a second, non-moveable Innovation Studio has opened a permanent space in a non-nursing building on central campus. We have funded over 200 teams to the sum of over $150,000 and have seen our first of what we hope will be many innovations reach the commercial marketplace. We are actively seeking franchising opportunities to launch the Innovation Studio throughout academia and healthcare.

Continuing to build out the foundation of innovation, the CON hired a director of the MHI program in the fall of 2017. The MHI program is a cross disciplinary program that prepares future generations of innovation leaders. The program places a strong emphasis on complexity theory, complex adaptive systems, design thinking, as well as the culture of innovation. Rooted in quantum leadership and emotional intelligence, the program prepares individuals with a variety of backgrounds, to move innovation forward from point A to point C. One of the mantras of the program is, “being comfortable with being uncomfortable,” where experimentation and tolerance of failure are givens. The program concludes with a team-based capstone project that begins with a design thinking course, where ideas are generated, iteration takes place and the phases of design are explored. The result of the design course moves the students into the two capstone courses where implementation and evaluation of the project are completed.

It is the philosophy within our College that the success of any Center is greatly dependent upon a strong academic program. There are many synergies between the MHI program and our innovation center including, student engagement, potential funding of projects, and relationships with industry that could lead to commercialization opportunities.

Bringing the CON's first Entrepreneur-in-Residence in the fall of 2019 completed the foundational build of our innovation team. Dr. Barr's arrival brought in the experience of a venture-backed academic entrepreneur, a rarity in nursing today. Her impact has been immediately felt through the development of a faculty mentorship program that was been piloted in 2020, with plans for a university-wide interprofessional release in 2021.

The combination of these efforts highlighted the need for a formal structure of innovation at the CON, which came to fruition in August of 2020 through the announcement of the Center for Healthcare Innovation and Wellness at The Ohio State University College of Nursing. The newly established center aspires to become the world's destination for developing innovative and entrepreneurial leaders who transform health and improve lives. The self-managed leadership team holds one another accountable and responsible for all aspects of the center. This allows management to be shared across the Core Team while a Governance Team ensures all decisions are consensus based. We believe shared interest and purpose lead to shared responsibility. https://nursing.osu.edu/offices-and-initiatives/center-healthcare-innovation-and-wellness

 Examples of Innovation Initiatives Without a Formal Innovation Center

As most colleges of nursing likely do not have dedicated innovation centers, we also wanted to provide an overview of how to conduct and structure innovation outside of a formal innovation center. We believe these colleges provide an example for those who are looking to enhance their current programs to support innovation-based initiatives but may not want to formally launch an innovation center.

 John's Hopkins University School of Nursing, REACH center and Center for Innovative Care in Aging

The REACH Initiative serves Baltimore City residents living with and at risk for HIV and associated co-infections. The Center for Innovative Care in Aging advances novel behavioral interventions to enhance the health, well-being, and aging of diverse adults and their families in various settings including home and community. These two centers function very much like traditional research centers and are primarily supported via grants and contracts. However, the Dean supported startup funds to get the centers going and provided support for 5 years for two positions that were eventually backfilled with grant money. They do engage with companies from time to time, providing additional sources of revenue beyond grants. The work coming out of the centers is innovative and cutting-edge, which speaks to the innovative leadership of the center directors. Innovative leaders create cultures that promote innovation and new ways of addressing common challenges. Both center directors saw an opportunity to innovate in their area of research and through their passionate commitment have kept their centers going through successive grant funding for the past few years. The REACH Center also provides continuing education (CE) opportunities for clinicians, opening a novel revenue stream while promoting education and outreach.

In terms of lessons learned, they too have shared the same challenge as the DUSON team, which is to negotiate for more time and effort to support their innovative efforts up front. This difficulty in negotiating for time to build innovation is a recurring theme for research scientists and has implications for long term stability. For both of their centers, they are heavily dependent (although not solely) on research grants, thus sustainability is a concern. There are not many research scientists with grants to support the work of the centers and succession planning for a center like this is uncharted waters. Both center directors are the PI's of the grants that support the centers. This is a challenge for most academic research centers and highlights an important opportunity to innovate in this area to allow teams to emerge with multiple grants and funding streams, as well as seamless transitions when individuals move. Given the difficult funding landscape, the directors both agreed that advocating for and seeking investments outside of grants and contracts is a must for the future. They are exploring shared positions across centers to save resources, the creation of dual appointments outside of nursing to maximize effort, and interprofessional opportunities and joint programming to increase student involvement. These centers are a great model for traditional research centers who are looking for ways to amplify innovation within their research programs and how to sustain center funding in a difficult funding environment. https://nursing.jhu.edu/faculty_research/research/osi/

 New York University Rory Meyers College of Nursing

Although the NYU College of Nursing does not have a separate innovation center, each of their research centers, has a focus on innovation. NYU Meyers is the second-largest private university college of nursing in the US and is most known for their research and innovative, evidence-based approaches to healthcare delivery. The Hartford Institute for Geriatric Nursing leadership shared some of the most important aspects of keeping innovation alive at the college are through strategic planning, bringing together academic and business partners to the same table, and being intentional about making meetings productive. They identify operational versus aspirational type meetings. Aspirational meetings are networking opportunities and community building opportunities for scholars with similar interests to come together to brainstorm. In this meeting they bring big hairy problems, new work (specific aims pages, ideas, program/product enhancements), mock presentations, etc and discuss data/papers/abstracts and opportunities for collaboration. This is also where they bring team policies and practices to discuss and reach agreement (e.g. mission/vision/values, publication policy, develop strategy, etc.) The second type of meeting is operational. These meetings are smaller, just with teams or subsets of teams. They are driven by the operational issues at hand and scheduled to stay on task. These all meet weekly and are meant to keep everyone on the same page, troubleshoot or even better prevent upcoming risks, and set the agenda for the upcoming week.

