How Nurses Are Changing Innovation Forever

[00:00:00] Jared: Hello everyone. And welcome back to the med+Design podcast. Today we have the immense pleasure of welcoming Dr. Marion Leary, a leader in the realm of nursing innovation and a purveyor of design thinking in healthcare as the director of innovation at the University of Pennsylvania School of Nursing.

Marion is redefining nursing practice through the lens of innovation and creative problem solving. Dr. Leary's journey is nothing short of inspirational, transitioning from direct patient care to spearheading numerous groundbreaking initiatives that have reshaped how we think about and deliver care.

Her work in Design Thinking for Health is transformative for a whole generation of aspiring nurse innovators. Dr. Leary has become a symbol of the potential of nursing in the broader healthcare ecosystem. Her efforts exemplify how nurses can be at the forefront of innovation, leading change and driving progress.

We're thrilled to explore her insights, experiences, and the impact of her work on reshaping the future of nursing and healthcare. So without further ado, let's dive into our conversation with Dr. Marion Leary. Welcome.

[00:00:59] Marion: Jared. Thank you very much. I think that's the nicest intro I've ever had.

[00:01:04] Jared: That was a wonderful compliment.

Thank you. And I think just getting started off, the profession of nursing has changed quite a bit over time. It's expanded quite a bit over time, and I feel like that makes it a bit harder to define exactly what nurses do. And so how would you explain what nurses do from your perspective and the impact that they have.

[00:01:23] Marion: Yeah, nurses do so many things, so many more things than I think even, the public or even some nurses might realize. Nurses are everywhere, right? Yes, we're at the bedside, but we're in so many other places. We're in the boardrooms, in courtrooms, we're in the military, we're in Congress, we're in research labs, we're in startups, we're out in the community, we're in schools, we're in All these places and so many more which gives nurses really this depth and breadth of knowledge that I think is really unparalleled and is not always recognized.

And in terms of leading in Health care leading in health innovation. Nurses have this again, breath and depth of knowledge that is just so essential to being able to see the problems, understand the problems and create solutions. And, a colleague once said to me, nurses are really good at that because they sit at that intersection of the patient and the problem, and they can see it and experience it in a way that a lot of other clinicians might not be able to.

[00:02:28] Jared: And also talking about just some of the, maybe some of the barriers that nurses are still having to overcome. I know that just having a seat at the table has been a major barrier. And I remember your podcast with Rebecca Love, where she mentioned how she got laughed at for saying that nurses should be involved in this conversation.

And I thought to myself, like, how is that even, how was that a thing?

[00:02:49] Marion: Yeah. And I think it's again, it goes back to nurses not being recognized as experts in these areas. And I feel like there's a lot of barriers for nurses in certain spaces. One is yes, not being invited or acknowledged for the skills and experience and knowledge that they have, but also there are a lot more constraints on nurses as a profession, especially in the healthcare setting that don't allow for them to be able to do certain things.

And there's not always time allowed away from the bedside to participate in innovation events and activities or other sorts of activities that they potentially would want to be able to be involved in. And that makes it difficult for nurses to then engage because you're asking people who are working 12 to 14 hour shifts.

To either come in before their shift or stay after their shift or come on their day off to do these extra things. And that's a real barrier. The nursing profession is a majority female profession and for right or wrong, a lot of times they're the primary caretakers of the family and so they have other responsibilities as well.

And this is a systems issue and a systems failure for nurses. There's a commission on nursing right now that's looking at how do you quantify nurses time outside of just being part of the room rate? Doctors get paid for the time that they spend with their patients?

Nurses should be having these same benefits and then, I'm not an expert in this, but that would allow them to be able to have some more of that autonomy to do other things.

[00:04:29] Jared: You opened my eyes to the fact that the scheduling of nurses is also a barrier to just peace of mind and finding routine. I feel like people that are not directly in the field, you always hear, Oh, they have three days that they work and, that's, and that's awesome.

Imagine having all those days off and hearing about how. You were talking about how people that you'll get called off and then you have to use your PTO and then the next day, then they'll call you in Oh, do you want to work today? Great. Just, I didn't, I could have just worked yesterday.

And anyways I can imagine how hectic that must be the calls on the weekends and just a barrier to like, peace of mind and finding routine. And what you do.

[00:05:07] Marion: Work is hard, right? Not just for nurses. My sister, the firefighter for the city of Philadelphia, like shift work is hard.

And I have mad respect for our clinicians, first responders who are out there, in hospitals and in the communities. Doing the things that a lot of us, including myself, , wouldn't wanna do. Like I only worked at the bedside for a very short period of time. I knew that wasn't for me, that wasn't why I got into nursing.

