Frontline Innovation Research Articles

Engaging Interdisciplinary Innovation Teams in Federally Qualified Health Centers.

To foster bottom-up innovations, health care organizations are leveraging interdisciplinary frontline innovation teams. These teams include workers across hierarchical levels and professional backgrounds, pooling diverse knowledge sources to develop innovations that improve patient and worker experiences and care quality, equity, and costs. Yet, these frontline innovation teams experience barriers, such as time constraints, being new to innovation, and team-based role hierarchies. We investigated the practices that such teams in federally qualified health centers (FQHCs) used to overcome these barriers. Our 20-month study of two FQHC innovation teams provides one of the first accounts of how practices that sustained worker engagement in innovation and supported their ideas to implementation evolve over time. We also show the varied quantity of engagement practices used at different stages of the innovation process. At a time when FQHCs face pressure to innovate amid staff shortages, our study provides recommendations to support their work.

EVALUATION OF A PROVIDER-DRIVEN STRATEGY TO ENSURE AGE-FRIENDLY CARE

Abstract Implementation of evidence-based care requires innovation. The Age-Friendly Health Systems Questionnaire (AFHS-Q) is an example of a front-line innovation that increases efficiency of implementation by having the patient complete eight 4Ms questions while waiting for their visit. We evaluated the usability, acceptability, feasibility, and effectiveness of the AFHS-Q by surveying nurse practitioners (NPs) across a retail clinic system and found that the innovative practice-based tool was effective and feasible. The AFHS-Q kit was sent to over 1,100 retail clinic sites and an online survey was sent four weeks later to the 3,300 NPs at these sites to measure their experiences. NPs (N = 100) completed the survey and reported overall positive feedback (scale range 1-5) about the AFHS-Q relating to comfort of use (M = 4.18, SD = .99), usefulness (M = 3.97, SD = 1.10), acceptability (M = 4.12, SD = .83), and effort for use (M = 2.75, SD = 1.17). NP’s confidence in completing the 4Ms (before AFHS-Q: M = 3.92, SD = 1.90; after AFHS-Q: M = 4.18, SD = .97) and documenting the 4Ms (before AFHS-Q: M = 3.84, SD = .99; after AFHS-Q: M = 4.17, SD = .91) was significantly higher following AFHS-Q use (completion: t = 3.58, p < .001; documentation: t = 4.33, p < .001). NPs reported a significant reduction in time for visits after using the AFHS-Q. Participants also provided open ended feedback indicating the AFHS-Q was overall easy to use as well as highlighting areas for other improvement.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Front-Line innovation: Rapid implementation of a nurse-driven protocol for care of outpatients with COVID-19.

Aims and objectivesOur objective was to rapidly adapt and scale a registered nurse‐driven Coordinated Transitional Care (C‐TraC) programme to provide intensive home monitoring and optimise care for outpatient Veterans with COVID‐19 in a large urban Unites States healthcare system.BackgroundOur diffuse primary care network had no existing model of care by which to provide coordinated result tracking and monitoring of outpatients with COVID‐19.DesignQuality improvement implementation project.MethodsWe used the Replicating Effective Programs model to guide implementation, iterative Plan‐Do‐Study‐Act cycles and SQUIRE reporting guidelines. Two transitional care registered nurses, and a geriatrician medical director developed a protocol that included detailed initial assessment, overnight delivery of monitoring equipment and phone‐based follow‐up tailored to risk level and symptom severity. We tripled programme capacity in time for the surge of cases by training Primary Care registered nurses.ResultsBetween 23 March and 15 May 2020, 120 Veterans with COVID‐19 were enrolled for outpatient monitoring; over one‐third were aged 65 years or older, and 70% had medical conditions associated with poor COVID‐19 outcomes. All Veterans received an initial call within a few hours of the laboratory reporting positive results. The mean length of follow‐up was 8.1 days, with an average of 4.2 nurse and 1.3 physician or advanced practice clinician contacts per patient. The majority (85%) were managed entirely in the outpatient setting. After the surge, the model was disseminated to individual primary care teams through educational sessions.ConclusionA model based on experienced registered nurses can provide comprehensive, effective and sustainable outpatient monitoring to high‐risk populations with COVID‐19.

Frontline Innovation in Times of Crisis: Learning from the Corona Virus Pandemic

The current COVID-19 pandemic brings about dramatic challenges for frontline police officers and their organizations. This will, we argue, likely have two implications for frontline learning and innovation. First, the pandemic will surely occasion a surge of frontline improvisation and innovation in police organizations responding to the crisis as the experienced needs for new solutions dramatically increase. Secondly, but equally importantly, this wave of frontline innovation is likely to be more transparent than is typically the case for innovations developed in frontline police work, because of changes in formal mandates and informal tolerance for procedural deviance. At this moment of unusually widespread and transparent frontline innovation, we propose an approach to capturing and diffusing this frontline innovation. By taking seriously the unique dynamics of frontline innovation, such an approach is likely to capture valuable innovations that might otherwise rapidly dissipate and be lost.

