Empowering Meaningful Care © 2013 Elsevier – Proprietary and Confidential Michelle Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer The

Empowering Meaningful Care

© 2013 Elsevier – Proprietary and Confidential

Michelle Troseth, MSN, RN, DPNAP, FAANChief Professional Practice Officer

The Role of the DNP in Managing the

Practice-Technology Polarity

Michelle Troseth, MSN, RN, DPNAP, FAAN

Chief Professional Practice OfficerElsevier 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, eHIDistinguished 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 15th 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

4

Major Shifts in Healthcare

ARRA/Meaningful

Use

Accountable Care

Organizations

Interprofessional Practice and

Education

Culture and Professional Practice

Framework for Sustainable Healthcare

Data capture and sharing

Advanced clinical processes

Improved outcomes

A Conceptual Approach to Meaningful Use

Accountable Care Organizations

ACO

Clinical Integration

Bundled Payments

Population Decision Making

Medical Homes

Continuum of Care

Technology Platform(The Focus)

Practice Platform(The Afterthought)

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 AdministratorSeptember 14, 2012

The Digital Generation of Healthcare

Exponential Growth Technology

• Show Video-Clip

Advancing Practice with Technology

Tasks Scope of Practice

Knowledge-Worker

Technology must bedesigned to enhancescope of practice and evidence-based practiceat the point of care

Technologyis key to embrace and shape so practice is trulyknowledge-driven

Technology must capturethe tasks performed butnot limit practiceto the rituals and routinesof traditional practice

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

The CPM Framework™Grounding Principles

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

TMTM

www.polaritypartnerships.comwww.cpmrc.com/polaritythinking

http://www.polaritypartnerships.com/

http://www.cpmrc.com/polaritythinking

Polarity Thinking™: Essential Skill for Healthcare Leaders

Polarities are interdependent pairs of different/competing/opposite values or points of

view.

What is a Polarity?

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

Why is it so important?

•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

MapMMAP the polarity

TAP the energy in the polarity to move to

Action.

Polarities – from vision to reality

Polarity Map © 1992, 2008 Polarity Management Associates, LLC

Values = positive results from focusing on the left pole

Values = positive results from focusing on the right pole

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

Deeper Fear from lack of balance

Greater Purpose Statement (GPS) - why balance this polarity?*

**

andInhale Exhale

Live

Die

Clean Out Carbon Dioxide

Increased Carbon Dioxide Too Little Oxygen

Polarity Management® Map

Get oxygen

Value-upside Value-Upside


Higher Purpose = Why Balance This Polarity?

Deeper Fear from Lack of Balance?

Basic Action Steps to Manage a Polarity Well Over Time*

**Positive results from focusing on this

left pole:Positive results from focusing on this right pole:

Negative results of over-focusing on this left pole to the neglect of the right pole:

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 left pole.

1.

Early WarningsMeasurable indicators (things you can count)

that will let you know that you are getting into the downside of this right pole.

1.

and

Action StepsHow will we gain or maintain the positive

results from focusing on this right pole? What? Who? By When? Measures?

1.


results from focusing on this left pole? What? Who? By When? Measures?

1.

Always tension between them

INHALE EXHALE


Greater purpose

Deeper fear

UpsideValues

UpsideValues

Pole Pole

DownsideFears

DownsideFears

A Tool to Visualize Polarities by Barry Johnson, PhD

Stability Change








Early Warnings***


1.



1.

and



1.



1.

Stability Change









Early Warnings***


1.



1.

and



1.



1.

Stability Change

Continuity-Sense of Direction

New EnergyNew Possibilities

Stagnation Chaos


34

Technology Practice

Sustainable Transformation

Unsustainable Transformation

InnovationStandardizes and integrates informationIncrease efficiencyData retrieval

EBP and professional practice/workflowClinical integration across disciplinesCaring culture

Lack of evidence-based informationDesign interferes with integrationLack of “humanization”

A. Ensure users understand the design, purpose and functionality of technology tool.

B. Provide time for users to learn the technology tool properly.

Lack of awareness of tech. benefitsLack of information impacts qualityDecrease timely access & retrieval of patient information

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.

A. Timelines for activation are all about technology, not about practice transformation

B. Modifying or deconstructing evidence-based content integration.

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.


• 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.


• 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.comwww.cpmrc.com/polaritythinking (healthcare)

[email protected]

@CPMRCmichelle

http://www.polaritypartnerships.com/

http://www.cpmrc.com/polaritythinking

mailto:[email protected]

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 21st century: An international look at practice, trends, and the future. (2nd 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, (8th 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 4th 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 5th 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).

Documents

Empowering Meaningful Care © 2013 Elsevier – Proprietary and Confidential Michelle Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer The