Bill Klaproth (host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership.

I'm Bill Klaproth, and joining me today we have Margo Minissian. We also have Krystal Rodriguez, and we have Gregory Eichelzer as we talk about Innovation Igniter, digital transformation through design thinking. Welcome.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Thank you so much, Bill. It is such a pleasure for us to be with you today.

Host: Margot. Thank you.

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Thank you Bill. We're so excited to be here today.

Host: Yeah, this is great.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Happy to be here Bill, and share our ideas.

Host: Thank you, Gregory. I am interested in learning about the igniter, the innovation igniter. Let's do it. Let's ignite this podcast. Yes, it's all good. So Margo, let me start with you. Of course COVID forced many of us to go through a digital transformation, if you will. Can you tell us what kind of digital transformation did you go through at Cedar-Sinai?

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Yes, absolutely. Because of COVID, we really had to pivot hard and quickly. And, I was, quite frankly, as a researcher, I was a little worried for the team that, you know, I had these ideas for a digital transformation and people don't always love change, but because of COVID, this might be one of the silver linings actually from COVID, which was we were able to bring some different types of platforms that have never been used before within nursing, to deliver that transformational change that really was a requirement. It wasn't a, that would be nice to have, which is how it started. So in that setting and in that context, we were able to implement a strategic digital transformation, that we subsequently published about in Nurse Leader Journal.

Host: Wow. That's really interesting and everybody pretty much had to go through this, so very interested to hear more about what you went through as far as your digital transformation. So I love this phrase, digital transformation through design thinking. Gregory, can you explain more to us what that is?

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Design thinking. So it's a framework for innovation and we really connect to it as nurses because it has a few steps to it; empathize, define, ideate, test and prototype, but we're stopped in our tracks with that first step of empathize because it's a, it's a core value of our nursing profession to think about what is this person experiencing and what would be best for this situation.

So much of the old past and old guard of nursing leadership is unilateral. And it's just, this is what we're going to do. And you don't think about that end user, the end user of the digital transformation, what is best for them, not what's best for me, what is best for them. So we really lean into that empathize part as nurses.

Host: I love that. Well, anytime you bring empathy in, I think that just works and I'm so happy to hear you say that. And I love how you also said design thinking really is a framework for innovation. People have great ideas all the time, but if you don't have processes to execute these things, a lot of times they just fall by the wayside.

Right. Absolutely. So Krystal can, can you explain to us, so, appreciate these great thoughts from Margo and Gregory so far. So then how did you take all of this and put it into action? How does this work?

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Absolutely. So, I just want to give everyone a little context here.

Host: Yeah. Please.

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: And just give a brief overview about the innovation process in general. So again, the quick steps are to first identify and define your opportunities, find solutions for the identified opportunities, develop a prototype solution, pilot and test your solutions and determine outcome measures to evaluate your success.

So that's innovation in a nutshell. So easy, right? But in real life, this process can take months, years, decades, even. And because technology is advancing at such a rapid pace, we really need to continuously innovate in order to stay ahead of the game. So the Innovation Igniter is really a quick and easy way to accelerate innovation cycles in organizations.

It's basically a one day meeting of the minds. And we've done this process now, two times in recent years, and we absolutely love it where you basically get about a handful, 20 to 30 key stakeholders together in a room from all different disciplines. In our most recent Innovation Igniter, we had nursing leaders, we had faculty from one of our academic partners, human resources, but you get everyone together in a room and really go through all of the steps of the innovation process in a single afternoon. So, it's a way to get you just get it out there. Accelerate. Yes. You get it out there. Done. Get it done, make it happen.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: It's so true. One of the reasons why I really love design thinking and why it's different than like PDSA or some of these other process models that we use, is that we talk about issues and it's okay gang to say problems because organizations hypothetically, could have a problem. And so we talk about that, what could be potential problems or potential barriers at the beginning.

And we try and flush out, okay, where's the furniture? How can we get it out of the way? And then what really happens is that we unleash our teams and then they can really ignite this process.

Host: The Innovation Igniter. I love it. This is so cool. So Krystal, thank you for going through that list for us. So if someone were thinking, how do I do this at my own shop? How do you put this into practice?

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Well, like I said, it takes a meeting of the minds. So the first step is to gather a group of individuals together in a single shared space. What really worked in our innovation igniter was giving everyone a structured approach for their group discussion.

So we actually gave everyone a PowerPoint template and each of the steps of the innovation process was listed as a header on a blank PowerPoint slide. And each group was given a lead facilitator to walk them through those steps and make sure everyone was on the same page. So that structured approach really helped.

