Change can be good.

January 05, 2025

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We have just entered a new year, the year of 2025. My year of 2024 was quite full of events, effort, activities, and more from start to finish. So full, that I did not quite catch my breath until the last day of the year. Even on the first day of the new year, I felt the need to slow down instead of speed up. Last year, I came out of the gate ready to go. I am not reading too much into this shift at this point. However, it is an indication of change. Change can be good.

                  Change can be good. However, change is often perceived as something to approach with trepidation and/or resistance depending upon where you fall in Rogers’ Diffusion of Innovation Adopter category for the particular change (e.g., innovator, early adopter, early majority, late majority, laggard).

                  I teach this in my academic role and see it in practice every day. When introducing a new idea or product to someone, there will be a reaction. The reaction will provide insight as to where that person or group falls on the adopter curve. That insight is crucial to understand the readiness of that person or group for change.

                  I will give you an example from my own experience thus far this year. Every January, I have my eyes examined to order my annual supply of contact lenses. I have worn glasses since I was in middle school. I had trouble reading the board in the classroom. As time went on, I was able to get contact lenses in college. Since that time, I have worn them nearly every day for some years now. 🙂

                  Two years ago, I was introduced to multifocal lenses. I spend a lot of time in front of my computer but need the prescription primarily for distance vision. The optometrist thought that I would like them. She sent me home with them to try out. I did not like them.

I did not like this change. I felt as though my eyes were looking all over the place and it was hard to focus with these new lenses. I called the office and asked them to fill the prescription from the lenses I had been wearing for years.  

                  I resisted the change because I did not need it. I was ok with how it was, and they worked for me.

                  However, this year, two years later, I shared that I was finding the ability to see tiny print (think of the print on an acetaminophen bottle 🙂 ) from the contact lenses quite difficult. I would fluctuate between my contact lenses, glasses, and readers and found it quite annoying to go back and forth throughout the day. I thought perhaps my vision had dramatically changed in the last six months.

                  As it turns out, my prescription remained the same but this time, she introduced the multifocal lenses again. Immediately, I felt the difference. I lit up and she even noticed my excitement and happiness.  I could see the tiny print and the distance with these lenses without difficulty. Those readers are now collecting dust, and I am absolutely ok with that for the time being!

                  She sent me home with a few trial lenses to confirm that I like them before committing to a year supply. I have been wearing them for the last two days and excited for this change. I did not expect this positive change from that visit. Change can be good.

                  Change can be good, but we need to give it a chance. We also need to feel that need for change to increase the likelihood of adoption. If the need for change is not yet there, it may just be too early for that person or group. Give it time and try again.

                  Cheers to a new year. May you find good change in 2025.

Telehealth Care: An Innovation in Waiting

October 15, 2021    |   , , , ,

I often ask my informatics and innovation students to take a guess as to when telehealth was first conceptualized for use. They are often surprised to hear me say that the concept emerged in the 1960’s (60 years ago). Now while we did not have the capabilities for such operationalization of telehealth care at that time, we did have that capability long before March 2020.

The tipping point to integrate telehealth technology services into care delivery was the Covid-19 pandemic and the need to be able to provide care to patients in a safe way that would not put people at risk for contracting Covid (to the extent possible – not all appointments could be televisits).

Prior to March 6th. 2020, telehealth services were not a service that was reimbursable for most visits. The Centers for Medicare and Medicaid Services (CMS), the largest payer of healthcare services in the United States, granted the ability for providers to be reimbursed for telehealth services (temporarily) across the US. This provision opened the opportunity to leverage the technology available, develop new processes and support people with their healthcare needs.

“Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.” (CMS.gov)

I’ve long advocated for the opportunity of telehealth to address visit types that may lead to missed appointments or access to care issues. Just this week I had a telehealth follow up visit. I scheduled it at the end of the day and was able to log off of my meeting to log on to my appointment without any need for travel, parking, rearranging my schedule and more. The visit did not require any labs, tests, auscultation or vitals. Therefore, this was an optimal use of telehealth.

Other use cases I often think about

  • individuals who perhaps do not have an effective and/or efficient transportation means for follow up or consult visits,
  • individuals who do not have the funds for parking, or cannot take an afternoon off for such a visit,
  • individuals seeking mental health services who may be too depressed to leave their home and make an in person appointment.
  • individuals in areas where the specialist is in network but not local to the patient

These are just a few use cases where telehealth has likely eased some pressures of patients seeking to access care where being in person was not a necessity. Access to care is essential for optimal outcomes. As we navigate forward toward a post-pandemic healthcare environment, the initial unmet need faced in March 2020 will have changed but this does not mean that there will not be a need to continue to offer such services.

Providing quality care requires patient-centered approaches. Why not continue to make it accessible to receive care?

