Transcript 2013TrosethPPT - Doctors of Nursing Practice
The Role of the DNP in Managing the Practice-Technology Polarity
Empowering Meaningful Care
Michelle Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer
© 2013 Elsevier – Proprietary and Confidential
Michelle Troseth, MSN, RN, DPNAP, FAAN
Chief Professional Practice Officer Elsevier Clinical Solutions Co-Chair TIGER Initiative Foundation Board of Directors National Academy of Practice (NAP) – Treasurer, Executive Committee Nursing Academy Member Campaign Chair: The Bonnie Wesorick Center for Healthcare Transformation at Grand Valley State University
Health Policy Committees: Reed Elsevier, AMIA-NWIG, eHI Distinguished Practitioner - National Academies of Practice (2007); International Group Recognition Award (CPM Consortium) - National Academies of Practice (2010); Sigma Theta Tau International Kappa Epsilon At-Large Award for Excellence in Leadership (2011); Distinguished Alumna Award Grand Valley State University (2011), Rutgers 15 th Recognition Award for Advancing Technology in Healthcare (2012). Selected Fellow in American Academy of Nursing (2012).
Objectives
• Describe major shifts in healthcare that are creating exponential growth in technology • Explain the concept of Polarity Thinking and the implications for Practice and Technology working together to achieve a higher purpose • Identify key ways the DNP role can manage the Practice and Technology Polarity
Major Shifts in Healthcare
ARRA/ Meaningful Use Accountable Care Organizations Interprofessional Practice and Education Culture and Professional Practice Framework for Sustainable Healthcare
4
A Conceptual Approach to Meaningful Use
Data capture and sharing Advanced clinical processes Improved outcomes
Accountable Care Organizations
Technology Platform (The Focus) Clinical Integration Practice Platform (The Afterthought) Medical Homes ACO Bundled Payments Population Decision Making Continuum of Care
Interprofessional Practice and Education “Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers. We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care. This coordinating center will help us move forward to achieve that goal.”
Mary K. Wakefield, Ph.D., R.N.
HRSA Administrator September 14, 2012
The Digital Generation of Healthcare
Exponential Growth Technology
• Show Video-Clip
Advancing Practice with Technology
Technology must capture the tasks performed but not limit practice to the rituals and routines of traditional practice Tasks Technology must be designed to enhance scope of practice and
evidence-based practice
at the point of care Scope of Practice Technology is key to embrace and shape so practice is truly
knowledge-driven
Knowledge Worker Wesorick, Troseth & Cato (2004) Intentionally Designed Automation. Healthcare Technology (vol. 2) McBride (2005) Nursing and the Informatics Revolution. Nursing Outlook.
“There is no aspect of our profession that will be untouched by the informatics revolution in progress.” Angela McBride
Distinguished Professor and University Dean Emeriti Indiana University School of Nursing
Framework for Sustainable Healthcare Transformation
•
Intentionally designed
•
Evidence-Based
•
Action oriented
•
Outcome Producing
•
Replicable
•
Capacity building
•
Technology enabled
•
Scalable
THE PRINCIPLES OF
PARTNERSHIP
THE PRINCIPLES OF
DIALOGUE
THE PRINCIPLES OF
POLARITY
Principles of Polarity
• • • • Polarities are interdependent pairs of different, competing, or opposite values or points of view Polarities are all around us and are unsolvable, indestructible and unavoidable Polarities are about “both/and” thinking, rather than “either/or” thinking Each polarity has an identified upside (values) and downside (fears)
Principles of Polarity (con’t)
• Polarities can be managed well over time to experience the upside and dynamic interdependencies of each pole, and to achieve a higher purpose • Rooted in Polarity Management™ (Johnson, B. 1996)
Navigating the Waters of Practice and Technology
• • Requires new skills Requires new ways of thinking Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.
A Key Life Preserver for DNP Leaders
18
www.polaritypartnerships.com
www.cpmrc.com/polaritythinking
Polarity Thinking™: Essential Skill for Healthcare Leaders
What is a Polarity?
Polarities are interdependent pairs of different/competing/opposite values or points of view.