But I have never known other individuals more dedicated and smart and compassionate than the nurses that I worked with while I was at the bedside. So yeah, I think to your point though, scheduling is a really. Big hot topic right now for this new generation of nurses. The Gen Zers who want the flexibility, want to be able to create their own schedules, don't want to work nights, weekends, holidays, as a new nurse, you get the schedule you get, and you have to work up to the flexibility of some other schedules.

And, I think part of what we're seeing in the issues that are plaguing the profession right now around burnout, retention, and recruitment is that need for work life balance and flexibility that Gen Z is really pushing health systems to acknowledge, and I said it in my podcast, and I'll say it here, I'm all for it.

I think it will only help health care, not just the profession of nursing, but health care to be a little more. Responsive to that, because this is also a physician issue to there's physician burnout issues as well. And so I think we need to figure out the work life balance for everyone.

[00:06:49] Jared: I really wanted to get into innovation but at the same time, I also wanted to talk a bit about the nursing shortage as well because I know that you're very plugged into what's going on. And I feel like we hear about. the nursing shortage as this, pandemic or epidemic of, what's going on, that there's not enough nurses, but you made a very interesting point in your podcast where we've got the most nurses or there's more nurses coming out statistically than any other profession at, to, to some magnitude.

And so how is there even a nursing shortage then like that was that's what even shocked me to hear that.

[00:07:24] Marion: Yeah, it's a good question is something I was actually talking with a colleague about yesterday. It's a little bit of a misnomer to say there's a nursing shortage because exactly what you said, there's Plenty of people going into nursing and wanting to be nurses.

It's really that retention issue of keeping nurses at the bedside. Nurses are going into the profession for a number of reasons. I just said it's a very versatile degree and nurses are in all these other places and a lot of times. just like me, some nurses use it as a stepping stone to another path in nursing, whether that's research or academia, teaching getting advanced degrees as nurse practitioners, and now, encouraging nurses to innovate and run startups and that pulls nurses away from the bedside, which is a problem.

The vast majority of nurses are needed at the bedside and there's, 5000 hospitals in this country and they need to be staffed with nurses. And I think. It's a retention issue that goes back to some of the things that we were already discussing in terms of, flexibility, work life balance, autonomy, time away from the bedside, et cetera, again, I think there are some potential solutions to that with the caveat, again, that I am not a clinician.

I don't work in a health system. I am an academic educator and researcher. And I again give mad props to all of our health system leaders and others who have to struggle with the balance of these problems. They're not easy. And, I try and see it from both sides. Yeah,

[00:09:03] Jared: we've talked a little bit about some of the problems that are going on, but maybe on the positive side, how things changed for the better throughout your career.

And what are you really excited about as far as the direction of nursing and nursing innovation, as well?

[00:09:15] Marion: Again, I think nursing. Because of the pandemic, in addition to the pandemic, nurses are now really being seen, heard and listened to, not as much as I would like in terms of the media and news and being used as experts in certain areas, but definitely more so than in the past.

And so I think, because of social media, because of a lot of folks using their voices now to lift up nurses as experts in all their different domains, it's only been, really transformative for the profession. And so I think that's going to continue. And again I think, I'm putting a lot of pressure on Gen Z, but I think that will continue to grow with this new generation of nurses who are feeling like they can use their voices in a variety of different ways to, speak their truth, so to speak, in the profession. And so I think that is a really good thing, not only for the profession, but for patients in terms of innovation. I think it's great. I think, we're now really seeing health systems and nursing programs starting to realize the power of innovation, having an innovation mindset for students and clinicians. And so these things are starting to take shape in hospitals, and there's a lot of hospitals now that are creating centers of innovation and innovation labs within their health systems.

For nurses and other clinicians and other folks who work in hospitals to be able to start innovating and, I think it's great that, we're starting to also educate nurses on these topics so that when they come out of nursing school, they already have that mindset to look at a problem differently and have the resources and skills to be able to then create the solution to address it.

And I really my thing is, I really think of innovation less of the thing you create less, it's less of a product or tangible thing, but more of a mindset, and if we can teach people the methodological process. And the mindset of innovation, they can use it no matter what they're doing. You don't have to have this mindset to create something new but you can use it to address any topic that you're engaging in.

I say it all the time, learning human centered and equity centered design changed not only the way that I come at my work and how I educate and do research. But how I live my life and how I interact with anyone I come into contact with.

[00:12:03] Ty: It gives a lot more agency to the individual as well. if you're, given the training, you just have to accept what's happening to you and there's no tools for change versus like you said, giving the mindset to be able to start to enact change, understand how that change can happen. Also the patience that it does take time to make change happen.

But you're, I love what you just said about that, thinking of in terms of a mindset, not just this. Hero who had a bolt of lightning hit them and yeah, innovation happened. I know it's more collaborative. It's more equity based in order to bring that about.