 

 

The Five Meta Stakeholders of Health IT

October 09, 2021    |   , , , , , ,

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“Once we get <insert name here> system, all of our tech problems will go away.”

You’ve likely heard this statement and/or have used it in regard to the integration of new health information technology solutions into the process of patient care delivery. During my initial year or two in the health IT field, I had moments of this perspective where I wondered why the tech system could not do this or that function in question. I also heard it often while conducting my research on the information needs of nurses caring for hospitalized patients.

However, almost a decade ago, a report was released by the National Academy of Medicine, Health IT and Patient Safety. Within that report was the introduction to the sociotechnical framework applied to health IT. When I read that report and saw the five meta stakeholders that all need to develop and create a symbiotic relationship, my whole perspective shifted toward one that was more aware of the competing variables (e.g., meta stakeholders).

These competing stakeholders are five dynamic and complex forces:

  1. People
  2. Processes
  3. Technology
  4. Internal Organization
  5. External Organization(s)

All five meta stakeholders need to work together to form the end product that meets the needs of the end user, not just the technology.  So much of the work done to work toward implementation of the new health IT solution or in this case the technology variable, is dependent upon the other four factors, especially the people and the processes.

As we embark forward, there will be times when the analysis of the current state process (#2) (e.g., this is the way we do it), will not be supported in a digital framework in a complimentary way to the way it was done before. Paper based records were static and limited in access. Digital access becomes dynamic and opens the door for more engagement with people (#1). People are beginning to ask for more data and information about their own health. Thus, exploration into a new way of achieving the same or better outcomes becomes a necessary conversation within the organization (#4) while adhering to the requirements of governing local, state, regional and national bodies (#5) (e.g., HHS, CMS, TJC).

Another question I’ve often been asked is if the size or overall influence of the five meta stakeholders are different from one another. In the NAM’s, Health IT and Patient Safety report, all five stakeholders are represented as the same size. I would argue that this should be the guiding principle and approach toward making change in general. However, there will likely be times when one of these stakeholder groups carries more influence than the others.

 

 

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What is the role of the patient in patient-centered care?

October 01, 2021

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If you’ve ever been a patient, you know that you immediately become more vulnerable when in a healthcare environment. Whether entering a primary care office or a tertiary care medical center, the vulnerability presents itself for all of us (even the healthcare professionals).

I believe that there will always be a sense of vulnerability for patients because of the nature of being in need of healthcare service at that moment in time. However, I do wonder about how we view patient-centered care as a concept and if we have an opportunity to amplify the patient’s perspective for the benefit of their overall experience.

For over 20 years now, the National Academy of Medicine’s Crossing the Quality Chasm‘s breaks quality into six factors:

1. Safe
2. Efficient
3. Effective
4. Equitable
5. Timely
6. Patient-centeredness

Each of the 6 factors are defined within that report. In this piece, I want to focus on patient-centeredness. Patient-centeredness is defined in that report as:

“This aim focuses on the patient’s experience of illness and health care and on the systems that work or fail to work to meet individual patients’ needs. Similar terms are person-centered, consumer-centered, personalized, and individualized. Like these terms, patient-centered encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient (NAM, 2000, p.48).”

Having had a few recent experiences as a patient (e.g., primary care and optometry)  and having listened to many about their experiences with healthcare, I began to wonder more about the operationalization of patient-centered care to address healthcare quality.

Some questions that run through my mind include…

  • Who decides what patient-centeredness means (and how it is measured) within a healthcare organization? 
  • How are the preferences of the individual patient being incorporated into the delivery of quality care? 
  • What mechanisms are available to help support patient-centeredness during a patient’s healthcare experience? 

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I personally have had very positive patient-centered experiences and some not so positive experiences. I imagine you have had a range as well. As we see movement toward more active participation in one’s own health with increasing access to data and information, I believe patient-centeredness will become a more prominent need from patients as they seek to be actively involved in their care.

For healthcare professionals, perhaps consider if there are additional opportunities to enhance patient-centered care.

For patients, perhaps find ways to engage in this dialogue with your healthcare professionals where appropriate.

Perhaps at some point we will even move away from the term ‘patient-centeredness’ toward ‘person-centeredness’. However, that may be a more long-term aspiration on my end…

Have a great weekend,
Tiffany

 

 

Know My Nurse Life!

November 21, 2019

Today there are many ways to communicate with our nursing peers. We have the ability to speak face-to-face and by phone. However, SMS messaging has become a popular form of communicating with over phone calls.

Over 81% of the adults in the United States own a smart phone today.  Over 95% of nurses own and use a smart phone each day. With  over 3.8 million nurses having access to a smart phone, it is not surprising that SMS messaging is a likely communication tool between nursing peers on and off of a work day. (All but 2% of those with a smart phone use SMS messaging on a regular basis).

