Portal de Periódicos da CAPES

Think Different:

2019; Elsevier BV; Volume: 18; Issue: 1 Linguagem: Inglês

10.1016/j.mnl.2019.11.013

1541-4620

Kathleen Bradley, Margie Godin,

Health Sciences Research and Education

The Think Different campaign was a nurse-driven approach to use technology as the driver of practice around education, staff and patient safety, and education costs. The journey to innovate included collaborating with the Apple higher education team to utilize mobile technology and to approach education methodologies in a tech-savvy workforce and environment. A competency first approach, using technology, provided the platform for rapid just-in-time learning capabilities, efficiencies, cost savings, and a cultural shift to peer accountability. Think Different is achievable for all settings and organization types. The Think Different campaign was a nurse-driven approach to use technology as the driver of practice around education, staff and patient safety, and education costs. The journey to innovate included collaborating with the Apple higher education team to utilize mobile technology and to approach education methodologies in a tech-savvy workforce and environment. A competency first approach, using technology, provided the platform for rapid just-in-time learning capabilities, efficiencies, cost savings, and a cultural shift to peer accountability. Think Different is achievable for all settings and organization types. Key Points•Recognize how to use resources outside of health care to transform the learning environment and provide innovative learning modalities to practice.•Identify educational opportunities where mobile technology can be incorporated into curriculum.•Capitalize on the benefits of incorporating technology into clinical practice that have impact on staff and patient safety, and educational cost. •Recognize how to use resources outside of health care to transform the learning environment and provide innovative learning modalities to practice.•Identify educational opportunities where mobile technology can be incorporated into curriculum.•Capitalize on the benefits of incorporating technology into clinical practice that have impact on staff and patient safety, and educational cost. Rapid change and a new age workforce requires a new strategy for how we prepare, practice, and manage our work in the health care setting. The “Think Different” campaign was launched as a means of aligning current communication practices with a tech-savvy workforce. This in turn, improved our safety strategies by providing immediate access to resources, education, training, and competency management. Leveraging mobile technology provided an innovated cost-savings format and resulted in a cultural shift to peer accountability. Think Different is supported by the capabilities of mobile devices and the convenience they offer. Approximately 1.1 billion people living in rural areas and 73% of the world population have access to mobile broadband.1International Telecommunications UnionITU Releases 2015 ICT Figures. May 2015.https://www.itu.int/net/pressoffice/press_releases/2015/17.aspxDate accessed: August 20, 2019Google Scholar,2GSMAThe Mobile Economy: 2015. 2015.https://www.gsma.com/mobileeconomy/archive/GSMA_ME_2015.pdfDate accessed: August 20, 2019Google Scholar In addition, the 2018 Pew Research Center reported 59% of adults worldwide own a smartphone.3Poushter J. Bishop C. Chwe H. 2. Smartphone ownership on the rise in emerging economies. In: Social Media Use Continues to Rise in Developing Countries but Plateaus Across Developed Ones. June 2018. Pew Research - Global Attitudes & Trends.https://www.pewresearch.org/global/2018/06/19/2-smartphone-ownership-on-the-rise-in-emerging-economies/Date accessed: August 20, 2019Google Scholar That number is even higher in consideration of a younger generation, where the EDUCAUSE Center for Analysis and Research reported that 95% of undergraduate students own a smartphone.4EDUCAUSEDevice Access and Ownership. EDUCAUSE Horizon Report, Louisville, CO2018Google Scholar Considering access and availability, Think Different should be achievable for all settings and organization types. The underpinning for this transformation was the realization we must have a new way to support clinical practice through the use of technology; and this technology needs to make information accessible in the moment, in the palm of the hand. Technology is a driving focus in today’s society and in the health care industry. The academic setting has begun to recognize the need to incorporate innovative technologies into the educational setting for health care.5Milic N. IIic N. Stanisavlijevic D. et al.Bridging the gap between informatics and medicine upon medical school entry: implementing a course on the applicative use of ICT.PLoS ONE. 2018; 13: e0194194Crossref PubMed Scopus (5) Google Scholar Methods of teaching must be cost effective and provide the knowledge and skills needed to support these changes. The Think Different campaign began in September 2016. The campaign included departmental reorganization, redesign of staff development delivery methods, and access to outside vendor support. As a teaching hospital affiliated with Stanford University, the Apple higher education team worked directly with Stanford Children’s Health. Over the