Innovation research at NYU is largely dependent on research grants, although the team is looking to explore novel funding opportunities in the future, especially given the current landscape amidst the pandemic. When it comes to innovation, teamwork is a must. Innovation only works when team members hold one another accountable, yet do so with grace and respect, thus the teams deal with challenges early and provide positive feedback as well as constructive feedback to one another each week. They engage in project management to outline clear deadlines and client support/feedback. Their team is diverse and consists of research and clinical faculty, operational staff, students and post-docs and all are seen as having a seat at the table, a voice, and personal experience and insight to improve their research, programs and products. NYU is a great reminder of how team-based initiatives can drive innovation and how innovation can drive research. When these two go hand in hand, there is much more that can be achieved and what emerges is an entirely new process in healthcare transformation. The whole is greater than the sum of the parts. https://nursing.nyu.edu/innovation

 University of Connecticut School of Nursing

The UConn School of Nursing's (SON) official innovation journey began in 2013, in collaboration with a health care entrepreneur and angel investor alumna. The initial efforts to stimulate innovation and innovative behaviors amongst the undergraduate students demonstrated the potential to develop the innovation knowledge, skills, and abilities of nursing students before entering the workforce. Students began inventing solutions to pervasive healthcare problems, filing patents, and developing commercialization plans. Such outcomes led to an alumni gift to fund a Visiting Professorship for Innovation to develop and execute on a strategic plan to integrate innovation science into the core curriculum of all degree programs: Bachelor of Science, Certificate Entry in Nursing (CEIN), Master of Science, Doctor of Nursing Practice and Doctor of Philosophy. To achieve this goal, the Visiting Professor worked closely with UConn SON faculty to understand the culture and ultimately identified six strategic goals that aligned with each program and the strategic vision of the overall School of Nursing. The Dean instituted the three overarching prioritization areas of caring, innovating and advocating to guide the strategic and operational efforts across the school of nursing.

As of fall 2019, all entering students across all degree programs now receive core education on innovation science. Beyond the formal education, UConn SON's students and faculty are encouraged to pursue ideas and meet with the visiting professor to discuss the next steps for those ideas. Additional programs, mentoring, and independent study courses are offered within the school of nursing to foster their ideas for new innovations. In addition to integrating innovation science into the core curriculum programs, there was a need for an intensive certificate program for those nurses and healthcare professionals seeking to understand the theories, concepts, methodologies and application of innovation to healthcare. The Healthcare Innovation online graduate certificate program launched in January 2020 and is one of the first in the United States. The program is designed to be able to accommodate the working individual who is looking for a program that meets their temporal and geographical needs while learning from an expert in the field.

Beyond the school of nursing, the University of Connecticut's ecosystem and infrastructure includes multiple grant opportunities along with the Werth Institute for Innovation and Entrepreneurship, the Technology Incubation Program (TIP), and the Connecticut Center for Entrepreneurship and Innovation (CCEI) to support innovators and entrepreneurs in their process to solve problems at scale for the benefit of others. With an infrastructure across the University, the college of nursing visiting professor works with these interprofessional groups to offer more resources to students, faculty and alumni.

Innovation also holds an integral role in research. In 2018, the Dean rebranded the already established Center for Nursing Scholarship to become the Center for Nursing Scholarship and Innovation (CNSI). The CNSI is now better able to express the growing mission of supporting innovation in nursing, emerging healthcare technologies and techniques. The DeLuca Foundation visiting professor for innovation and new knowledge role is quite unique in academic nursing. we believe such a role can serve as a model for other schools of nursing who are looking to integrate innovation into curricular programs. https://cnsi.uconn.edu/

Acknowledgements

The authors would like to thank Marion Leary RN, MSN, MPH, FAHA Nursing Director of Innovation University of Pennsylvania School of Nursing; Ryan Shaw PhD Founder and Director of the Health Innovation Lab Duke University School of Nursing; Sarah Szanton PhD MSN RN, FAAN, ANP Professor, Director, Center for Innovative Care in Aging and Jason Farley PHD, MSN, MPH, RN FAAN, ANP-BC, AACRN, Professor, Director REACH Initiative Johns Hopkins University School of Nursing; Nancy M. Albert PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN Associate Chief Nursing Officer, Office of Nursing Research and Innovation; Abraham Brody, PhD, RN, FAAN, Associate Professor Director of the Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing; and Tiffany Kelley, PhD, MBA, RN DeLuca Foundation Visiting Professor for Innovation and New Knowledge in Nursing University of Connecticut School of Nursing.

Funding

This work was supported by the Ohio State University College of Nursing Center for Healthcare Innovation and Wellness. This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.