A while back, I began to think about how much fun I had bonding with my nurse colleagues on every day aspects of being a nurse. Whether trying to put isolation gowns and gloves on without an issue or finding the scissors and tape when you need it to having the right shoes on for the long shifts, there was often some level of humor found that helped bond with each other.

However, trying to express this on SMS text messages could be made better. What if we had nursing related images that represented many of the things we as nurses needed over the course of our work day or shift? Things that represent that Nurse Life experience?

The standard emojis didn’t translate to healthcare or nursing. So, I got together with my team and said, “What if we made digital images or “stickers” that represented the day to day life of the nurse?

From there we got to working on Know My Nurse Life!

Know My Nurse Life is our iOS based SMS app that offers 20 different digital images that represent the nursing professional experience day to day. This app is available for consumer purchase in the Apple app store. A link to that app is found here: Know My Nurse Life 

Below several of the images are featured from our instagram page: @nightingaleapps

Tell us your favorite one by taking a screen shot and tagging us on Instagram or Facebook! We’d love to hear from you!

 

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Enjoy and have a wonderful weekend!

Best,

Tiffany

Tiffany Kelley PhD MBA RN-BC

Founder & CEO

Nightingale Apps LLC

May you find the opportunity in every challenge.

April 21, 2019

The internet erupted on Saturday about something that Senator Walsh in Washington State said in a hearing about nurses. Her tone and underlying assumptions about our ability to play cards while at work were very disrespectful to the 4 million of us in the United States.

This is the second time in a few years where someone in the public eye made an uninformed statement about the most trusted profession in the United States for 17 years in a row.

I’ve learned over the years, through my own entrepreneurial endeavors, that assuming statements are often due to a lack of knowledge.

If we had to put a care plan together and form a nursing diagnosis for this situation, we’d likely use something similar to: “Knowledge deficit related to the reality of being a nurse.

 

Let me share some of my realities about being a nurse:

  • I never played cards while caring for patients. (I’ve never played cards in any of my nursing roles over the last 19 years).

Some things that I always did while caring for patients include:

  • I always felt as though despite all that I had done for my patients, there was more I could have done to care for them as I left each day over and above what was necessary. (Try carrying that around at the end of every shift and having it add up over time).
  • I always dreaded night shift because that first hour was the most anxiety provoking for me. Parents wanted to put their children to bed to get their rest (understandably so). I would be getting out of report around 7:30pm not even having prepared any of the 8 o’clock meds for my 4-5 patients all due at the same time.

 As nurses, we know we have to prioritize those patients that are in need first but try telling one parent that his or her child needs to wait while you care for another. That is REALLY hard to do. I often wouldn’t finish that first 8 o’clock med round until 11 o’clock at night.

(OF NOTE: Why do we expect nurses to deliver all of their patients’ meds in the same hour right after starting their shift and not having assessed any of them yet? Can someone find a new innovative solution to this system level problem?)

  • I always worried about whether or not one of my assigned patients would code on me during my shift. I often had palpitations before work each morning because of this concern.
  • I always wanted my patients to have a new clean bed or crib and bathed (if an infant) or have an opportunity to shower if possible. This wasn’t required but it was something I felt was important to do.
  • I always prioritized my patients and their families over my own personal needs for nourishment over 12 hours. Sometimes I wouldn’t eat anything until 8 or 9 hours into my 12-hour shift.

 

I say this about myself, but I know that I am not alone. Perhaps I had palpitations more than other nurses, but the other statements are likely transferable to most if not all other nurses.

Today, I spent a lot of time on my computer catching up on some things.  While working at my desk, I would occasionally open Twitter in seek of a distraction.  I could not open Twitter without a flurry of reactions to Senator Walsh’s remarks today.

Throughout the day, I continued to think of the Woodhull Report. In the most recent report, the results demonstrated that nurses are only cited in 2% of journalists’ stories.

If we are only in 2% of stories, how can we assume that the public knows the extent of our work? Well, one thing we can safely say going forward is that everyone will know we don’t play cards. 🙂 

Yet, this just scratches the surface. How do we use this unfortunate incident that set Twitter ablaze today as an indication that we can do more as a profession to educate others on what we do?

How do we proactively educate a nation on why we are the most trusted profession year after year at a level that abominates the possibility of such comments from happening in the future?

Honestly, it starts with us, the nursing professionals. If we each share our knowledgeable voices on a proactive and consistent basis in a consumable way, we can begin to make the positive change necessary to dispel misconceptions and assumptions.

Think about how you might be able to share something you know with others that might not know it.

We’re trained for this! We educate our patients every day about things they do not know but need to know for their own health and wellbeing.

How can you educate others through your spoken or written words in a way that can influence their perspective? How can you present the information in a way that opens the door for the reader or listener to want to know more and ask more questions?

If I can educate someone not in healthcare about the role of nurses in informatics, interoperability, and innovation, you can find your niche and do the same.

 

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