past 40 years, Apple’s higher education division has worked with education leaders to envision, plan, implement, and evaluate technology-rich learning environments that meet the needs and aspirations of their institutions. Through vision, community, and ongoing professional learning, they helped to develop a plan that would foster a culture of learning.6Apple EducationEight Elements for Success. Apple INC, 2015https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=1061241828Date accessed: August 20, 2019Google Scholar As a result of this support, the nursing leadership for the Center for Professional Excellence and Inquiry (CPEI) at Stanford Children’s Health was invited along with other selected leaders to attend an executive briefing at Apple’s headquarter in Cupertino, California. Apple shared a vision of health care transformed by mobile digital technology, where educational content is delivered in ways that promote real-time learning and intervention. At the close of this session, our collaboration with the higher education team at Apple began. The team is composed of former educators and administrators with experience in developing mobile technology initiatives, as well as systems engineers that support the more technical aspects of deploying technology. Together, we developed a support system for the roll out of the Think Different campaign. The guidance and insight provided specifically around a mobile initiative, allowed the CPEI to launch a successful program with a focus on innovation and a culture of learning. At this point, the leader of the CPEI needed to have someone who could speak the language of technology and understand how to apply rapidly changing learning methods to a tech-savvy workforce and a young patient and family population. This person would serve as our spokesperson and connection back to Apple. They would also help translate how we could use technology for our professional practice, improving digital fluency. EDUCAUSE Horizon Report 2019 defines digital fluency as the ability to leverage tools and platforms to critically communicate, creatively design, make informed decisions, and solve current problems at the same time as anticipating any new ones.7EDUCAUSE2019 Higher Education Edition. EDUCAUSE Horizon Report, Louisville, CO2019Google Scholar This would require a new role to be developed. To make this new role a reality, a restructuring of the professional development department occurred. This new role, informatics nurse specialist, would use the knowledge and skillset of the nurse informaticist, along with the networking and relationship with the information services (IS) department to focus on the innovative use of technology for professional development and clinical practice. In the summer of 2017, the CPEI leadership team, including the informatics nurse specialist, with the guidance from the higher education team at Apple, began reviewing different educational methodologies and a professional relationship was developed. The higher education team started by introducing their work with a network of academic sites. The goal was to explore whether the use of mobile technology, iPad and iPhone, could be translated to education within the health care setting. Translating this work from academia to practice was an important consideration, because studies in academia have demonstrated mobile devices have the ability to support interactivity, which has the potential to improve engagement.8Mills M. Student preference of a customized, open-access multi-touch digital textbook in a graduate education course.Contemp Educ Technol. 2016; 7: 123-137Crossref Google Scholar The benefits of these powerful tablets give the learner a rich interface, interactive widgets, and the ability to annotate, and integrates with social media and embedded audio and video.8Mills M. Student preference of a customized, open-access multi-touch digital textbook in a graduate education course.Contemp Educ Technol. 2016; 7: 123-137Crossref Google Scholar The deliverables of the Think Different campaign after this meeting included 4 components: assessing current state, setting the vision, initiating action, and evaluation. CPEI invited the higher education team to attend 2 initial brainstorming sessions to help assess current practice and how technology could be integrated. The financial impact for supporting new technology was a consideration because technology was not incorporated into the current budget cycle. A creative leasing plan allowed for a variety of tools including MacBooks and 65 iPads for clinicians to help them create and have easy access to educational materials. We consulted with experts who focused on innovative technology for education, while attending Apple educational training opportunities on system capabilities through meetings, one-to-one training sessions, and personalized curriculum workshops. CPEI staff took advantage of a personalized curriculum workshop and no-cost “Today at Apple” sessions developed with health care in mind. CPEI staff also took advantage of these no-cost training sessions by going to “Today at Apple” at their local community store locations. One of the strategies for the educator team within CPEI was to promote team learning so staff could bounce ideas and learn from each other along with their own individual learning. So, for each of the education sessions, 4 to 5 educators would attend together, and work together on specific projects during the training. The Think Different Campaign started an innovative movement which incorporated real-time learning using mobile technologies. Our organization chose mobile technology, specifically iPhones and iPads, for their accessibility and identified they would be the primary tools for communication within our workforce. We also recognized the majority of our workforce uses a smart device as the primary communication tool in their private lives. This recognition, along with the availability of mobile devices at the bedside, quickly brought us to the vision of providing immediate access to information, resources, and education at the time needed and in the format needed. The hope was to impact patient safety and compliance with policy and practice standards. Therefore, in order to reach staff and to get the best engagement with learning and education, mobile technology was the tool of choice. By the fall of 2017, we were able to restructure resources and personnel to overlay technology with all professional development activities. New educational platforms were created to facilitate learning. Some of the new technology included: Apple Books and iTunes U courses for educational training and residency programs, reflective learning, electronic portfolios, videos for just-in-time learning, and QR codes for new training and competency demonstration. In the summer of 2017, the organization was completing extensive plans for staff training and orientation to our newly constructed hospital. All staff needed orientation and hands-on practice to new pieces of equipment. Using Think Different, CPEI leaders worked closely with the IS project management office to approve and download QR code readers onto the new iPhones, a piece of equipment every nurse or other clinician would carry. The goal was to acclimate staff to this new technology by using different QR codes on new equipment such as the new ceiling lifts. A second QR code was utilized for the education on the interactive TV system in the patient rooms. During new building orientation, the QR codes were scanned and a short video created by the CPEI team played. QR codes continue to be the most frequently requested tool in the Think Different Campaign. These codes can direct staff to videos, policies, registration, or websites. To comprehend the power of this technology is to consider the clinicians perspective; having access to resources in the moment through the use of technology. The neonatal intensive care unit (NICU) also had early adopters in the Think Different campaign. In the fall of 2017, the NICU nursing professional development specialist (NPDS) and clinical nurse specialist (CNS) worked with the higher education team at Apple on the creation of an iTunes U course for all new hires and nurse residents into the neonatal units. Each new hire was provided access to the 28 assignments imbedded into a 4-chapter course. The course included articles, policies, videos, quizzes, and access to learning at any time of the day. This methodology provided automatic notifications to the NPDS and CNS when the new resident completed assigned work and allowed them to see performance on the quizzes. New staff, particularly the new residents, are familiar with this format from recently completed academic courses and are typically able to navigate the new learning. One of the biggest benefits to this program was the ability to spend more time to focus on hands-on competency demonstration rather than sitting through lectures. New graduates have also expressed their appreciation to be able to review materials or videos at a later date for a refresher when they have that type of patient assignment. In June 2018, the new educational technology of Apple Books was also used for annual house-wide educational workshops for shared governance. Paper binders were replaced with e-books. The shared governance e-book could be downloaded on any smart devices and a PDF file was available for all other electronic formats. Technology did not stop there, all information shared for this educational event was made available on the new shared governance intranet page, used as the communication hub for all shared governance councils. The ability to create Apple Books was a skill set that was demystified and attainable even for leaders. As we prepared for our recent Magnet® survey, one of the CPEI leaders had an afternoon where her iPad was the only accessible device working. She spent the afternoon creating an Apple Book that was then used from the board room, to the frontline in preparing for our survey. Instead of relying on professional services, a video of the chief nursing officer (CNO) was made using the same iPad and inserted as the opening for the book. This process took about 15 minutes of the CNO’s time and saved several thousands of dollars for professional services. The ability to electronically share e-books was a new skillset within the organization. This particular book was a demonstration for many within the organization about the impact and innovation of the Think Different Campaign. The ability to provide real-time education improves the confidence level of nurses for high-risk and/or low-volume