Bill, the president of a large multihospital healthcare system that is nationally recognized as one of the most successful vertically integrated healthcare systems in the nation. The organization was recently designated as one of the first providers in a statewide accountable care contract because of its organizational structure, which supports community-wide point-of-service care, holds exemplar quality standards, and is a positive workplace for healthcare providers. 

Even though Bill holds a lofty position, he often interacts with individuals at all levels of the organization. He makes a point of visiting each hospital campus and talking with gardeners, nurses, dietary aides, physicians, and, of course, patients and their families. Bill  is committed to excellence in patient care and strongly believes that an empowered and engaged workforce is the best way to achieve that goal. Even though the healthcare system is widely recognized for excellence, Bill  is uncomfortable simply resting on the status quo. He realizes that the competitive forces in the region and in health care and the sweeping changes in how health care is provided and reimbursed threaten the status quo.

He meets with his senior executive team and tells them, "We can't sit still and wait for the future to happen. We must invent the future and write the script for how we will interact with the forces that can either make or break us as a healthcare system. If we are truthful with ourselves, none of us really thrive in a constantly changing environment, and we often long for stability. Unfortunately, we do not live in a stable environment. We see major changes in healthcare reimbursement, challenges in serving the community as it changes ethnically and economically, threats from a union environment that demands more than our organization can offer, and a constantly deteriorating physical plant that needs replacement or refurbishment. We are compelled to accelerate new and creative thinking to proactively address some of these challenges."

He goes on to tell the team that he is not comfortable with slow, incremental changes, and he challenges them to consider ways that organization leaders can incentivize innovation from the point-of-service all the way to the top of the organization. He informs them that he recently attended a national meeting of presidents of healthcare systems and that innovation was the most discussed and hotly debated topic at the meeting. It seemed as if all healthcare leaders were feeling the need to reinvent their organizations to position them for Accountable Care Organization expectations and the consequences of other national issues, such as the potential for community terrorist acts, natural disasters, growth of diverse immigrant populations, the opioid crisis, and the impact of an aging population with chronic and acute illnesses.

Bill recommends that a comprehensive strategy be developed in order to create a culture of innovation and instill excitement about developing new and more economical ways to meet patient needs while still supporting the enhancement of professionalism among caregivers. Bill states that this is not a new budget-cutting initiative to meet the financial bottom line, but rather a willingness to invest in new, innovative ideas that can revolutionize how care is provided in primary care settings, hospital settings, and the home environment after discharge. He wants the executive team to consider how the organization's leaders can partner with physician groups, community leaders, the organization's nursing leaders, and clinical directors to instill and incentivize a culture of innovation.

Later, Bill meets with all of the CNOs from the system's hospitals and informs them of his new vision for a culture of innovation. He states that he believes that nursing is a key stakeholder in creating innovations at the bedside and that he is willing to support key innovations in their testing and implementation phases of changes.

The CNOs discuss Bill's vision and the need for innovative thinking. They are convinced that advancing nurses' knowledge and expertise in evidence-based practice will be an important step in creating a culture of excellence and innovation. The CNOs asked the respective leaders in research and professional development to develop a plan to advance evidence-based practice at all hospitals. They also discussed having an annual nursing innovation conference that would recognize nurses who developed innovations in care, education, or leadership and then disseminate new knowledge to the entire healthcare system. They discussed a plan to financially reward the top innovation, which would be chosen by the executive team with clinical nurse representation and evaluated on financial and clinical outcomes and alignment with the healthcare system's mission, vision, values, and behavioral standards. They asked Bill for an innovation development budget that would finance an evidence-based practice institute and an annual innovation conference with financial prizes of $2,500 for the first-place winner, $1,500 for the second-place winner, and $1,000 for the third-place winner.

The evidence-based practice institute would use an established framework for project development and a mentor-mentee format. Research mentors would be CNSs, but it was anticipated that future mentors would be past graduates of the evidence-based practice institute. Mentees would be recommended by their unit managers. Each mentee would be given 8 hours of pay per month to attend the evidence-based practice institute didactic classes and 4 hours to work on their evidence-based innovation projects. The institute would be conducted once a year with an annual evidence-based conference to recognize program graduates and to disseminate findings from completed projects. The cost of the institute would also include expenses to have a nationally known nursing leader as a keynote speaker and to display poster presentations of projects, with podium presentations from those that meet criteria and had the greatest impact on unit changes and patient outcomes.

The CNOs decided to make the annual innovation conference interdisciplinary and invited physicians and other discipline representatives to help plan the next conference. Using the evidence-based practice institute as a model, they invited nationally recognized healthcare leaders to be a keynote speakers on innovation and then the rest of the day was filled with presentations from the healthcare system's employees and physicians who developed innovations to improve workplace environment, patient outcomes, or workflow processes.

The CNOs are excited to present three proposals and prospective budgets to Bill and the senior executive team for consideration, and in addition, a proposal to advance the culture of innovation. The CNOs recommended that their healthcare system partner with major businesses in the region to expose healthcare leaders to research and development (R&D) processes of businesses and to engage business leaders in advancing innovations in health care. Several major healthcare vendors had corporate offices and production plants in the region, and would be perfect partners to design, build, and finance innovations involving the physical plant, medical equipment, information technology systems, workforce planning and resource procurement. Bill and the senior executive team are really interested in the three proposals and the plan to partner with regional businesses to advance innovations. They embraced advancing clinical nurses' knowledge and expertise in evidence-based practice and the healthcare system's leaders in R&D processes of regional businesses. The annual innovation conference was also well received, and the senior executive team committed themselves to support these initiatives and to allocate funding to ensure their success.

1. How do you think the three initiatives will facilitate the development of a culture of innovation in the healthcare system?

2. What types of incentives do you think would be necessary to encourage and facilitate innovation among clinical nurses or other clinical leaders in the healthcare setting?

3. How effective do you think the initiative to expose the system's leaders in the research and development of regional businesses will be in developing a culture of innovation?

4. What effect will advancing nurses' knowledge and competence in evidence-based practice have on innovation at the clinical level?

5. What purpose do the annual conferences for the evidence-based practice institute and the innovation conference serve in promoting a culture of innovation?