INNOVATION PROPOSAL ADVANCING EVIDENCE-BASED INNOVATION IN NURSING PRACTICE — D031

Video Education for Patients

1. Innovation Proposal

The increasing demand for quality healthcare has led to various changes including changes in healthcare innovation. Innovation involves the process of invention, adoption, and diffusion of ideas to significantly benefit individuals, groups, or organizations. Innovative efforts in healthcare are observed to focus on improving the patient experience, improving the health of populations, and reducing the cost of healthcare. Registered nurses are among the top healthcare professionals working to improve the patient experience by re-imagining and redesigning healthcare through innovation. Nurses have been strong promoters of health information technology (HIT) to ensure patients receive information necessary for improved healthcare services (Thomas et al., 2016). This discussion focuses on the use of video education for patients as one of the innovative ideas that can improve patient experiences.

Explanation of Role

Nurses are leading the way to the of healthcare through innovation. Nurse innovators are involved with developing, testing, and implementing products and processes to improve care. Their formal role is to cultivate and advocate for the development of concepts and processes that can elevate healthcare today (Thomas et al., 2016). Through the application of nursing knowledge and skills, nurse innovators advocate for patients, consumers, and the nursing profession. Nurse innovators work with nurse educators to develop and implement curricula that reflect an active role in the utilization of technology. These leaders assume top positions in private and government sectors to ensure quality initiatives are given priority.

 Organizational Characteristics

The healthcare organization of focus in this discussion is Union General Hospital located in Georgia. The organization’s mission is to provide high-quality, cost-effective healthcare, and promote wellness throughout the community. The institution is ranked among the best healthcare facilities in Union County due to the quality of services provided. The bed capacity of the organization is 189 and serves a population of more than 24,000 people across the county (United States Census Bureau, 2019). The facility mainly served residents from Union County and provides an array of healthcare services including emergency care, laboratory and imaging, outpatient care, rehabilitative care, maternity and child welfare, and cardiopulmonary rehabilitation services.

Demographics

The general patient population served in this facility cuts across all ages. About 33% of the total population served is above the age of 65 years while 3.7% represents patients under the age of 5 years. The area served contains individuals from different racial and ethnic backgrounds. The county statistics indicate that about 96.7% of the population are Whites, 0.9% Black or African American, and 3.4% Hispanic or Latino (United States Census Bureau, 2019). The majority of the individuals have health insurance coverage that improves access to healthcare services. Regarding the income and poverty level, the median household income in the area is $44,978 with about 13.8% of the population living in poverty (United States Census Bureau, 2019). Lastly, the majority of the patients or individuals served are educated with about 22.4% having a bachelor’s degree or higher.

Team Member Roles

The team members involved in the innovative plan include the nurse administrator, information technology specialist, nurse educator, nursing services manager, and clinical research manager. During the CPE, the nurse administrator was involved in overseeing the plan to include video education for patients in the facility. The administrator’s presence was also an influence on the other team members leading to successful meetings and formulation of ideas. The nursing services manager functions formally to coordinate changes affecting nurses and representing the nursing team in matters of quality change. This individual was the point of contact for reaching out to staff regarding the new change to improve acceptance in the institution.

The nurse educator was crucial in informing other members how education will be delivered to staff and patients regarding video education. This individual’s knowledge was also crucial in directing the team towards the selection of the best innovative idea. The IT specialist was involved due to the use of technology for the selected innovation. The individual provided insight on video education, challenges that could be observed, and the organizational preparedness to adopt the innovative change. Lastly, the clinical research manager acted to guide stakeholders to select evidence-based innovative changes and demonstration how the patients and the organization could benefit. The involvement of this individual gave other stakeholders a strong belief that the innovative idea chosen was tangible and applicable in improving patient experiences.

Shared Team values

Effective teamwork is now globally recognized as an essential tool for implementing changes that can improve the quality of healthcare. An effective team shares values that ensure working together and understanding to achieve set goals. One of the values portrayed by the stakeholders in this innovation was respect. Each team understood that every member had a role to fulfill and no member was more special than the other. Secondly, honesty was highly appreciated during discussions to ensure decisions made were for the benefit of the patient and not the individual. While upholding these values, the goal of the team was to implement a strategy that could improve quality patient care. Quality improvement was among the values shared between the team and the organization. For example, the stakeholders understood that video education could improve quality through improving access to health information and the reduction of medical errors.