situations. An example of this, was how the Think Different campaign has embedded just-in-time teaching tips in the isotope room. This room is used for patients who have radioactive infusions typically for end-stage oncology patients. The need for this room is sporadic and individual nurses may not be required to care for these patient but every 6 months, or even yearly. The use of this medical intervention impacts safety for patients, families, and the caregivers. Workflow and practices change because of special precautions for this therapy. Think Different was used in creating a series of just-in-time educational materials and references for clinical staff. The innovation in this example was utilizing QR codes dispersed throughout the room. For example, a QR code was placed on the computer. When scanned, the code takes the nurse to a short video that explains specific documentation requirements for this patient population. In other areas of the room, QR codes are strategically placed to explain the anteroom, the family room, the isotope room, exit procedure, and specific equipment in the room. Each QR code is attached to a short video to provide easily accessible, immediate information. This improves safety for all involved. This Think Different process replaces an old standard of having a large binder in the room with paper and tip sheets to explain proper procedures. There has been significant cost savings as a result of the Think Different Campaign. The first major change was a request for education around sterile central line practice changes. The nursing quality team within CPEI presented an education plan for each nurse to complete a 4-hour education module. The cost of this education for the organization was projected at over $570,000. The CPEI leadership team applied “Think Different” and requested a technology focused approach. The Think Different education developed included 3 videos and 1 e-book. The final cost of education on this practice change was $34,000 resulting in a 94% cost savings for this single initiative. Several other projects have used technology versus traditional classroom formats. CPEI was able to demonstrate cost avoidance savings of $846,000 in 2018 and $522,000 for year-to-date 2019. Capturing return on investment (ROI) of education programs is now a standard of practice. Culturally, we now review educational requests with an eye for efficiency, accessibility, and resource requirements. We have achieved dramatic cultural changes with the use of simulation, and just-in-time education with no classroom time for the past two years (Figure 1, Figure 2).Figure 2Think Different 2019 ROI Savings. Abbreviations: HAPI, Hospital Acquired Pressure Injury; PCU, Patient Care Unit.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Our next step was to share and disseminate how strategy can benefit and contribute to advancing health care. Several opportunities have presented themselves for dissemination of the Think Different campaign. The CPEI leadership team and the higher education team at Apple have copresented at regional and national briefings and conferences. These sessions have included participants from high school through graduate academic settings, school district administrators, health care academic settings, and health care organizations. Additional dissemination and coaching has occurred when we shared our Think Different journey and success with innovative use of technology to improve safety and education, and demonstrated cost savings at multiple events hosted by the higher education team at Apple. The journey of Think Different innovation included all professions within the health care team and aligned with organizational priorities. Understanding how adults learn and having mobile learning resources has transformed our learning and practice environment. The philosophy around Think Different has changed our educational environment by:•Aligning with competency•Providing electronic competency attestation methodology•Offering asset creation training•Standardizing communication plans•Creating materials for the tech-savvy workforce•Standardizing practice•Offering real-time education•Creating the opportunity for ongoing education The next step for the Think Different campaign is to target how to use technology differently to support and improve patient and family education. Think Different concepts of using mobile technology as an educational platform is possible in nearly all settings within health care. Use of simple tactics such as QR codes provide immediate access to information and can result in greater efficiency as seen in links to class registrations. Other uses of QR codes can include immediate access to information regarding equipment usage thus improving staff and patient safety. Learning how to use technology to educate staff is readily available. The challenge is being willing to accept the change, to recognize and allow mobile technology to be put in the hands of our clinicians. Kathleen Bradley, DNP, RN, NEA-BC, is the Associate Chief Nursing Officer and Executive Director at the Center for Professional Excellence & Inquiry, Stanford Children’s Health, in Palo Alto, California. She can be reached at [email protected] Margie Godin, MS, BSN, RN-BC, is the Informatics Nurse Specialist at Stanford Children’s Health.