[00:12:38] Marion: Yeah. And it's really rare for a new product or technology or app to

change almost anything, right? We can come up with as many technologies and apps as we want, but at the end of the day, it's really the individuals and the mindset that you have that make the difference, and hopefully your solution will solve a problem, but not always. But, It's about the way that you come at it and yeah, the mindset that you create.

[00:13:08] Jared: I also just want to ask about yourself as an innovator. What's got you into innovation? I feel like a lot of people that are within the innovative world, they tend to be also creatives to some degree. And was that true for you as well? And just, yeah, tell us about your innovative journey.

[00:13:27] Marion: Yeah I've always been creative. I like to draw, I like to build things, come up with ideas, and so that's always been with me ever since I was little but really I didn't, I didn't know innovation was a thing until much later in my career. So I was a resuscitation science researcher for about 12 or 15 years looking at ways to improve survival from sudden cardiac arrest.

And my focus area was really trying to come up with innovative solutions to training and educating both lay responders and in hospital clinicians. And I started looking at different ways that we could think about taking what existed in terms of CPR training and looking at it in a more creative and trying to avoid saying the word innovative but a more innovative way.

And so I was using different technologies like augmented reality and virtual reality to just put a little realism into these trainings. And it was while doing that work that I was interacting with a lot of nurses. And seeing that they were the ones who really, again, solved the problem and were coming up with these really creative solutions, but solutions that were being one offs that were either lost after their shift or lost after it like left the floor, they didn't have the terminology, methodology, experience to say I could take this and really scale it up in a way that could not just help me or the nurses on my floor, but nurses everywhere.

And that's not to say there weren't nurses doing that. There were. But it wasn't the majority and still not the majority, but we're getting there. So it was from there that I really started thinking nurses should be leading in this space of like healthcare innovation. And I at the time had a couple failed startups learned a ton from them but really, started engaging in this space of accelerators and incubators and health tech innovation challenges and thought it was like the cool and hackathons and thought it was like the coolest thing ever.

And so started talking with some colleagues at Penn Nursing and it was just like the perfect storm of Penn as a university was focusing on innovation. The school of nursing had just put out their new strategic plan that included innovation. And I had been begging folks for was like a couple of years at that point to bring me over to help them lead whatever new innovation program that they were going to create. And I went, the School of Nursing bought out one day of my research time to think about with our Associate Dean of Research and Innovation, What an innovation program could look like and that quickly turned into three days quickly turned into them appointing me as their first ever director of innovation and that was five years ago.

It was more than five years ago, but and we took off out of the gate and it's been an incredible journey ever since a really leading in the space of nurse led innovation in a way that never could have imagined.

[00:17:05] Jared: And your doctorate dissertation also was on human centered design as well and design thinking.

And I guess for folks that are, not necessarily experts like yourself on this, if you could maybe define those what they are, and also maybe a bit of some of the outcomes of your dissertation that you'd like to share as well.

[00:17:23] Marion: Sure. I did a three paper dissertation, and the first paper was a review looking at the literature around who is using human centered design and design thinking to create health care innovations and for those who don't know, design thinking is a five step process that starts with empathy and goes through define ideate prototype and test and the whole idea with having a human centered and equity centered mindset is that we're not going out as researchers, clinicians, designers, and telling people what we think their problem is, but we're really allowing them to show us and tell us what they know their problem is so that we can co collaboratively create solutions that meet their needs and desires.

In a way that decreases our own biases and raises up the voices and the needs of the people again, who we're designing for. And so for my dissertation again, for that paper one I was just looking at which clinicians were using the design thinking process and how they were using it and

really, to make a long story short here most people who were using design thinking in the healthcare setting were physicians, and nurses only made up about 6 percent of the articles that were published online using human centered design. Now, there are a couple caveats to that, and that could be just be that nurses were, publishing less than their physician counterparts, again, because of all the things we've already talked about or they really weren't using it as much as other clinicians and that could also be true.

There's no way to really know, but what we see is that, there were, there are less nurses in the past who knew what human centered design and design thinking were I think, we've already seen an increase in articles being published by nurses now in the, 2022 2023 area.

So I think that's going to increase.

[00:19:33] Ty: There's the one embodiment of design thinking with is a 5 step process. You also see it as a double diamond and so much of that is an empirical creative approach to problem solving. You have so many of those one offs that could be a like, intuitive sense of what design thinking is that probably just isn't tagged as such in the literature,

[00:19:53] Jared: right?

[00:19:53] Ty: Which, you see that. We have those opportunities come to us as a design firm where we talk to a lot of those kind of medical innovators who have an idea. I'm not sure what to do next because. Those one offs are really those kind of core sparks of a great program and you start seeing that as an emergent quality, but just offering some of that support and training.