Discussion of Internal and External Factors

Various factors influenced the selection of the idea to use videos for patient education in the facility. Internally, there was a need to address the issue of patient experience to boost the hospital HCAHPS scores. Previous data indicated that there was an increased number of patient readmissions due to a poor understanding of their care upon leaving the facility. Another internal factor was the need to utilize technology in improving patient care. Most of the quality improvement projects focused on healthcare worker performance leaving a gap in involving patients to redesign their healthcare. Externally, there was the need for the organization to implement new changes to improve the quality of care in the facility which could address the issue of competition. Another external factor was pressure for regulatory bodies to demonstrate meaningful use of technology in the facility and quality improvement that could have an effect on funding.

Alignment to Strategic Initiatives

The strategic initiative that aligns with the selected innovation is the Medicare and Medicaid Services (CMS) HCAHPS scores that are indicative of patient experiences. These scores encompass 30% of the value-based purchasing (VBP) performance that is used for Medicare reimbursements (Timmers et al., 2020). These scores encompass different areas of organizational performance include the aspects of communication, medication administration, and safety among many others. Through the use of video education, the organization will be able to improve patient safety and reduce errors in mediation alongside an understanding of discharge information that will have a huge influence on patient experience. Additionally, the use of video education will serve to address the challenge of communication and understanding that always arises in healthcare leading to improved patient satisfaction.

Purpose Statement

Patient experience encompasses the range of interactions patients have with the healthcare system that reflects the perceived quality of services in the institution. Education is among the key approaches to improving patient experiences and the use of video education is a strategy that can satisfy more clients during hospitalization. The purpose of the innovative change is to address the issue of patient experience through the use of video education.

Innovation Goal

The goal of this innovation is to increase the patient satisfaction scores through the implementation of a video education program within six months. Through the use of video education, the HCAHPS scores on ‘patients who understood their care upon leaving the facility’ should increase to a score above 80% indicating a better understanding of healthcare services received.

1. Relevant Sources Review

Table 1.

Relevant Sources Summary Table

Reference Citation	Relevant Findings	Evidence Strength	Evidence Hierarchy
Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016). Registered nurses leading innovative changes. Online Journal of Issues in Nursing, 21(3), 3. https://doi.org/10.3912/OJIN.Vol21No03Man03	The purpose of the article was to describe key innovative goals for nurses, identify barriers, and recommend practices leading to innovative change in healthcare. Findings indicate that innovations in health information technology can greatly impact the quality of care. Nurses are now moving towards standardizing patient care that includes the use of EHRs, education mechanisms like video education, and delegation of duties.	Level VII	Expert Opinions
Stribling, J. C., & Richardson, J. E. (2016). Placing wireless tablets in clinical settings for patient education. Journal of the Medical Library Association : JMLA, 104(2), 159–164. https://doi.org/10.3163/1536-5050.104.2.013	The purpose of the study was to analyze the feasibility of delivering tablet-based educational materials to patients in clinic waiting areas and to understand the effects on patient satisfaction. Upon implementation of the technology, patients reported satisfaction across the domains of education, usability, and satisfaction.	Level IV	Cross-Sectional Study
Kamat, N., Rajan Mallayasamy, S., Sharma, P., Kamath, A., & Pai, G. (2019). Effect of video-assisted patient education on compliance with therapy, quality of life, psychomorbidity, and cost of illness in irritable bowel syndrome. Postgraduate Medicine, 131(1), 60–67. https://doi.org/10.1080/00325481.2019.1549458	The purpose of this study was to determine the effects of video education in improving quality of life for patients with irritable bowel syndrome (IBS). Upon implementation of the intervention for six months, there was significant improvement of quality of life scores among patients.  There was improvement in compliance to medication, psychomobility and reduced cost of illness.	Level IV	Cohort Study
Timmers, T., Janssen, L., Kool, R. B., & Kremer, J. A. (2020). Educating patients by providing timely information using smartphone and tablet apps: Systematic review. Journal of Medical Internet Research, 22(4), e17342. https://doi.org/10.2196/17342	The objective of the study was to provide an overview of using smartphones and tablet apps  to educate patients. The study demonstrated highest effects on satisfaction with information, adherence to treatment instructions and to medication usage, clinical outcomes, and knowledge.	Level I	Systematic Review
Chan, L. W., Choi, S. Y., Chan, H. H., Wong, T. W., & Lau, C. C. (2017). The use of patient education video in improving patient satisfaction in the accident and emergency department. Hong Kong Journal of Emergency Medicine, 16(1), 5-13. https://doi.org/10.1177/102490790901600102	The study aimed at assessing the impact of video education  for improvement of patient satisfaction in the emergency department. Results indicated that the short video improved the understanding of AED workflow. More than 75% of the patients were able to retain knowledge about AED workflow and understand most frequently asked questions better.	Level IV	Descriptive Study