Why is it so important?
They need each other, they are
interdependent.
Polarities are all about relationships.
Why is it so important?
They need each other to achieve higher purpose, they are
interdependent
•
Problem Solving is about “either/or”
•
Polarity Thinking is about “both and /and”
Why is polarity thinking so important today?
When leaders are not able to differentiate problems to be solved from polarities that need to be managed there is wasted time, money, energy and the inability to achieve improved, sustainable clinical outcomes.
“The first accountability of a leader is to know reality.”
~Max Depree
Navigating Realities
• We have seen reality through the lens of problems not through the lens of problems and interdependent opposites. • The skill of polarity management supports a whole new way of thinking and acting.
SEE (identify) the polarity TAP the energy in the polarity to move to Action.
polarity
Polarities – from vision to reality
Polarity Management
®
Map
Values = positive results from focusing on
Value-upside
Live **
Values = positive results from focusing on
Value-Upside
Get oxygen Inhale
and
Exhale Too Little Oxygen
Fears = negative results from over-focusing on the left pole to the neglect of the right pole Fears = negative results from over-focusing on the right pole to the neglect of the left pole
Die
Deeper Fear from lack of balance
Polarity Map © 1992, 2008 Polarity Management Associates, LLC Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.
Basic Action Steps to Manage a Polarity Well Over Time Action Steps
How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?
1.
Higher Purpose = Why Balance This Polarity?
Positive results from focusing on this left pole:
* **
Positive results from focusing on this right pole:
Action Steps
How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?
1. Always tension between them
INHALE Early Warnings ***
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole.
1.
Negative results of over-focusing on this left pole to the neglect of the right pole:
and EXHALE
Negative results of over-focusing on this right pole to the neglect of the left pole:
Early Warnings
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.
1.
Deeper Fear from Lack of Balance?
Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.
Greater purpose Upside Values Upside Values Pole Pole Downside Fears Downside Fears Deeper fear
A Tool to Visualize Polarities by Barry Johnson, PhD
Stability Change
Basic Action Steps to Manage a Polarity Well Over Time Action Steps
How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?
1.
Higher Purpose = Why Balance This Polarity?
Positive results from focusing on this left pole:
* **
Positive results from focusing on this right pole:
Action Steps
How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?
1.
Stability Early Warnings ***
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole.
1.
Negative results of over-focusing on this left pole to the neglect of the right pole:
and Change
Negative results of over-focusing on this right pole to the neglect of the left pole:
Early Warnings
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.
1.
Deeper Fear from Lack of Balance?
Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.
Basic Action Steps to Manage a Polarity Well Over Time Action Steps
How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?
1.
Higher Purpose = Why Balance This Polarity?
Positive results from focusing on this left pole:
* **
Positive results from focusing on this right pole:
Action Steps
How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?
1.
Continuity Sense of Direction New Energy New Possibilities
Stability Early Warnings ***
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole.
1.
Negative results of over-focusing on this left pole to the neglect of the right pole:
and Change
Negative results of over-focusing on this right pole to the neglect of the left pole:
Early Warnings
Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.
1.
Stagnation Chaos Deeper Fear from Lack of Balance?
Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.
34
Sustainable Transformation
A. Ensure users understand the design, purpose and functionality of technology tool.
B. Provide time for users to learn the technology tool properly.
A. Timelines for activation are all about technology, not about practice transformation B. Modifying or deconstructing evidence-based content integration.
Innovation Standardizes and integrates information Increase efficiency Data retrieval EBP and professional practice/workflow Clinical integration across disciplines Caring culture
A. Create and support time for interdisciplinary team to do transformation work needed to integrate evidence-based professional practice B. Provide processes and tools to embed into technology: EBP, scopes of practice, & integrated workflow.
Technology Practice Lack of evidence based information Design interferes with integration Lack of “humanization” Lack of awareness of tech. benefits Lack of information impacts quality Decrease timely access & retrieval of patient information Unsustainable Transformation
A. Users demand that technology not change what is familiar (e.g. documentation practices) B. Comments about the fear that technology will dehumanize care and dictate practice.