It's a missed opportunity that I think it sounds like you're addressing in a big way. Yeah, I think we're really trying to, and that's the work we're doing at Penn Nursing is around educating nurses in this methodology. So right so that they can start using it in their practice and hopefully publishing, but that's not really the main goal of it, but really being able to have this methodological approach to creativity and to be able to look at problems differently which only then benefits patients and our health systems in general.

[00:20:47] Jared: And so do you feel like design thinking is being properly utilized across the health care space. It seems like it's not necessarily, maybe there needs to be more opportunity to engage in it properly from leaders.

[00:21:02] Marion: Totally, absolutely. I think we're on a really good trajectory up of, again, hospitals and health systems starting to create centers and working towards using this methodology in practice, but I think there's a long way to go.

And one of the programs that I am lucky to run at Penn Nursing is the Johnson Nurse Innovation Fellowship Program, which we're, in our first year, we're closing out year one in May, and this is a one year fellowship program for chief nursing officers and senior nurse leaders from around the country to learn about Innovation and innovation methodologies, but also we partnered with Wharton to provide business and leadership skills specific to innovation.

I would have been working in this space for a while and working with clinicians at the bedside who totally get it totally want to be innovating and creating new solutions within their health systems. But, there's a lot of barriers between a bedside nurse and being able to create and implement a solution.

And thankfully, Johnson recognized that, we have to come at it from both sides from the bedside clinicians, but also from the health system leaders. And having this fellowship where senior nurse leaders get to engage in an innovation project, learn innovation methodology and mindset, and really buy into it.

So that they can then go back and spread it throughout their hospitals and support their nurses and other clinicians who want to do these things, I think, is really going to be the game changer for innovating in health systems.

[00:22:59] Jared: Gosh, that's gonna be awesome. And honestly, shout out to Johnson and Johnson as well from your podcast as well.

I heard Rebecca tell a story about how they were integral and trying to change this narrative of nurses as innovators. And I forgot exactly her story behind it but gotta go listen to to Marion and Rebecca Love's podcast to get the full story.

[00:23:20] Marion: Love and Leary podcast. We're only on episode three, but you can definitely check it out.

But yeah, Johnson and Johnson is a huge supporter of nurses. They support the nurse hack for health, which has been going on for about 4 years now virtually because of the pandemic and they're now supporting this nursing innovation fellowship and they do a lot to uplift and give voice to the profession and they do it in a way that is really thoughtful and meaningful and really does elevate, I think, what the general public sees when they think about nurses.

Very thankful to them.

[00:24:00] Jared: Yeah. And also your other program as well that has quite a bit of notoriety design thinking for health. I love the content that you put together for that program. One of the questions I had around this was just how did you pull this all together? It seems like it was, how did you get the university to fund such an undertaking?

How big was the team that actually pulled this off? And yeah, just tell us a little bit more about that story.

[00:24:24] Marion: Sure. Design Thinking for Health, for those who don't know, is a free, online, open access platform for nurses to learn about human centered design thinking, and nurse led innovation, but also then use it as a way to actively create solutions.

And so it was actually funded by the Hillman Foundation, and we created it in partnership with the Hillman Foundation, and I'm really lucky to say that we're in the process of completely redesigning the platform with a more equity centered approach focusing on equity centered design as well.

And the new launch of that will hopefully happen in May. It'll still have all the same human centered design and design thinking content, but we'll have more of a focus on equity centered design as well. But to your point, for the design thing for health platform, we created original lecture videos, podcast videos, and mini documentary videos of nurses who have used human centered design in their practice and created this sort of asynchronous platform where again, nurses can learn about these things.

And what we really want people to do is to take the content. And insert it into their existing courses or create new courses using the content however they think would best help them or their staff or students, this is a we have a creative commons license on it. We just want it out there to help nurses to learn these things and be able to use it in a positive way to solve problems.

[00:26:07] Jared: And, when you talk about barriers to entry, there's no barrier to entry. I thought initially when I was like looking up the program, trying to figure out more about it, I thought, okay, you have to apply for it. And, I'm sure they'll get back to you, whatever. No, it's all there on the site.

Like you just have to dig in a little bit and it's all there for you. So kudos to you for removing any barrier to entry for design thinking.

[00:26:27] Marion: With the equity center design framework in mind, we want everyone to be able to access these resources and to be able to use them in a way that will move not just their individual needs forward, but the profession forward.

[00:26:43] Jared: Yeah. And the other part of that you did so well with was like the storytelling aspect as well as there's these nurses that are innovators and they have created change and you get to follow them through their journey. And I thought this should be on Netflix, like it was so good.