 Synthesis of Literature

Nurses act as innovators to leverage technology and policy to improve the quality of services given to patients. Patient education is among the best approaches observed to improve their satisfaction upon seeking health care. The use of videos in education is supported by literature to serve as a tool for increasing information access and retention of important details about the patient’s care (Thomas et al., 2016). Using health information technology tools like smartphones, tablets, and television screens, healthcare providers can provide basic information to patients across all departments. Today, almost every patient contains a smartphone that can be used to offer education even without the healthcare provider’s presence. Stribling and Richardson (2016) explain that waiting room delays can create opportunities for clinicians to provide disease-specific health information designed to increase their patients’ health literacy by making use of information technology.

Patients clearly have education and support needs in the management of their conditions. Evidence demonstrates that patients, especially those suffering from chronic conditions have insufficient ability to perform basic aspects of care. Timmers et al., 2018; Thomas et al., 2016 demonstrate that education is the key to the patient’s management of their care. For instance, diabetic patients that fail to recognize a drop in their blood sugar levels may eventually have little control over their health outcomes as a result of knowledge deficit. The aspect of language barrier and cultural diversity may affect the other verbal health education approaches to patient care (Stribling and Richardson, 2016). Video education serves to break this barrier and gives patients more direct control over their health.

Video-assisted education should be part of patient treatment to help reduce satisfaction issues that result in many hospital units. According to Kamat et al., (2019), video education can be crucial especially to patients with low literacy levels as it improves understanding. This approach can also help reduce the need for translation because videos can easily be followed without the need for much explanation. Additionally, it is observed that video education using smartphones and tablets provides timely information to patients reducing anxiety, and frequent asking of questions during care (Timmers et al., 2020). Regardless of the approach used, video education can be is a predictor for increased engagement in shared decision making, improved medication and treatment adherence, higher levels of satisfaction, and even better treatment outcomes.

Recommendations

Recent healthcare reforms in the country including the Affordable Care Act (ACA), and HITECH mandate the use of technology to promote the patient’s health literacy (Stribling & Richardson, 2016). Video education is among the best approaches to achieve quality care through improved knowledge about the patient’s condition, medications, and procedures of the institution. Video education, especially in busy units like AED ensure that patients are familiar with protocols and their questions are answered without necessarily seeking the help of the provider (Kamat et al., 2019). Patients today have access to smartphones and tablets that can be used to easily watch videos and receive notifications when new material is available. The use of videos is recommended in this innovation because it can increase knowledge about the patient’s condition, improve adherence to medication through the provision of instructions, and provide reference to areas that patients might find difficulty upon discharge (Chan et al., 2017).

1. Data Collection Methods and Technology

Idea Generation Process

During the initial stages of developing the innovation, a meeting was held to generate ideas. The nursing services manager briefed the team about the healthcare problems that required change and selection of the patient experience area was done. Each stakeholder was given an opportunity to present an innovative idea to address the challenge of patient satisfaction in the organization. Because several ideas were generated, consensus decision making involved discussion of the ideas while ruling out innovations that could not provide adequate satisfaction to patients. Using evidence-based data, the clinical research manager was able to determine the effectiveness of video education and the organizational readiness to adopt the technology.

Data Examples

Big data represents data sets that provide useful information when analyzed while small data represents information sets that are in volume, easily accessible, and understood. Small data in the institution include patient’s vital signs, medications taken, symptoms, and laboratory investigation results. Big data in the institution include personalized patient healthcare experiences, hospital administration automation, and hospital-readmission prevention programs. These data are used to gauge organizational performance especially the patient experience surveys that translate to the amount of reimbursements from the CMS.