Frontline Innovation in Times of Crisis: Learning from the Corona Virus Pandemic

The current Covid-19 pandemic brings about dramatic challenges for frontline police officers and their organisations. This will, we argue, likely have two implications for frontline learning and innovation. Firstly, the pandemic will surely occasion a surge of frontline improvisation and innovation in police organizations responding to the crisis as the experienced needs for new solutions dramatically increase. Secondly, but equally importantly, this wave of frontline innovation is likely to be more transparent than is typically the case for innovations developed in frontline police work, because of changes in formal mandates and informal tolerance for procedural deviance. At this moment of unusually widespread and transparent frontline innovation, we propose an approach to capturing and diffusing this frontline innovation. By taking seriously the unique dynamics of frontline innovation, such an approach is likely to capture valuable innovations that might otherwise rapidly dissipate and be lost.

Data Security in Cloud Computing using Three Way Mechanism

Cloud computing is the front line innovation of the decennium. It empowers users to store enormous collection of information in distributed storage and make use of it as and when they please from any corner of the world, with any sorts of hardware. As this distributive computing is reliant on the internet facility, issues of security like privacy, security of information, authentication and data confidentiality is experienced. So as to dispose of these issues, an assortment of encryption calculations and systems are utilized. Numerous specialists pick what they discovered best and made use of these in different blends to give the security to the information in cloud. Going through a comparable circumstance, we have decided to utilize a mix of validation system and key trade calculation mixed with an encryption calculation. The blend is alluded to as a "Three way mechanism" since it guarantees all three of confirmation, information protection and inspection insurance policies. In this paper, we have proposed to utilize two-factor authentication mixed in (AES) Advanced Encryption Standard encryption calculation that secures the secrecy of information put away within cloud. Without user’s private key that is special to the user, even if the key that is moving is stolen or hijacked the feature of key exchange renders it pointless and is of no use. The given proposed engineering of three way mechanism making it tedious for unauthorized personnel to break this security framework, therefore securing information put away in cloud.

Frameworks for Leading Frontline Innovation in Health Care:: Failure, Microclimates, and Leadership

Leading innovation in health care requires the full participation of frontline nurses. Many times, nurse leaders struggle with how to include all members of the team in innovation activities and see innovation as a daunting radical change rather than it being inclusive of the incremental activities that happen naturally every day. This article describes tools and mindsets that nurse leaders can use to build innovation capacity in the frontline and the entire care delivery team through the use of microclimates, failure, and leadership actions.

Carlson’s Law and the Power of Frontline Innovation

Carlson’s Law and the Power of Frontline Innovation

Reducing or Holds: How Frontline Innovation, Interdisciplinary Collaboration, and Lean Thinking Improved Perioperative Throughput

Reducing or Holds: How Frontline Innovation, Interdisciplinary Collaboration, and Lean Thinking Improved Perioperative Throughput

Foundations of Relating: Theory and Evidence on the Formation of Street‐Level Bureaucrats’ Workplace Networks

AbstractDespite the importance of peers in forming role expectations, fostering group identity, and facilitating job learning, limited theory and empirical evidence exist on the antecedents of street‐level peer relationships. To address this gap, the authors draw on social capital and social exchange theories to develop hypotheses about the micro‐social foundations of street‐level bureaucrats’ peer selection. The hypotheses are tested using a rich data set from an intraorganizational network of teachers in a large urban school implementing a reform that strongly promoted frontline innovation. Both structural and instrumental considerations, such as seeking peers possessing characteristics and resources valued by the reform, figure prominently in the work relations of street‐level bureaucrats. These results imply that the introduction of improvement initiatives requiring frontline participation, in addition to altering work practices, may also alter social networks within the frontline of an organization in a manner that favors some frontline workers over others.

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

Sintero server scalable interoperability framework for DALLAS communities

We describe a prototype open source UK-scalable Health Information Exchange (HIE) to support patient-centric care, translational research and other secondary uses. It has been designed by interoperability experts to standardise information flows across the patient path—for example from home, work, mobile, clinical and community care locations. Sintero enables secure information sharing within the patient’s named ‘circle of care’ including family, third sector, social care, community pharmacy, specialist care networks and named statutory (e.g. NHS) carers. Patients may access to their own personal health records and manage consents for their sharing and secondary uses. Sintero’s infrastructure is a low-cost ‘commodity’ approach to delivering scalable DALLAS community solutions. It does this by taking a collaborative approach to capacity development, working with NHS informatics and frontline innovation centres towards efficient use of the technology by the workforce. There is a strong focus on delivery of patient value by continuous measurement and systematic feedback of outcomes. Sintero is being made available to UK DALLAS communities on a collaborative basis.

Frontline innovation is free but not easy

Delaney's final conclusion on his editorial on cutting-edge information technology struck a chord with my work over the last 8 years. He suggested that in the future such IT will have to be freely available and with universal standards.1 So far I have received no monetary grants for my work and have made my ideas …

Alternatives to Blood Transfusion

Blood transfusion therapy in the 21st century continues to present limitations regarding efficacy and risks. Blood management partners optimal blood transfusion therapy with anemia management that incorporates nonblood strategies and techniques. A planned approach to anemia prevention, identification, and treatment can reduce the need for blood transfusion and improve patient outcomes. The use of pharmaceutical agents and tools to minimize blood loss also leads to blood transfusion reduction. Nurses play an integral role in affecting the use of alternatives to blood transfusion. Through assessment, communication, and an understanding of blood management strategies, nurses are patients' front-line innovators in promoting best practices.

Why Innovative Schools Don't Remain Innovative

Schools that are frontline innovators have difficulty sus taining their leadership thrust, the writer contends, pri marily because of difficulty in the broad areas of training, leadership, professionalism, and community.