[00:26:57] Marion: I have to give props to our documentary

film team so leveler media who are based in Philadelphia. I've been able to work with them for about 4 or 5 years now because of this project and on other projects and they are just an amazing group of filmmakers who really understood what we were trying to do, what story we were trying to tell, and were able to put it together in a way that was really fun.

Meaningful and authentic. And yeah, I love watching those videos. And yeah, we actually did a send one of them for some film award one time, but we should probably keep doing that didn't get accepted. But I think they're great.

[00:27:43] Jared: Yeah it's something that I feel like for people, they need to be able to see that transformation that they need to be able to see that change.

And to be able to see it in so many different instances and so many different contexts. The other part, yeah, so just curious also about how did you find those, those innovators? And were they people that came out of your program or were they just like people that you knew of?

[00:28:02] Marion: It's a good question.

And, back when we were first starting to plan this, which was probably six years ago, there weren't a lot of people identifying as nurse innovators. So it's actually really hard to find people. And now it's much easier. And there are tons, you can Google nurse innovators and tons of like web pages and articles come up listing a variety of nurses doing cool things in cool spaces.

That wasn't how it was six years ago. And so we had to do a lot of research and investigation and digging around and asking, I was asking folks if they could recommend people and we're so fortunate to be able to highlight the people that we got to highlight because their stories are incredible and the work that they did really forerunners in this space. And I'm glad we get to share their stories. And I've actually stayed in contact with all of them, which has been great, really good friends and colleagues with most of them still to this day. So that really to me is one of the best parts of this program.

[00:29:11] Ty: Something I was curious about, and Jared, you touched on this, which is the stories of change and making real change happen.

And I think lived experience has been that coming up with the idea, developing the product, clearing the FDA, that's one scale of difficulty, but seeing the change through and actually driving a change through the health care system. Seems like that's a order of magnitude harder. Do you have any advice or like thoughts on the after the idea, making the change happen, making the startup go, making the change happen.

[00:29:43] Marion: It's really hard. It's really hard. So I run our Penn Nursing Innovation Accelerator program and we provide funding, mentorship and education to our students, clinicians or faculty who want to take an idea and try to scale it up or out, whatever that means to them, whether that's a startup or within their hospital or health system.

And there's no easy way to do it. We talked about some of this in terms of the barriers that nurses face. A lot of the folks who go through our accelerator are, working full time either as faculty or clinicians. A lot of them are in grad school. A lot of them are raising families and doing other things, and you both probably know this, you have to put in a hundred percent in order, more than a hundred percent, in order to make a startup successful. And balancing all of those things makes it extraordinarily hard. For harder for nurses, that doesn't mean there aren't nurse led companies that are succeeding.

There are, and we have some, and I know of a bunch, and I just, I think it's a another barrier to entry for nurses who really want to do these things, but have to manage and balance. Other priorities, and we've started thinking about how we can help them do that in other ways. With either the support or education or mentorship that we're providing them our accelerator program was only supposed to be 1 length and then we extended it because we, the nurses needed longer to be able to do certain things.

So it's about flexibility, really. In how you're working with these individuals in these startups, but I also think, once they have their innovations and they have their startups ready to go, there's a real barrier to entry into health systems, and that's one of the things that I've been talking with a lot of folks in the Philadelphia area and beyond about recently is how do we make it an effective and efficient pipeline from start up to implementation in a hospital or health system, and we're putting all these resources, all this education,

not only into nurses and to nurse led startups, but all the biotech and health tech startups. Then, we get them to a place where they have these great solutions and the barrier to entry into the hospital is so hard and so long and requires so much resources so many resources It's really hard for Startups to get past that for a variety of reasons, right?

Like health systems want you to have data and show return on investment before they will implement a new outside solution. Which I get, right? It makes sense. But startups don't have the data they need to be able to get into the hospitals to get the data. And so you're caught in this loop of the hospitals need you to have data, but you can't get the data unless the hospitals allow you in to do pilots or trials.

Which is the other problem because hospitals don't want to pay startups for their innovations. But startups don't have funding to just implement something in a hospital without funding. So there's a lot of issues here that I think we need to figure out and those conversations are happening.

I really think that's going to be one of the big areas for this year from what I'm hearing from different organizations who are very invested in this.

[00:33:42] Jared: And also for nurses that are maybe trying to aspire to be innovators and work in startups. And, they have some idea. What are some of the skill gaps that they may have to shore up that they didn't even know about?

Initially they just had an unmet need, but then they realized, Oh there's all these other X, Y, and Z. And I'm sure you've, experienced quite a bit of this as well. And, you're working startups as well.

[00:34:04] Marion: Yeah, there's a whole like language and terminology and things that you don't know until you're in it, right?

So there's the whole like venture capitalists funding process that you have to learn, and there's Obviously, the design process you have to learn, there's manufacturing, depending on if you're creating a product, and there's IP and patents, and all the things that go along with creating an innovation, all the things that go along with creating

a startup you need to get funding, like, all that comes along with that. If you're going to go, the VC route, if you're going to go the federal grant route there's a lot of things that, a lot of things, there's a lot of things, but there are a lot of resources and a lot of people who want to help and in Philadelphia, in the nursing profession, in the country, there are so many programs for new startups, new health tech, biotech, nurse led health care innovation, that there's no lack of support or resources.

And so I don't want nurses or other new founders to be, put off or intimidated or scared by this. It is a hard, sometimes complicated process, but there's so many people who want to help. And again, because I'm a nurse and the nursing part is what I do especially. Since the pandemic, I think people are really excited to help nurses launch new companies and new innovations, and they see, the value in that.

And it's actually been really nice for me because I have to match a lot of our nurses and a lot of our nurse lead teams with mentors and people are so gracious with their time and energy in what they want to contribute to these teams. And rightfully so nurses, healthcare providers again, frontline providers, they are at the forefront of what we were dealing with during the pandemic.

And so I think people feel like they want to give back to, which is nice.

[00:36:20] Jared: Yeah, some I didn't even know that was happening. So I'm very grateful to see that. I've heard you make a real interesting point about innovation and just your past discussions that you've had and how unfortunately, it seems like a lot of innovation takes place from the top down without listening to people at the ground level, taking an empathy approach.

And so do you think the innovation is still happening that way, maybe in the context of health care, and obviously at Trig we prefer an empathy first approach. I'm sure you do as well.

[00:36:51] Marion: Yeah, I think, yes, I think you're always going to have that. As health care leaders, rightfully so in some cases they really people think do you think they know

what their workforce needs, what their health system needs, and they're, designed to come up with a solution, implement it, and move it forward. And, again, working with our senior nurse leaders for this Johnson fellowship, it's been really interesting to see how they come at these problems and solutions and how we have to have them take a step back and have a more empathetic approach.

Everybody comes in, not just Nurses and senior nurse leaders like humans, every human comes in with a solution already in place. No matter what the problem is. I see this in every student. I teach in every class. I teach. I constantly have to write it on the board. No solutions. No solutions. No solutions until you get to the solution phase.

And so it's really trying to deprogram people and help them. See that you have to have this empathetic approach of understanding the problem from the point of view of the people who are experiencing it, removing your own, again, biases and experiences because it's not about you and understanding what your end users need.

And so that happens at the top, it happens at the bottom, and it happens everywhere in between and it's part of this learning process, this human centered design learning process, where we get to deprogram and reprogram people to think at it and come at it differently. Yes, I do think it's still happening at the top, but I think with our program and others as senior nurse leaders.

Start learning these processes. They will start coming at it from a more empathetic mindset and spreading that throughout their health systems. And that will change. I'm already seeing it change.

[00:39:07] Jared: That's wonderful. And when people think about innovation, also they think about creativity.

I think, the two words are next to each other in a lot of places. And I think, but the other side of that is when people think of nursing, I don't necessarily think that they think of creativity. And I think that a lot of nurses don't give themselves the credence to say I am a creative I can be creative.

And I guess just, where is the place for creativity within nursing, do you think.

[00:39:35] Marion: Yeah it's a great point and I don't think even just that I don't think of it even just in nursing but in healthcare, you don't think you have the freedom or flexibility to be creative because there are all these processes and algorithms and things that you have to follow to keep your patient safe, right?

And we come up with evidence based practices for a reason. When you tell a healthcare provider you have to think outside the box and be creative, they get a little wary. This is where we really have to express that there are ways to do these things in a rigorous methodological way that allows for creativity, but also, in the construct of health care.

So most not most a lot of the nurses and students that I work with are hesitant to call themselves creative or don't think they're quote unquote creative. And again, I think that's where processes like human centered design allow for you to take risks and work through activities that make you think differently, that infuse creativity into the process so that you get comfortable with it.

Creativity is not one thing. It's not an artistic ability. It's not being able to constantly come up with these million dollar ideas. Creativity is means different things to different people and comes across in different ways. And so I think everybody's created in different ways.

And it's just giving people the permission and acknowledgement to consider themselves as creative. I think, nurses, who's more creative than nurses? Nurses can do all these amazing workarounds to the problems they're seeing at the bedside and in their practice. They just don't call it creativity, they don't call it innovation, but it is what they're doing.

And I say it all the time the nursing process and the innovation process they're exactly the same thing, like you're assessing a problem, you're defining that problem, you're trying to figure out how to intervene, you're intervening with whatever solution you came up with, and you're evaluating it.

It's the design thinking process and it's the nursing process that go really nicely together. And that's why I think it's really natural for nurses to be innovating because they're already doing it. They just aren't calling it that. It's the same thing with creativity, like you're thinking about a problem from a very different lens and coming up with a solution that others probably wouldn't.

That's creativity.

[00:42:16] Ty: It's just music to my ears, everything you just said there. It's something that we talk about so much and just to hear the way you talk about that in particular, like how that. matches the workflow for nurses that they're already doing.

One of the things we talk about is that every, but every human has the capacity for creativity. Yeah, that's a fundamental part of our psychology. We've got a dopamine pathway of like when we're walking, that's when that dopamine pathway is open. That's when most of your ideas happen when you're on the move.

And so allowing yourself that acceptance of it is like you were talking about of like those one offs innovation is really recognizing that something valuable happened here. And now we want to figure out how to spread the word for it. So it doesn't just become lost as a one off, but rather open that up.

And and we just see so much potential there. Yeah.

[00:43:07] Marion: The physiology makes sense, right? Nurses never sit down. They're always running around. So of course they're always creative.

[00:43:13] Jared: Yeah, exactly.

[00:43:14] Ty: That's a data. Like you're going to be like moving and Oh, I wish I had thought about this differently.

And Hey, here's a cool thing we should try.

[00:43:21] Jared: And so we've talked a lot about the different opportunities that are available to nurses now, there's nurses are everywhere across the healthcare space. And do you think that because of all this opportunity.

That's maybe possibly why we're seeing a bit of a nursing shortage in a way because, you don't have to be by the bedside any longer you can stay there for a couple of years or for as long as you want. And all of a sudden now you can go work in a startup. You can start your own thing. And I'm just curious if this opportunity has, it's wonderful.

And I'm so glad that it's happening. And do you think, I think physicians fall into this also maybe a bit. And I'm curious of your thoughts on that.

[00:44:02] Marion: Yeah, I absolutely do. I think there's a lot more pathways and possibilities for nurses and physicians than there ever was in the past. I think we all know the stereotypes of nurses and physicians in hospitals or in clinics and that was all you, that was really the only path you had but that's not what it is anymore.

And I think it's great, but like we talked about earlier, we need physicians and nurses in hospitals and clinics and these places to care for the plethora of people who are going to continue to frequent those places. And back to again, what we were talking about, I think this is a really critical point and a really critical time for health systems to start to think differently about how you're going to recruit and retain health care providers.

If you want folks to stay, there's got to be incentives to that, and whether that's scheduling, whether that's, flexibility and autonomy, whether that's providing childcare and fitness facilities. I remember when I first started out almost 20 years ago, one of the hospitals I was working at had a gym, it had I think it had child care, like all that stuff has gotten cut and gone away in a lot of health systems for for employees.

And I think if you want to start attracting people back, you have to make it easy for them to want to be there. This is my, I might be going down the wrong path here, but it's the same for If you want people to come back to the office and not work from home, you need to make coming back to the office as enticing as being at home, where you can work out, you have child care, you have free coffee and food, like you can do your laundry, like all these things that you can get done during the day while you're home that you can't do when you're at a place of employment, and I know that's tricky for health systems especially, but I think there are ways to

using a human centered approach here to build better health systems for the people who are working in them. I had a group of students, it's probably five years ago now, who wanted to tackle this exact problem of how you could make their question was how you could make working at a hospital as enticing as working as a startup.

See all these startups back in the day that had, ping pong tables and free drinks and snacks and you could bring your dog and all these things that make it enticing to go and hang out with your friends while you're at work. Like, why can't healthcare do something similar.

Now, obviously, you can't take your dog to work, but they were trying to get at, you need to make it better for wanting to work in these institutions for the people who you want to work there.

[00:47:12] Ty: And also from an innovation context the bedside is where that's the source of truth, like where you're directly connected to the most pressing problems today.

And the further away you get from that, if there's like a partition of going off in startup world and you're removed from the bedside, then you're, then your connection to truth, the ground truth of what's happening is for when you left bed side, and you get further and further away from that as time goes on.

So there has to be some way of allowing for that protected time to stay connected to the pressing problems. And also be able to work on socializing, like bringing those innovations to a bigger scale.

[00:47:55] Marion: Yeah, and most clinicians don't want to leave the bedside. All the clinicians I talk to love working at the bedside.

That's why they went into nursing. They want to help patients. They want to take care of people. They want to use their skills that they learned at the bedside, but they're finding it so restrictive and feeling like it's an impossible decision. They want to be there, they just can't. And I know a lot of nurses who left the bedside and now pick up a shift, here or there, per diem, because they don't want to lose that truth.

They don't want to be removed from the patients and from the health systems and from the bedside. I don't think it's a lack of desire but a lack of, connection in some way.

[00:48:43] Jared: And do you feel that, I attended the last Nurse Hack for Health from Johnson and the winning device or not the winning concept was note taking app using artificial intelligence for nurses.

And do you think that maybe part of the solution to keep nurses by the bedside is to make their job maybe smoother through the integration of technology? I know that Ty's always no, don't add more technology, but maybe sometimes, it is a good thing.

[00:49:07] Marion: I think it depends. I think, if it's done right with the right end users and doesn't make more work for clinicians than maybe.

I'm with Ty. I don't know. It depends. It's, more technology is not always better. And I don't think that is the thing that's going to save the profession.

[00:49:30] Ty: Did just want to touch on that. It's if you could un invent some of the additional processes that are in place.

Cause I think layering on one more thing when there's so much, I don't know bureaucratic debt. That's baked into the system of so many antiquated processes that are so hard to get rid of. If there's a way to un invent some of those and start with a fresh slate, unfortunately, you can't do that whole, a whole scale within healthcare, but instead of adding one more thing on top, rather, okay, let's remove three things in order to make a better focus on the a replacement.

[00:50:03] Marion: Yeah, I would really tear it all down and start over. Honestly, that's not just in healthcare. Like the number of hoops, every single person has to go through every day to get mundane tasks done is ridiculous, whether that's dealing with the insurance company, dealing with healthcare, dealing with almost everything.

And it just seems like we've, added barriers and technologies that prevent us from being efficient and effective in almost every facet of our lives. Yeah, I don't think healthcare is any different. I do think there is a lot and a lot of red tape administrative things that are probably not necessities.

But again, I haven't practiced clinically in a really long time probably not the best to answer this, but I know they exist because this is why we constantly have nurses and other providers coming to these hackathons and other innovation programs trying to solve for those problems.

[00:51:02] Jared: And, we're getting real short on time.

I did want to get to an audience question as well from Mike Howell. He said, I appreciate your recognition of multiple modalities are involved in process improvement. And would you share an example of multiple healthcare involved areas? How did you get all the invested areas at the table? And what challenges do you experience in doing that?

[00:51:27] Marion: I would love to, I'm not sure I exactly understand the question. So I'm going to answer it the way that I think it's being asked. Innovation is not solely based on one type of profession. So you have to have designers, you have to have engineers, you have to have, your nurses, your physicians, you have to have all the people who have some sort of knowledge and experience all at the table to be able to create.

The right solution, and that includes people with lived experience. So if that's patients and you have that patient, if it's community members, you have to have those it's really hard to get all those people to come together. We have a new ish program at Penn called the Penn Community Collaboratory for Co Creation. We call it PEN4C for short, and it is a partnership between Pen Nursing, Pen Engineering, and community based organizations in Philadelphia, so that we can do exactly what we've been talking about, understand and let the communities drive the problems that they have and the solutions that we're going to then create together from a nursing and an engineering lens.

And getting all those people together to be able to match expertise and resources and needs is really, difficult. It was not as easy as we thought it was going to be. And it took us, a really long time to build relationships across engineering, across nursing, across communities, and match those folks together.

And it's not easy. It takes a lot of outreach and talking and negotiating and coming together to be able to get all the people at the table. But it is absolutely worth it and has been a tremendous opportunity to collaboratively design solutions for communities who are in really the greatest of need in our city and hopefully when people do this in other cities.

And I hope that answered the question, but it just takes a lot of work building relationships.

[00:53:42] Jared: Oh, that's a really cool initiative. I hope we have something like that over here in Los Angeles. That's really cool. And I guess, we're here at the top of the hour, just what's going on next for Marion Larry.

What can we look forward to in the future as well?

[00:53:52] Marion: Yeah, hopefully, stay in the course for now. You want to check out our Amplify Nursing podcast at Penn Nursing, check out the Love and Leary podcast a lot of great programs going on that we're working on at Penn Nursing, including the Johnson Nurse Innovation Fellowship Program our Innovation Accelerator Program, and so many other things that that we can do to help Nurses learn about innovation and design and I mentioned it before, but we are launching that our new design thinking for health platform.

Hopefully in May with the equity center design. framework. So check that out as well. But I'm easy to keep up with on LinkedIn and other social media platforms. So please connect with me there. And I'm always happy to meet up and help nurses who are trying to push stuff forward in any way I can.

[00:54:46] Jared: Absolutely. Dr. Leary, thank you for your time today. We're very appreciative of your precious time and thank you for everything that you do. Golly, like the impact that you're having is just incredible. So thank you so much.

[00:54:56] Marion: Jared, Ty, thank you so much for inviting me on here. I really enjoyed talking with you.

[00:55:00] Ty: It's such a pleasure to have you on.

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