Home > RNJ > 2005 > January/February > Editorial: Six Steps to Innovation

Editorial: Six Steps to Innovation
Elaine Miller, DNS RN CRRN FAHA Rehabilitation Nursing Editor

Reflecting upon the various stimulating presentations at the ARN annual conference held this past October in Atlanta, it is apparent that many extremely busy and talented rehabilitation nurses are responding to difficult clinical situations with novel solutions (i.e., pediatric day health center, work reentry programs, interdisciplinary pain management, workforce recruitment and retention, etc.). These inventive solutions will redefine the science shaping our practice, expand the scope of our practice, and improve the quality of patient care we provide. I also was impressed with how rehabilitation nurses and associated actions reenergized their professional practice, rewarded their efforts threefold, and helped transform pessimism into optimism with regard to what they can accomplish when they work together.

Do you ever struggle with recurrent obstacles that cause frustration and dissatisfaction with the quality and timeliness of your care? If so, consider the following six steps that may stimulate your creative spirit …

  1.  Be open to new ideas and approaches to care.

Each day, rehabilitation nurses experience the taxing demands of multiple patients who require medications and holistic care. We need to remain receptive to innovative strategies for managing recurrent problems and listen attentively to our colleagues’ alternative approaches that have supportive evidence. Because nurses have the most constant contact with patients and families, they frequently possess unique patient insights.

  2.  Observe other innovators who have demonstrated success.

Take a moment to reflect upon Thomas Edison’s vision and tenacity that led to his more than 3,000 attempts to create the first functional light bulb, effectively changing the world (The Great Idea Finder, n.d.). Edison was an inventor who possessed the right skills and work ethic to do great things. He serves as an outstanding example for health professionals. Look around and identify colleagues who seem to have new ideas or unique ways of doing things. Follow their example and make creativity a key aspect of your own work ethic.

  3.  Blend tenacity with patience.

Innovation alone is not the key to success. Unfortunately, the work world is full of obstacles that demand persistence. Therefore, a comprehensive plan is required to overcome challenges. Such a plan may involve collaboration with others, working within existing care guidelines, translating changes into the current clinical situation, and obtaining the resources required to implement the innovation. In addition, it takes time and patience in working through the intermediate steps to achieve the targeted outcome.

  4.  Translate innovations into real-world clinical situations.

Innovations must be translated into a particular context of practice. For instance, a creative work-reentry program, a bar code system designed to reduce medication errors, or interdisciplinary pain management regimens may require adaptation to diverse work environments. Research suggests that the process of diffusion of innovations is much more interactive than previously perceived. Adopters are not passive, but rather are engaged in seeking information, debating the information, and using professional networks to seek corroboration of the relevance and value of the information (Shabot, 2003).

For instance, in this issue, you will learn about novel strategies pertaining to mentoring a brain-injured peer, modifying beds to reduce patient entrapment, examining health promotion and quality of life for patients with disabilities through the use of an innovative care model, discovering lessons learned from the use of computer technology, identifying how spirituality can influence life satisfaction following a spinal cord injury, and exploring how rehabilitation nurses need to consider the role of genetics in the delivery of care.

These articles provide a vehicle for the dissemination of information and reaffirm the creativity of our colleagues who have, in most instances, performed research to clarify how and under what conditions the innovation works. In spite of these and other novel approaches to problems, decisions regarding whether to adopt and use an innovation are made by individual professionals and local groups of practitioners, often following a period of debate with evaluation of the robustness of the evidence, rises in patient satisfaction levels, cost implications, and other factors influencing the decision (Fitzgerald, Ferlie, & Hawkins, 2003). In most instances, adoption of an innovation entails a careful assessment of favorable and unfavorable circumstances that may arise from the use of the innovation.

  5.  Carefully examine the resources required to accomplish the innovation.

An essential consideration when choosing what innovation to implement involves Pareto’s Principle, also known as the 80-20 Rule, which states that 20% of an effort usually requires 80% of the resources. Consequently, giving priority to only a small number of revolutionary improvements at one time is central to successful outcomes (Koch, 1998). As a result, rehabilitation nurses need to be wise in choosing the innovations that they want to support, implement, and evaluate. Moreover, they should be cognizant of what supportive resources need to be in place (i.e., technology, labor, educational materials, etc.) to perform the innovation as designed.

  6.  Recognize that innovation requires leadership.

This last step, taking a leadership role, is perhaps the most challenging for rehabilitation nurses. It requires nurses to be proactive in identifying problems and possible innovative solutions, providing the rationale for their implementation, identifying the resources needed to support the innovation, and developing measurable goals as well as specific action plans. Personnel at all levels of the organizational structure must work together in a timely and collaborative manner to improve care and gather the important evaluative data to monitor the long-term success or failure of the innovation and potential policy implications. Finally, nurse leaders must always be cognizant of the need to test and adapt the innovation to varied clinical situations.

This is an optimal time to be practicing as a rehabilitation nurse. With the modifications in the demographics of our patients and their families, influx of technology, reforms in health care financing, and shortages of practitioners and educators, now is the time to be innovative and reframe our situation. Although change is seldom easy, consider the possibilities. Revisit how and why you practice in the manner that you do and ponder new approaches that may have far reaching influences on present and future care. Take that first step!


Fitzgerald, L., Ferlie, E., & Hawkins, C. (2003). Innovation in healthcare: How does credible evidence influence professionals? Health and Social Care in the Community, 11, 219–228.

Koch, R. (1998). The 80/20 principle. New York: Doubleday.

Shabot, M.M. (2003). Closing address—Breaking free of the past: Innovation and technology in patient care. Nursing Outlook, 51(3), S37–S38.

The Great Idea Finder. (n.d.) Fascinating facts about the invention of the light bulb by Thomas Alva Edison in 1879. Retrieved October 31, 2004, from www.ideafinder. com/history/inventions/story074.htm.