Polarity map showing the practice and technology poles and ways to balance the tension between them.
Key points about how polarities “work”
• Both sides of the polarity are important.
• Most of us have a preference for one side or the other.
• The more strongly you are attached to one side, the harder it is to see the downside.
• Polarities are interdependent pairs that need each other over time in order to sustain both sides.
•
Key points about how polarities “work”
Polarity thinking helps us understand another person’s point of view.
• • • • One sided thinking leads to accuracy without completeness. You may be accurate, but not complete in your view.
Forcing others to come over to your point of view is likely to create feelings of resistance and resentment. Confirming someone else’s accuracy increases the possibility they will supplement it with yours. The challenge is to find the “rightness” in the other point of view.
Key points about how polarities “work”
• If you over focus on one and neglect the other side, you will get the downside of the one you focus on. • If you want to guarantee failure of a change effort, tie it to one pole of a polarity.
• When dealing with a polarity, the smaller the minority voice, the more important it is to pay attention to that voice.
• The oscillation between poles is ongoing. The natural tension between both sides is unavoidable, unsolvable, indestructible, and can be tapped.
All of the DNP’s in this room are leaders for transformational change for Practice & Technology The challenge of leadership is to be strong, but not rude; be kind but not weak; be bold, but not bully; be thoughtful, but not lazy; Be humble, but not timid; be proud, but not arrogant; have humor, but without folly ~Jim Rohn
Polarity Thinking teaches us how to live this everyday
Open Dialogue
In what ways can the DNP role in support evidence-based, professional practice in a technology driven world?
www.polaritypartnerships.com
www.cpmrc.com/polaritythinking @CPMRCmichelle
•
References
• Abrahamson K., Arling P., Wesorick B., Anderson J. (2012). An application of the socio technical systems approach to implementation of electronic evidence into practice: The Clinical Practice Model framework. International Journal of Reliable and Quality E Healthcare, 1(1). 13-20. January-March. • Clancy, T (2009). Improving patient safety, increasing nursing efficiency and reducing cost through technology supported pull systems. IN: C. Weaver, R. Carr,, C. Delaney,(et al.) (Eds.), Nursing and
informatics for the 21 st
century: An international look at practice, trends, and the future. (2 nd ed.). Chicago, IL: HIMSS Publications.
• Elsevier CPM Resource Center (2011). The CPM Framework™: culture and professional practice for sustainable healthcare transformation. (Brochure). Grand Rapids, MI. • Hinton-Walker P., Troseth M. (2010). Business coalition: Shaping health reform through technology and science. In: Cowen PS, Moorhead S, (Eds.), Current Issues in Nursing, (8 th ed., 438-448). St. Louis: Mosby, Elsevier.
• Johnson, B. (1996). Polarity Management: Identifying and managing unsolvable problems. Amherst, MA: HRD Press.
References ( con’t)
• Staggers, N. & Troseth, M. (2011). Usability and clinical application design. In Ball, M., Troseth, M. et al (Ed.). Nursing Informatics: Where Caring and Technology Meet 4 th Edition. Springer.
• Troseth, M. (2012). Informatics & the Future of Nursing Practice. Advance for Nurses. April 27, 2012.
• Troseth, M. (2011). The TIGER Initiative. In McCormick and Saba (Ed.). Essentials for Nursing Informatics 5 th Edition (in progress of publication). Chapter 27. McGraw Hill.
• Wesorick, B., & Doebbeling, B., (2011). Lessons from the field: The essential elements for point-of- care transformation. Medical Care, 49(12), Suppl 1, S49-S58.
• Wesorick, B., Troseth, M., Cato, J. (2004). Intentionally designed automation creates the best places to work and receive care. In Health care technology: Innovating care through technology, 2. San Francisco: Montgomery Research, Inc.
• Wesorick, B (2013). Essential steps for successful implementation of the EHR to achieve sustainable, safe, quality care. In A. Moumtzoglou & A. Kastania (Eds.), E-Health Technologies and Improving Patient Safety: Exploring Organizational Factors (pp. 27-55).