Host: So do people come in with problems they see in the organization, or we need to make this better, or we, as Gregory was saying, we need to make this better for our patients. This is lacking. Do people come in then with their ideas or their problems that you're trying to address? Is that what it is everybody come in with where you think we can make things better? Is that.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Yeah, I mean, we really follow our nursing strategic plan. We're very goal oriented and very focused. We want to make sure that we're all swimming in the right direction. And so typically what happens is the problems of the greatest importance are usually brought by the leadership.

And they'll say, Hey, we're seeing this issue. Or you may see something that is coming from the boots on the ground that organically percolates up through our shared leadership process. That could happen too. But whether it's coming from leadership or it's coming, from our frontline staff, there is an issue that it's identified that is a high priority on our nursing strategic plan.

And then everybody looks around and says, okay, what do we do? If this is your first time, for example, if this is the first time you're hearing about an innovation igniter or design thinking, you'll kind of wonder where do I start? For us, we chose to bring in a consultant. And so we had brought in Dr. Bonnie Clipper and we had Bonnie run through as a third party kind of unbiased, a thorough SWAT analysis of our professional development programs and our edu current education processes. And then together we identified some opportunities. We don't have problems at Cedar-Sinai. We just don't, never.

It's

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Just opportunities.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Only opportunities. And so then we went on and we had Bonnie actually facilitate the very first one, which was focused on the front piece of how graduated nursing students enter into the new graduate residency program. That was the first one that we did.

Host: So you understand where the friction points are, so that's what you're always trying to address. Yeah. And fix through design thinking.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Bill I just wanted to add the importance of how an igniter can impact digital transformation.

Host: Okay. Yeah.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: So as leaders, especially in healthcare, we are inundated with digital companies that want to come in and work with us. And if you can believe it, there's about 32% of hospitals' budgets are going towards digital care.

Host: Okay.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: And 32% is equal to $47.4 billion annually.

Host: Okay.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: So it's a lot of money that's on the table. And we as leaders need to have a very critical mindset and be stewards of our budgets to make sure we're implementing the best innovation. So to use design thinking process and this igniter process to evaluate these literally thousands of companies who want to come in and work with us is the best way because it is collaborative. It is empathetic. And the last thing you want to do is spend a $10 million contract on an innovation or a platform that fails and it's adopted.

Host: Right.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: So that's really what we found great outcomes using the igniter for digital transformation.

Host: Yeah. So what kind of outcomes have you seen Gregory?

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Krystal.

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Well I can talk about our participant feedback after our most recent innovation igniter. So our participants really loved the event. It was one of the most fun things that we've done. It didn't feel like a day of work, to be honest. But they loved having the contributions from the subject matter experts together in one room.

And they also really loved that structured process that I mentioned before. And, we did ask them also to evaluate their proposed solutions that were identified during the session. And all the participants agreed that their solutions would have either a high value impact or a moderate value impact on things like nurse satisfaction, patient satisfaction, care team productivity, et cetera.

So, we were all really excited about the ideas that we came up with that day.

Host: Can you share a very brief example of something that's come out of the innovation igniter that went through the process and you've changed?

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Yeah, I can. So whenever you invest time and take everyone in a room, you, you want to do something about it, right? So some of our next steps included doing some pilots with this platform. So this platform is called Accolade Health. It's a wonderful platform, so forward thinking where they have personalized avatars that create peer reviewed content and it's in a cloud form. So these are videos that are for patient and staff education, which can be easily shared and edited because it's in the cloud format.

And those are all items that we identified in the igniter process. So from there we did some pilots within the units, some patient education. We have some really great preliminary results related to chlorhexidine bathing treatments for patients. If patients do not get that chlorhexidine bath, they're at risk for clabsi, which ends up being a great cost to the hospital. So we're having some great preliminary results there. We're planning to publish that hopefully present at Magnet or Health or Vive and we're about halfway through those pilots.

Host: Great.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: I would love to elaborate a little bit more on the education platform. So not only is it just an avatar of yourself. It's actually a deep fake. But a positive connotation to a deep fake. It also has the capability of having you, Bill, speak in 144 different languages. So it is a PowerPoint presentation. It's your patient education forms. It could be anything.

It's uploaded and then it is engineered by ChatGPT. So it also has a search key function. So if you're a patient, for example, and you just watched your nurse Beth deliver your discharge planning instructions, for example. You could put into the chat, Beth, when do I come back again for my appointment? What was my dosage of my medication? And through that ChatGPT function, it'll be able to answer most of the questions that patients have. And then if it gets stumped, it actually will have a way of being able to alert the nurse.

The other component of it that's really neat is everything on that platform is licensed. So you don't have to worry about getting permissions or getting any kinds of approval. So when you've got busy nursing professional development practitioners and specialists, their time is so valuable and they spend hundreds of hours developing education. Right, Krystal?