Big Data Support

Big data that can be used to support the proposed innovative idea is the patient healthcare experiences. This data consists of the HCAHPS scores for each individual analyzed to produce results that gauge patient satisfaction. This means that video education innovation will be tied to the patient experience whereby improved HCAHPS scores will indicate the idea benefits the patients. The organization can also use the big data to make adjustments to the innovative idea upon implementation.

Technology Enhancements

The first enhancement to support the innovation will be a high-quality video and sound recorder. The information technology department will use its expertise to select the enhancement. Secondly, a computer station will be required for editing the videos and uploading them to the screens available in the patient rooms, waiting rooms, and corridors across the facility. To make the technology more accessible, the hospital website will harbor all the videos for easy access by patients. Lastly, internet access will be required to support the online content including live streaming of the videos on smartphones and tablets by patients.

1. Interprofessional Collaboration

Disruption

The use of video education serves to supplement the face-to-face education provided to patients in the organization. Disruption of this innovation will mean that patients will face challenges in receiving timely education due to issues like shortage of staff and time barriers. Processes in the institution like admission in the emergency department will be disrupted because patients will not be able to understand procedures easily compared to when video education is provided. The result is increased waiting time and poor patient satisfaction. To the organization, disruption of the technology will mean persistence of the challenge of patent satisfaction. Low HCAHPS scores will continue to be observed leading to decreased reimbursements.

Strategies to Mitigate Challenges

The firsts strategy to solve the potential challenge of patient education is to increase funding to the project and monitor it effectively until full implementation. Secondly, the institution can educate staff on effective ways to deliver education to patients including important areas of stress. For instance, more education should be given to patients in the AED because they form the majority of patients receiving care in the facility. Additionally, using the teach-back method will continuously inform providers of areas that are well understood and those that require improvement. For the healthcare organization, regular assessment of the HCAHPS surveys and the use of alternative education approaches will help mitigate the challenges of disruption.

Leverage Benefits of Disruptive Innovation

The use of video education is an evidence-based approach to the improvement of patient satisfaction in healthcare. To proposed innovation will ensure that all patients get the same health education message repeatedly. Through this approach, patients will be able to demonstrate understanding of their care upon discharge, the use of medications, and danger signs that may prompt further seeking of healthcare. The use of video education will ensure that patients get to move across departments easily as they seek treatment without having to seek help from hospital guides or waiting for long queues before getting direction. Regarding the aspect of cost, video education will enhance safety, reduce medication errors, and hasten recovery that will lead to reduced cost of hospitalization.

1. Pre-Implementation Plan

Diffusion of Innovation

Diffusion of innovation is a model that describes how an idea spreads through a social structure or community. This theory explains that people take in ideas differently whereby some can adopt early while others may take far too long to adopt any idea no matter the benefits (Dearing & cox, 2018). Under this model, people are divided into early adopters, early majority, late majority, and laggards. Rodgers’ diffusion of innovation contains five stages that describe how new changes or products are adopted. These stages include knowledge, persuasion, decision, implementation, and confirmation.

The first stage describes knowledge acquisition where the adopter is first exposed to the innovation. At this point, the healthcare provider’s role is to increase awareness about the new strategy. The second stage involves persuasion where the adopter seeks more information about the product to aid in decision making (Dearing & cox, 2018). During this stage, the role of the change manager will involve discussion of the benefits of video education to patients and the healthcare organization.

The third stage of the innovation process involves decision making by weighing the pros and cons of the innovation. Rodger’s emphasizes that most people do not make rational decisions, but instead follow their underlying perceptions (Dearing & cox, 2018). The role of the innovation team is to increase awareness and educate individuals the importance of the new product. The fourth stage is the implementation of the innovation where the user decides to use or not to use the product. During the confirmation stage, the user evaluates their decision and decide whether to use keep using the product or abandon it. Continuous reminder of patients about the video technology, collection of their views, and addressing any challenges will serve to support this stage of innovation adoption.

Innovation Action Plan Table

Table 2.

Responsible Person (Role)	Responsibilities	Timeline
Administrator	Allocate finances for implementation of the innovation. Monitor the progress of the innovative plan,	6 months (Throughout the implementation)
Nursing Services Manager	Mobilize nursing staff for education and training.	2 Weeks
Nurse Educator	Provide education and training for the use of the innovation.	3 Weeks
IT Specialist	Ensure the new technology is purchased, installed and protected. Provide education to staff and patients on how to access the videos.	2 Months
Clinical Research Manager	Monitor the implementation, collect data, and provide findings to the administration.	6 Months (Throughout the Implementation)

 Financial Implications

The adoption of the proposed innovation will require training, development, purchase of equipment, and maintenance. Equipment and supplies required to adopt the innovation will include video and audio recorders, computers for editing videos, television screens to display videos in patient rooms, and installation of a backup plan. Internet access will also be an additional cost for maintaining the innovation. During training, the administration will cater for the cost of equipment like projectors, maintenance of halls, payment of the trainers, and refreshments.

