The goal of the 2011 North Star Invitational Summit was to generate a nurse executive-focused constellation of research questions utilizing the collective wisdom of national nurse executive leaders and scholars to provide a catalytic direction for the creation of evidence-based leadership practice designed to strengthen the emerging role of the nurse executive.
The question to answer in this epilogue is: Was the goal achieved? My response is: The journey to the obtainment of the goal has been launched. The outcomes of the Summit include a constellation of research questions framed by the 3 domains of professional and personal organization, high reliability in nursing practice and transitions in care accountability, and the results of the discussion from the 4 nominal group questions.
CONSTELLATION OF RESEARCH QUESTIONS: FIRST LAUNCH
In the North Star Invitational Summit executive summary chapter, all of the research questions generated by the attendees are displayed in the Table. As guest editors of this nascent Summit, 20 of the research questions were selected "most likely to enable insights and breakthroughs for change and innovation." They are shown in the Table.
A TREASURE TROVE OF NEW LANGUAGE
During the 11/2-day summit the attendees frequently questioned each other about the meaning of new words or unfamiliar words and language used. The guest editors of this issue promised to include the new language as an outcome of the Summit. The treasure trove of new language is visually displayed in a "tag cloud" in the Figure followed by key definitions.
1. Tag cloud: A visual representation of data. A "tag" is usually a single word, and the importance of each word is shown with font size and/or color. Numerous social networking and communication vehicles are emerging at a rocket-like speed. The nurse executive of tomorrow needs to create processes through people or machinery to keep pace with each generation of the workforce and how best to "speak to them" not "at" them. This tag cloud was developed by a "Generation X" (nonnurse) master's prepared instructional technologist who is employed by the Nursing Department at the Hospital of the University of Pennsylvania.
2. Vienna circle: This is a term that was used to describe the Planning Committee for the Summit. The Vienna Circle was an association of multidisciplinary scientific philosophers in 1922 Germany who influenced the scientific language and methodological approach to research. Their basic propositions impacted the empirical sciences of physics, geometry, and the psychological and social sciences through the concepts of logical positivism and the verification principle. Both concepts are embedded in scientific vigor today. I wanted the Summit attendees to appreciate the metaphorical connection to their participation in this invitational.
3. Black Swan: Invitational Summit attendees discussed the Black Swan phenomenon. In 2007, Nassim Nicholas Taleb, an epistemologist, authored the book, Black Swan: The Impact of the Highly Improbable. The book focuses on the impact of rare and unpredictable events and how humans tend to find simplistic explanations for those events retrospectively instead of identifying early areas of vulnerabilities, in order to turn Black Swans white. What evidence-based practice acumen must a nurse executive possess to avoid Black Swans?
4. New learning paradigm: The creation of "team science." Team science is the development of a common language and constructs for interdisciplinary and multidisciplinary clinical terms to function as a "holistic mind" to provide patient care and quality outcomes from basic bench science to personalize care of an individual. Science teams are trained to observe, measure, interpret, diagnose, plan, and deliver care.
5. Clinical intelligence: Intelligence to understand, interpret, and select technological applications that transform data into information. The emerging nurse executive needs acumen and skill in not only business intelligence but in how to select the best software and applications to improve (1) quality of care, (2) patient safety, (3) risk mitigation, (4) staff performance, (5) operations, (6) efficiency, (7) patient flow, (8) scheduling of clinical resources, (9) patient satisfaction, (10) bed capacity, and (11) length of stay and costs. He or she must also possess clinical intelligence in architectural principles to engage and lead patient and family-friendly spaces and faculty design.
6. Syndromic surveillance: Pamela Cipriano, PhD, RN, NEA-BC, FAAN, introduced this new language to the attendees. The 2009 American Reinvestment and Recovery Act, in support of the concepts of the electronic health record, establishes syndromic surveillance as a way to monitor public health. Syndromes or collections of symptoms over time quickly and adequately detect outbreaks or monitor diseases, disorders, or conditions. Once the data is complied, information streams can be utilized by providers to evaluate the analysis of health partners and outcomes of chronic conditions. Such as congestive heart failure, diabetes, and use of health care services. What evidence-based nurse executive practices do we establish to demonstrate the impact of nursing care and to justify the outcomes?
7. Disruptive innovation: This term was coined by Clayton Christensen, a Harvard Professor, in 2004. This concept describes a process by which a product or service takes root in simple application and then relentlessly moves up and eventually displaces the established product or service. Examples of disruptive innovation are landline telephones to cell phone to iPhone to iPad use and free flow intravenous pumps to SMART pumps. An evolving competency for the nurse executive is how to stimulate and energize clinical staff to identify opportunities to transform patient and family care due to a disruptive innovative insight.
8. Diffusion of innovations: This theory was developed by Everett M. Rogers in 1962. Diffusion of change and new ideas is the process by which an innovation is communicated through certain channels over time among members of a social system (nursing). Diffusion is a special type of communication concerned with the spread of messages that are perceived as new ideas or positive remarks or outcomes. The mastery of diffusion of innovation theory for the nurse executives is defined as the skill to spread positive gossip about evidence-based practice changes, innovations, and technological advances.
9. Chunking: A principle that applies to effective communication of information between human beings. It is particularly useful in the domain of written communication. It was coined in the 1950s by the Harvard psychologist, George A. Miller. This new language is especially meaningful for nurse executives to know and understand as e-learning becomes the cornerstone strategy for lifelong learning, mandatory education, ongoing competency assessments, and training on new technologies. In the terms of e-learning, chunking means breaking up the text and culling it down to the essential intent so readers do not view a solid block of text. Content is presented in informational units that are small, related, and easy to comprehend. Topics are addressed one topic at a time. Subheadings are used to emphasize the main points visually. Chunking is a major pedagogical approach to ensuring that e-learning modules are just as effective as classroom tutelage. As nurse executives: What are the best chunking techniques to create double and triple loop learning outcomes?
10. Potpourri of new language: Additional new phrases used at the Summit that appear self-explanatory and are visually displayed in the tag cloud are mind map, volume versus value, new space, sense maker, harmonizing technology, user-driven, comfort in ambiguity, deconstructing a model, social machinery, social networks, comma of complacency, culture of caring, and idealized influence and domain of practice.
THE CONTINUATION OF THE NORTH STAR JOURNEY
The North Star Invitational Summit concluded with the following 4 recommendations: (1) conduct North Star Summit 2.0 and include nurse executives and scholars from across the continuum of care with emphasis on nonacute care delivery systems representation; (2) explore funding support from Schools of Nursing, government agencies and private donors to continue this concept; (3) consider inviting other clinical professionals to attend, for example, physicians, pharmacists, and so on; and (4) ensure that minority nurse executives and scholars are represented and unique leadership research questions are discussed and strategies defined to explore answers to the future questions
In summary, the North Star Invitational Summit did reach its initial intent but the continuation and expansion of the Vienna Circle Planning Committees that include not only nurse leaders and scholars but other related disciplines from medicine, pharmacy, engineering, informatics, psychology, and anthropology are imperative moving forward in spite of the realization that we are all on a never-ending journey for the perfect research question and outstanding results!
-Victoria L. Rich, PhD, RN, FAAN
University of Pennsylvania
Penn Medicine, Hospital of the University of
Pennsylvania, Philadelphia, PA
([email protected]).