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The CONCEPT Office at the Duke School of Nursing is developing a new elective course for Doctorate of Nursing (DNP) students called Healthcare Innovation and Entrepreneurship.  Advanced nursing students will be teamed with engineering graduate students and MBA students at Duke to learn and apply a focused approach toward the innovation process.  Interdisciplinary teams will observe clinical environments, discovery unmet clinical needs, assess the market opportunity for new products and services, propose viable solutions, research the legal and regulatory domains, perform patent searches, construct business cases and develop evaluation plans for assessing whether their new idea is credible or not.

This course is part of a larger trend in higher education, where students are being offered educational experiences that prepare them to tackle real-world global problems.  Much of that new educational energy focuses on instilling the entrepreneurial spirit across the curriculum.  For more on this trend, read Duke Professor Cathy Davidson’s column for Fast Company, “A Core Curriculum to Create Engaged Entrepreneurs.”


Fellowship programs are a great way of stimulating collaboration across the disciplines.  In 2008, for example, alumni from the University of Massachusetts Amherst Colleges of Nursing and Engineering endowed a highly successful fellowship program that supports two graduate students in the College of Engineering and the School of Nursing so they can do collaborative research in the area of clinical health care.  The fellowship, which provides an annual stipend of $25,000 to each student, stipulates that fellows “will work on research projects from both disciplines, seeking solutions to real problems in the clinical setting using engineering-based approaches.”


As an article describing the opportunity explains, “engineers might have technical ways of dealing with healthcare problems that would never occur to nurses, while nurses might have first-hand insights into solving those same problems that would never occur to engineers.”  For instance, the first graduate student fellows dovetailed their research interests in digital dashboards and telehealth to help increase the efficiency of nursing home settings and implement remote monitoring of patients with chronic diseases.


In four years, “Hluchyj fellows have tackled such key issues as allocating the short supply of inpatient beds, studying the human side of telehealth reforms, creating a foolproof system for reporting falls in elderly patients, building smart homes for older people, and using technology to provide the vital information needs of patients nearing the end of their lives.”


This kind of collaboration benefits both disciplines in a number of ways:

  1. The research triggers grant proposals that are collaborations among engineering, computer science, and nursing.
  2. The collaboration with nursing faculty mentors gives engineering researchers a built-in network of “insiders” to help apply their findings in the medical workplace.
  3. The opportunity for graduate students  leads to their first publications and prestigious post-docs.


In my last post, I mentioned the “workaround” culture of nursing.  Those who study consumer habits for the technology industry have recognized that we are all engaged in a workaround culture of sorts, in which every consumer functions as a de facto designer.  No matter how many focus groups they hold, product manufacturers continue to release new gadgets that we end up modifying in interesting, unanticipated ways.

Actually, some experts on innovation say that consumers are the new innovators.  Eric Von Hippel, a longtime advocate of “user-led innovation” (as opposed to innovation that is merely “user-driven”), studied consumers in the UK and concluded that they spend twice as much as companies in product development and adaptation efforts or their own.  In an interview appearing in Innovation Management, von Hippel explains, “Historically it was thought that producers were the innovators.  Because, of course, they can spread the cost, and justify the cost, of doing research and development. But when you look at it, every market starts insignificantly, so for example in skateboards it’s the kids who develop them and it is the company, say a Mattel, that jumps on board later when the user has a product. The user innovates.”

I remember watching a kid skateboard down an imposing staircase in central London.  He landed, with a crack that could be heard across the Thames, directly on his head.  Unbelievably, he picked himself up and wobbled away.  And became, forever after, an object lesson for my son, who was 9 years old at the time and deeply impressionable (for which I am eternally grateful).

Needless to say, the boys who first took up The Board and invented this exciting entertainment may not be the best example to employ when talking with healthcare leaders about “user-led innovation.” Fortunately, the authors of “Unlocking the Power of Innovation” in The Online Journal of Nursing Issues speak of user-led innovation in a manner commensurate with the seriousness of the healthcare arena.  The article offers a  fine overview of the nature of nurse-generated innovation and what will have to change inside the culture of healthcare organizations in order for nurse-driven innovation to thrive.

Here are some key points from “Unlocking the Power”:

  1. Healthcare is “a quality driven, but risk-averse field.”  In other words, it hasn’t been the most hospitable environment for innovation.
  2. An infusion of methods developed by other disciplines will help.  Since healthcare is relatively new to the science of innovation, healthcare leaders “must look to other fields, such as social science, engineering, and business” for methods and structures that unlock innovation within the organization.
  3. Innovation is measured by impact.  A great idea is not yet an “innovation.”  To qualify as an innovation, a nurse’s “workaround” at the bedside must be passed along, gain traction, attract champions, be piloted on a broader scale.  As Clayton Christensen (“The Innovator’s Dilemma”) explains, “innovation is something different that has impact (my emphasis).”  And impact is only attained with help from others.  You don’t have to be an engineer to come up with the idea of a self-disinfecting bandage, let’s say, but you’ll probably need an engineer’s expertise to make that idea a workable reality.
  4. Innovation needs a support structure.  The article concludes by calling for the creation of “innovation communities” — i.e. support systems that offer the “divergent thinker” a structure and a set of tools for multiplying the impact of a great idea.


Filed Under (Uncategorized) by on 26-01-2012



Research labs across the country are already hard at work fashioning the “smart” care  environments of the future—without much input from the patients and clinicians who will be most affected. We read about hospital rooms with mounted cameras in the ceilings to make sure doctors and nurses scrub their hands. Computer engineers tell us that vision software will be able to analyze the facial expressions of patients for signs of severe pain and send alerts to nearby nursing stations. Car manufacturers plan to install sensors in car seats to monitor blood pressure and assess stress as commuters fight traffic. Household robots that dispense medication will help the elderly “age in place.”


This blog will track the latest trends in healthcare innovation and entrepreneurship with a particular objective in mind.  We want to follow the forces at work in today’s healthcare industry that are leading to new professional hybrids – the clinician-engineer or the nurse-architect.   These may not be professionals with dual degrees, although we will be tracing the prospects of new cross-disciplinary certificate and degree programs.    No, for the most part, these will be nurses who have been introduced to the principles of discovery, design, business planning and systems thinking.  They will also be human factors analysts, architects and biomedical engineers who spend time shadowing nurses in the workplace, studying nursing principles and practices, and observing the interpersonal and organizational forces at play in a variety of clinical settings.


Right now, experienced nurses are compensating for poorly designed medical devices and inefficient care environments by using materials at hand to craft ingenious “work-arounds” where they are needed most — at the point of care.   Yet their innovations are rarely heralded.  Moreover, there has been no clear pathway that the entrepreneurial nurse can take to bring an idea to the attention of those whose business it is to think in terms of broad impact and identify, prototype, produce and promote workable solutions.  But a change is coming.   Research universities are poised to become incubators for nurse-generated innovation.


We’ll be posting links to interesting stories on trends in healthcare technology, education and entrepreneurship.  We’ll also be using this forum to chronicle a story of our own.  You’ll be able to follow the fortunes of Duke’s Center of Nursing Collaboration, Entrepreneurship & Technology as it works to build “innovation teams” of nurses, physicians, engineers, environmental scientists, social entrepreneurs and market analysts dedicated to changing healthcare for the better.


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