Unlikely Partnerships Spark Creativity

Kelly Kester, DNP, RN, NE-BC, CCRN-K

Clinical Operations Director, Heart Services
Duke University Hospital

Our story of innovation is valuable to share because of the relationships made during our journey. These relationships, made for the most part blindly, were based on our varied experiences and skillsets. What started as a basic idea expanded beyond what I could’ve imagined on my own. But that’s the point of working with people unlike you, isn’t it?

My Problem

My biggest frustration as a nurse manager was not having the tools I needed to do my job efficiently, particularly related to developing a staffing plan and maintaining it through effective hiring practices. Simply put, how many nurses do I have? And how many do I need to hire, and when should I hire them? It may be surprising to many that this is a very common problem. I knew that continuing to use numerous Excel documents and lists wasn’t a sufficient option.

My Proposed Solution

I pitched a “calculator” as a solution to my problem. I simply wanted to move away from my paper and pencil method of calculating staffing and hiring projections. Excel was working for portions of it, but the information wasn’t real-time and overall, was too time consuming.

Our Creative Partnership

Internally, my idea for a “calculator” was supported by the Duke Heart Incubator, which is funded by Duke Heart to help Heart faculty and staff navigate the innovation process and get ideas off the ground. The next step was to devise an internal team and I recognized the need to partner with individuals who could anticipate and breakaway barriers, such as an internal technology expert and someone who was experienced with the innovation process.

Externally, we partnered with a local product development firm, Smashing Boxes, to expand on the initial idea and co-create. Smashing Boxes lives at the intersection of business value and technology; their goal is to disrupt multiple industries through their technology transfer, IP commercialization, and Spin-off incubation. The team members from Smashing Boxes were of non-healthcare backgrounds and were talented with business development, user experience, and design. The mix of our teams initiated an incredible process of co-creation. For a full look at the Co-Creation Process used, see our article in Nursing Outlook.

I realized that my idea was transforming into something bigger when the timeline for development was created. And further, I was stunned when I saw the product design. These milestones were when I really understood the value of the Duke/Smashing Boxes partnership and the Co-Creation Process.

Tips for co-creation:

• Allow others to expand on your idea and you’ll create something better than you ever imagined
• Trust the process
• Be flexible and relinquish some control
• Be willing to leave your comfort zone

The Product

Our creative partnership led to HealthForceRx, which is a web-based product to support nurse leaders in their day-to-day and strategic work. Focusing on the initial goal of this work, we built a system that helps nurse leaders understand and manage their staffing and hiring needs.

HealthForce^Rx was built to:

• Expedite decision-making by providing real-time information about the workforce at local, service line, entity, and health system levels
• Provide tools to support planning of future workforce needs
• Maintain consistency across the health system
• Improve communication among leaders, human resource partners, and nurse recruitment

By giving nurse leaders the tools they need to be effective, they have more time to invest in relationships with their team, staff development, and patient care. Focusing on what’s important allows us to re-stabilize our teams.

Building Momentum

Because HealthForce^Rx is a product for nurse leaders, built by nurse leaders, and we’ve touched a pain point that is widespread, interest continues to grow. Not only are nurse leaders desperate to re-stabilize their workforces post-pandemic, they are also seeking ways to spend more time investing in their nurses’ development.

During the early phases of the Co-Creation Process, key stakeholder interviews were conducted to expand our knowledge of the problem we were trying to solve. We also observed workflows and brainstormed ideas with leaders, including non-nursing leaders. The Co-Creation Process allows for continuous improvement based on feedback by nurse leaders who use HealthForce^Rx. As users see that their feedback is being integrated, the system continues to improve to meet their unique needs.

Integrating non-nursing roles and teams to HealthForce^Rx is also important to our progress. Engaging with teams such as respiratory therapy, environmental services, patient transport, pharmacy, and others, has allowed us to continue expanding the support of leaders across the healthcare platform.

Innovate, Not Workaround

While we face challenges and often workaround them, nurses have opportunities to innovate workflows and develop tools to improve how we deliver care. We may not have all of the answers or a fully-formed idea, but creative partnerships are an opportunity to engage with diverse teams that share skill, knowledge, and experience.

I could have continued using my spreadsheets, lists, and pencils. But, why?

As Florence Nightingale noted back in 1860, “Were there none who were discontented with what they have, the world would never reach anything better.”

My recommendations for innovation are these:

• Channel your frustration
• Seek partners with backgrounds, skills and knowledge that you don’t possess
• Engage those who can break down barriers early in the process
• Celebrate and build upon the small wins

Kester, K., Hatton, J., Kelly, J., Carroll, M., Lindsay, M., Jordan, N., Fuchs, M.A., Engel, E., Granger, B. (in press). Moving nursing innovation to prime time through the use of creative partnerships. Nursing Outlook.