I was recently watching television, and it struck me that the word innovation was used in 7 consecutive commercials. I spent the next half hour pondering, "What is the common link between automobiles, haircuts, soda, airlines, hardwood flooring, and healthcare?" and "What do people mean when they say 'innovation'?" Eventually, I came to the conclusion that TV commercials used innovation to convey a new idea that produces, adds, or enhances value or, in marketing language, to say "the next great thing."

In healthcare delivery organizations, we are uniquely challenged in that there is a real and defined need for innovation. Yes, there is a long history of innovative inventions, products, and discoveries in healthcare (ie, vaccines, medications, artificial organs, etc). But what happens when we need to innovate the structures and processes for how healthcare is delivered?

The existing paradigms of care delivery have proven to be fiscally unsustainable and may not support the delivery of the safest, most effective, timely, patient-centered, equitable care. Thus, a comprehensive plan for the future must address cost reduction, but also fundamentally how care is provided. Large governing healthcare entities such as the Centers for Medicare & Medicaid Services1 and the American Nurses Credentialing Center's Magnet Recognition Program(R) identify innovation as a key component of transforming healthcare.2 This has driven a growing need to quantify, articulate and replicate innovation in a tightly resourced, operational care delivery setting.

The experiences from the Massachusetts General Hospital Innovation Unit Program (Program) provide a unique insight into innovation in a care delivery setting and specifically evaluation of innovation. The Program was developed as a frontline initiative to address the gaps in the continuum of care and utilize the expertise of all clinical disciplines to improve the patient experience, quality of care, staff satisfaction, and empowerment while decreasing redundancy, costs, length of stay, and readmission rates.3 The progress and successes of this trailblazing model are in response to current and future healthcare reform stem from interventions that span philosophy, practice, technologies, and roles4 and also include a thorough strategy to evaluate innovation interventions in an operational setting, essentially letting us know how we are doing rebuilding the ship while it is sailing.

The initial, broad approach to data collection and evaluation of this complex innovation Program utilizes multiple measures including focus groups, surveys, observations, and analysis of quality and administrative data.5 As this expansive approach to data collection was planned, there was a conscious effort to also prepare to support specificity in inquiry as needed. The immense amount of data were valuable, but the how, when, and what was the emerging story that needed to be clearly articulated and discussed to best understand driving forces leading to outcomes. Were we really on to the next great thing?

During the early part of the Program's data collection and analysis, the differences between research and evaluation became increasingly clear. Specifically, part of operations in a care delivery setting innovation evaluation is enhanced by broad, frequent, repetitive inquiry, and near real-time dissemination of findings. Operational innovation evaluation is not designed to be definitive; rather, it provides an understanding of directionality to support knowledge-based justifications and to assist in posing new questions.

As such, a 90-day innovation implementation and dissemination cycle was used to frame the approach. This 90-day innovation cycle stemmed from work by Proctor and Gamble,6 later used in healthcare at the Institute for Healthcare Improvement7 as part of those organizations' innovations work. The implementation and frequent evaluations helped to identify trends promptly and support both initiative acceleration and rapid cycle course correction as needed.

Healthcare currently exists in what Kuhn8 described as a "pre-paradigmatic state"-when we know that the way we viewed things previously is not correct, but we do not yet have a widely accepted model we can follow. Nursing leaders have great opportunities to contribute and define healthcare's new paradigm. It is those courageous nurse leaders, who promptly explore, implement, evaluate, and respond to the trends, who will identify the "the next great thing" and influence the future of care delivery.

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