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Precision Vision:
Innovation, Fearless Motivation and the Power of Failure

November/December 2020


Elizabeth CardElizabeth Card, MSN, APRN, FNP-BC, CPAN, CCRP, FASPAN
ASPAN President 2020-2021

Delivery of nursing care is customized for the individual patient and circumstances. The application of the science of nursing in this creative customized way, is the art of nursing. Often, this application may result in an innovation. Innovation is a method or process that utilizes creativity to form solutions for unresolved problems.1 This process involves small tests and revisions to the innovation, then testing again, with the impact of the innovation measured and resulting in a positive outcome.2,3 Magnet has adopted the definition of innovation as “…the application of creativity or problem solving that results in a widely adopted strategy, product, or service that meets the need in a new and different way. Innovations are about improvement in quality, cost effectiveness, or efficacy.”4 

Innovation is happening at the speed of light in response to the COVID-19 pandemic. Telehealth, automobile manufacturing plants refitted to assemble ventilators, virtual meetings, even virtual cocktail hours are reactive innovations and problem-based. They provide solutions to problems or barriers. However, innovation can also be a powerful process within reach of all nurses in the correct climate. There are several methods and processes for supporting and sustaining nursing innovation.

IDEO Method for Nurse Innovation
IDEO is a famous design and development consulting firm located in California. Their method for innovation has been applied successfully around the globe resulting in a multitude of awards for their work.2 They developed and perfected a “brainstorming-and-build” rapid cycle testing technique they named the “deep dive.” The “deep dive” process begins with observation, moves into storytelling, followed by a synthesis of the stories, progressing into the brainstorming followed by the rapid cycle testing and then rolled out into field testing (real world application). This is accomplished in several steps, beginning with observation and ending with field testing of the innovation.

Phases of IDEO
The observation is made of the end-users in real time in their work environment to identify problems or barriers. Next, storytelling uses the understanding gleaned from observations and “field research” to create vignettes. Historically, vignettes provide a descriptive short scene that captures the defining details of an idea or situation. The next step is synthesis of all observations and vignettes into opportunities for innovations. Brainstorming follows, exploring all ideas in a playful manner often revealing unexpected or unexplored ideas or opportunities. The resulting potential solutions are then made into prototypes. This occurs during the rapid prototyping technique resulting in tangible representation of the innovations to spark additional discussion and revision. The final phase is field testing of the most promising innovations by the end-users in real time. 

Suggestions and comments from the end-users come back to the group for revising the innovation and then testing again. This is a rich process that has been very successful due to the diversity of the innovation team, and inclusiveness of the end-users who have the best understanding of the environment and practices in which the problem or barrier is occurring.

Transforming Care at the Bedside
The Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement collaborated in creating and founding an innovation method for nurses: Transforming Care at the Bedside (TCAB). This method embraces the principle of end-user-driven innovation, which is a team-based approach that includes the end-user in the innovative process of identifying the problem and new solutions.3 In this circumstance, the end-user is the clinical/bedside nurse. 

TCAB uses multiple tools to guide creative thinking and forming ideas, then provides the rapid cycle improvement framework for testing this idea quickly and measuring the outcomes with precision. These cycles are broken into two parts. The first part guides the examination of what barriers or problems are impacting nurses’ ability to provide excellent patient care through brainstorming. The second part guides the nurses in a deeper examination of potential solutions to these problems by identifying inefficiencies and design flaws and potential improvements to both, borrowing IDEO’s “deep dives.”2 

Creative Solutions in TCAB
The creative solutions are then ranked by ease of implementation and impact (1 = easy to implement/low impact, 2 = easy to implement/high impact, 3 = difficult to implement/high impact, and 4 = difficult to implement/low impact). This ranking gives clarity to which solution to implement first. The process results in creative ideas and solutions to implement and test pre-post, then revise the solution, implement the revised improved solution and test again. Ambulatory nurses in Pittsburgh used TCAB to improve patient wait times, patient and staff satisfaction, and treatment area flow efficiency through innovations identified and created using TCAB.5

The Success of Failures
Success is about more than methods. Successful innovative teams need to be courageous in their approach to the solution for the identified problem/barrier and prepared to be tolerant of failures. These teams practice fearless motivation. Their motivation is not impacted by the fear of failure. Thomas Edison was fearlessly motivated. He famously revealed he had tried 10,000 times before successfully inventing the light bulb.6 He embraced and believed in the eventual success of failures. His work ethic, tenacity and love of learning is what led him through those 10,000 failed experiments to arrive at the final successful one, the only one that mattered and the light bulb! Edison understood and was fearlessly motivated. He once stated “our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.”6

There is another interesting famous quote on tolerating failure: “…contentment in the thrill of action, knowing that success was never final and failure never fatal. It was courage that counted.”7

So, do not view problems as obstacles. They are the opportunity for innovation. Do not fear failures. Instead, embrace failures as part of the creative process. Success is not final, and neither is failure. Beginning again is always the next opportunity to find success. There is no finality!


  1. Senge PM, Carstedt G, Porter PL. Next industrial revolution. MIT Sloan Management Review. 2001;42(2):24-38.
  2. Christensen C, Raynor M. The innovator's solution: creating and sustaining successful growth. Harvard Business Review Press. 2013:76.
  3. Kelley TA. The Art of Innovation. Broadway Business. 2001.
  4. Kaya NN, Turan N, Aydin GO. A concept analysis of innovation in nursing. Procedia-Social and Behavioral Sciences. 2015;195:1674-78.
  5. Lorenz HL, Greenhouse PK, Miller R, Wisniewski MK, Frank SL. Transforming care at the bedside: an ambulatory model for improving the patient experience. JONA. 2008;38(4):194-199.
  6. Thomas Edison quote. Good Read website. Accessed August 18, 2020.
  7. You can’t tell him there’s no fishin.’ Anheuser-Busch advertisement. Trenton Evening Times. September 21, 1938. GenealogyBank. 

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