Krystal is finishing her doctorate and she is an NPD.

I wanted something that they could put together, a full program in a micro learning point of care at that time, at that space. And they could put it together in 15 minutes and the end user, whether it's the nurse or the patient, could complete it in two minutes.

Back to chlorhexidine bathing, we actually were able to see a 1% change approximately, which is a huge number when you think about how many of these chlorhexidine treatments we give throughout a month. I mean, the numbers are very, very large, so to even move the needle even slightly, we've had our epidemiology team just thoroughly impressed.

And so we're very excited about being able to wield this platform in the future.

Host: Yeah. It sounds like the innovation igniter has worked for y'all for sure.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Absolutely.

Host: Well, before we wrap up, I would love to get just very quick thoughts from each of you, and thank you so much for coming by today.

Margo, let me start with you, final thoughts.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Thank you so much, Bill. So my key takeaway is when you're thinking about innovation, there's no crazy idea. As a matter of fact, the crazier the better. Why? Because you have 20 to 30 other people that are going to be in the room. They're going to take that idea. And at first people go, that's ridiculous. And then you start going through this design thinking process and you start to smooth out these edges. And then before you know it, you have created an opportunity for radical transformation. Which is what we're all looking to do. I also want to remind our nurse leaders, nurses are A students. We're so used to being calculated. Everything's based on safety and regulatory measures. And so this idea of not being afraid to fail. You know, when we think about fear, exhilaration and fear mechanistically are grounded in the same emotions and chemicals and feelings. The only difference between the two is people stop breathing when they become fearful. So if people can literally, as you're going through this process, and when Greg was getting his doctorate degree, I said, if your project didn't make your palm sweaty, then it's not good enough for Greg Eichelzer because.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: And man they sweat a lot.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: He, he was an exceptional innovator and you know, he went to this little teeny school called Yale. I don't know if you've heard of it.

Host: I don't think I have no. Where is that?

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Yeah. You know, we'll have to, it's great Pizza Town map Quest it. Yeah. Mm-hmm.

Host: Wow. Well, I love those thoughts, Margo. Thank you. And I love the thought of the bigger the idea, the better. So I, that's right. I think that's Go bold. Go big. I think that's where we absolutely really need to start at that level. And then through the igniter we shape it down into something that can actually really will work. So.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: And be feasible. And be feasible and pragmatic. Actionable. Right. Very good and scalable, which is what everybody's trying to achieve at a medical center.

Host: That's great. Well thank you for that.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Thank you. Thank you.

Host: Yeah. Krystal, final thoughts, key takeaways.

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Well, just to piggyback on what Dr. Minissian said, when I was speaking to Dr. Bonnie Clipper yesterday after our presentation on our innovation igniter process, she thanked me for bringing this topic to the table and just to urge nursing leaders everywhere to just do something. Don't let that fear paralyze you. Just try the innovation igniter process and let the magic happen. Trust the people in the room. Trust yourself and just go for it.

Host: Trust the process. Trust the process. That's great. Well, thank you for that, Krystal. I appreciate it. Gregory, final thoughts?

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: My final thoughts, innovation is a team sport. And there is great risk if you don't engage that team idea. Any kind of unilateral decision to implement something that's innovative has so much risk of failure, and if you want to talk about return on investment, it's much more effective to get a group of experts together in a room for a day that might cost maybe a couple thousand dollars, than to make a decision on your own, which costs $10 million, which never gets adopted. So use innovation as a team sport, get people together, use the innovation igniter process to get consensus and make the best choice, and we're happy to go out there and help you facilitate any kind of igniter that you need.

Host: I love that.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Lastly, I would really love to thank our Senior Vice President and Chief Nurse Executive Dr. David Marshall. Yes. David Marshall. Woo-hoo. David. You know, if we don't have our senior leadership support to be able to have these nurses do this type of work to protect and understand the importance of this work; then innovation becomes stifled and we become lackluster. So, thank you David Marshall for making sure that Cedar Sinai Nursing is a shining star.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Visionary and legend.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: That he is.

Host: Shout out to David Marshall. We love it. Alright, well thank you so much. This has been great. Margo, Krystal, Gregory, thank you so much for your time.

Gregory Eichelzer, DNP, RN, NEA-BC, CEN: Thank you, Bill.

Krystal Rodriguez, MSN, RN, NPD-BC, CNOR: Thank you Bill.

Margo Minissian, PhD, RN, ACNP-BC, FAAN: Thanks for having us. Fun.

Absolutely. Yeah. Thank you so much.

Host: So once again, that is Margo Minissian, Krystal Rodriguez and Gregory Eichelzer. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is today in Nursing Leadership.

Thanks for listening.

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