Interprofessional Communication Plan

Weekly meetings will act as the formal method of communication for all stakeholders involved. However, the use of emails and phone calls will serve to continuously update the stakeholders on the progress of the report including any changes that will be required. Communication to the staff and patients will be made through the nursing services manager and unit managers. Internal memos will be used to address and inform staff about any training required, venues, and required materials. The administration will receive monthly reports on the progress of the implementation, financial implications, and adjustments required. The success of the project will be communicated by the project manager at the end of the sixth month using internal memos, emails, and to the patients through the hospital website.

Evaluation 

The effectiveness of the innovation plan will be evaluated using the HCAHPS scores and a short questionnaire given to patients. Successful implementation and adoption of the innovation should raise the HCAHPS scores on the area of patient’s understanding care upon leaving the facility to above 80% within six months. The questionnaire will focus on the aspects of retaining information after education, the efficiency of the knowledge gained, and overall satisfaction with the new educational approach.

1. Conclusion

Innovation in healthcare can significantly impact the quality of care. The purpose of the proposed innovation is to improve patient experiences and achieve higher patient satisfaction through the implementation of video education technology. Video education is among the approaches that can be used across all populations and can be easily adopted because of the available technologies like smartphones and tablets. With the increasing competition in healthcare, implementing this innovation can serve to improve patient experiences. During the selection of this innovation, key stakeholders like the administration, nurse educator, and the IT specialist were crucial in supporting the innovative change. Using a consensus decision making method, it was agreed that the video education approach formed the best strategy to address the issue of patient satisfaction.

The strengths observed in this plan include the demonstration of collaborative efforts through the involvement of different stakeholders, clear communication plans, and mutual agreement to adopt the innovative practice. A few challenges observed were time barriers for meetings and discussions, deciding on equipment like tablets or television display use, and deciding the cost of implementation. I have learned that the involvement of staff during innovative changes is crucial to promote acceptance. Additionally, I learned that communication is an important tool for the success of projects. In the future, I will ensure to have a clear communication plan for my projects, involve employees earlier in any change, and collect ideas from staff to promote acceptance of the innovation.

References

Chan, L. W., Choi, S. Y., Chan, H. H., Wong, T. W., & Lau, C. C. (2017). The use of patient education video in improving patient satisfaction in the accident and emergency department. Hong Kong Journal of Emergency Medicine, 16(1), 5-13. https://doi.org/10.1177/102490790901600102

Dearing, J. W., & Cox, J. G. (2018). Diffusion of innovations theory, principles, and practice. Health Affairs, 37(2), 183-190.
https://doi.org/10.1377/hlthaff.2017.1104

Kamat, N., Rajan Mallayasamy, S., Sharma, P., Kamath, A., & Pai, G. (2019). Effect of video-assisted patient education on compliance with therapy, quality of life, psychomorbidity, and cost of illness in irritable bowel syndrome. Postgraduate Medicine, 131(1), 60–67. https://doi.org/10.1080/00325481.2019.1549458

Stribling, J. C., & Richardson, J. E. (2016). Placing wireless tablets in clinical settings for patient education. Journal of the Medical Library Association : JMLA, 104(2), 159–164. https://doi.org/10.3163/1536-5050.104.2.013

Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016). Registered nurses leading innovative changes. Online Journal of Issues in Nursing, 21(3), 3. https://doi.org/10.3912/OJIN.Vol21No03Man03

Timmers, T., Janssen, L., Kool, R. B., & Kremer, J. A. (2020). Educating patients by providing timely information using smartphone and tablet apps: Systematic review. Journal of Medical Internet Research, 22(4), e17342. https://doi.org/10.2196/17342

United States Census Bureau. (2019). Quick facts: Union County, Georgia. Retrieved From https://www.census.gov/quickfacts/fact/table/unioncountygeorgia/HSG445218#HSG445218