1. Empowering Meaningful Care © 2013 Elsevier – Proprietary and Confidential Michelle Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer The Role of the DNP in Managing the Practice-Technology Polarity

2. Michelle Troseth, MSN, RN, DPNAP, FAAN Chief Professional Practice Officer Elsevier Clinical Solutions Co-Chair TIGER Initiative Foundation Board of Directors National Academy of Practice (NAP) – Treasurer, Executive Committee Nursing Academy Member Campaign Chair: The Bonnie Wesorick Center for Healthcare Transformation at Grand Valley State University Health Policy Committees: Reed Elsevier, AMIA-NWIG, eHI Distinguished Practitioner - National Academies of Practice (2007); International Group Recognition Award (CPM Consortium) - National Academies of Practice (2010); Sigma Theta Tau International Kappa Epsilon At-Large Award for Excellence in Leadership (2011); Distinguished Alumna Award Grand Valley State University (2011), Rutgers 15 th Recognition Award for Advancing Technology in Healthcare (2012). Selected Fellow in American Academy of Nursing (2012).

3. Objectives Describe major shifts in healthcare that are creating exponential growth in technology Explain the concept of Polarity Thinking and the implications for Practice and Technology working together to achieve a higher purpose Identify key ways the DNP role can manage the Practice and Technology Polarity

4. 4 Major Shifts in Healthcare

5. A Conceptual Approach to Meaningful Use

6. Accountable Care Organizations Technology Platform (The Focus) Practice Platform (The Afterthought)

7. Interprofessional Practice and Education “Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers. We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care. This coordinating center will help us move forward to achieve that goal.” Mary K. Wakefield, Ph.D., R.N. HRSA Administrator September 14, 2012

9. The Digital Generation of Healthcare

10. Exponential Growth Technology Show Video-Clip

11. Advancing Practice with Technology Technology must be designed to enhance scope of practice and evidence-based practice at the point of care Technology is key to embrace and shape so practice is truly knowledge-driven Technology must capture the tasks performed but not limit practice to the rituals and routines of traditional practice Wesorick, Troseth & Cato (2004) Intentionally Designed Automation. Healthcare Technology (vol. 2) McBride (2005) Nursing and the Informatics Revolution. Nursing Outlook.

12. “There is no aspect of our profession that will be untouched by the informatics revolution in progress.” Angela McBride Distinguished Professor and University Dean Emeriti Indiana University School of Nursing

13. Framework for Sustainable Healthcare Transformation Intentionally designed Evidence-Based Action oriented Outcome Producing Replicable Capacity building Technology enabled Scalable

14. THE PRINCIPLES OF PARTNERSHIP THE PRINCIPLES OF DIALOGUE THE PRINCIPLES OF POLARITY The CPM Framework™ Grounding Principles

15. Principles of Polarity Polarities are interdependent pairs of different, competing, or opposite values or points of view Polarities are all around us and are unsolvable, indestructible and unavoidable Polarities are about “both/and” thinking, rather than “either/or” thinking Each polarity has an identified upside (values) and downside (fears)

16. Principles of Polarity (con’t) Polarities can be managed well over time to experience the upside and dynamic interdependencies of each pole, and to achieve a higher purpose Rooted in Polarity Management™ (Johnson, B. 1996)

17. Navigating the Waters of Practice and Technology Requires new skills Requires new ways of thinking Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.

18. A Key Life Preserver for DNP Leaders 18 TM

19. Polarity Thinking™: Essential Skill for Healthcare Leaders

20. Polarities are interdependent pairs of different/competing/opposite values or points of view. What is a Polarity?

21. They need each other, they are interdependent. Polarities are all about relationships. Why is it so important?

22. They need each other to achieve higher purpose, they are interdependent Why is it so important?

23. Problem Solving is about “either/or” Polarity Thinking is about “both and /and”

24. Why is polarity thinking so important today? When leaders are not able to differentiate problems to be solved from polarities that need to be managed there is wasted time, money, energy and the inability to achieve improved, sustainable clinical outcomes.

25. “The first accountability of a leader is to know reality.” ~Max Depree

26. Navigating Realities We have seen reality through the lens of problems not through the lens of problems and interdependent opposites. The skill of polarity management supports a whole new way of thinking and acting.

27. SEE (identify) the polarity MapM MAP the polarity TAP the energy in the polarity to move to Action. Polarities – from vision to reality

28. Polarity Map © 1992, 2008 Polarity Management Associates, LLC Values = positive results from focusing on the left pole Values = positive results from focusing on the right pole Fears = negative results from over-focusing on the left pole to the neglect of the right pole Fears = negative results from over-focusing on the right pole to the neglect of the left pole Deeper Fear from lack of balance Greater Purpose Statement (GPS) - why balance this polarity? * ** and InhaleExhale Live Die Clean Out Carbon Dioxide Increased Carbon Dioxide Too Little Oxygen Polarity Management ® Map Get oxygen Value-upside Value-Upside Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.

29. Higher Purpose = Why Balance This Polarity? Deeper Fear from Lack of Balance? Basic Action Steps to Manage a Polarity Well Over Time * ** Positive results from focusing on this left pole: Positive results from focusing on this right pole: Negative results of over-focusing on this left pole to the neglect of the right pole: Negative results of over-focusing on this right pole to the neglect of the left pole: Early Warnings *** Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole. 1. Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole. 1. and Action Steps How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures? 1. Action Steps How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures? 1. Always tension between them INHALE EXHALE Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.

30. Greater purpose Deeper fear Upside Values Pole Downside Fears Downside Fears A Tool to Visualize Polarities by Barry Johnson, PhD

31. StabilityChange

32. Higher Purpose = Why Balance This Polarity? Deeper Fear from Lack of Balance? Basic Action Steps to Manage a Polarity Well Over Time * ** Positive results from focusing on this left pole: Positive results from focusing on this right pole: Negative results of over-focusing on this left pole to the neglect of the right pole: Negative results of over-focusing on this right pole to the neglect of the left pole: Early Warnings *** Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole. 1. Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole. 1. and Action Steps How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures? 1. Action Steps How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures? 1. Stability Change Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.

33. Higher Purpose = Why Balance This Polarity? Deeper Fear from Lack of Balance? Basic Action Steps to Manage a Polarity Well Over Time * ** Positive results from focusing on this left pole: Positive results from focusing on this right pole: Negative results of over-focusing on this left pole to the neglect of the right pole: Negative results of over-focusing on this right pole to the neglect of the left pole: Early Warnings *** Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole. 1. Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole. 1. and Action Steps How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures? 1. Action Steps How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures? 1. Stability Change Continuity- Sense of Direction New Energy New Possibilities StagnationChaos Copyright © 2009, CPM Resource Center, an Elsevier business. All rights reserved.

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35. Technology Practice Sustainable Transformation Unsustainable Transformation Innovation Standardizes and integrates information Increase efficiency Data retrieval EBP and professional practice/workflow Clinical integration across disciplines Caring culture Lack of evidence- based information Design interferes with integration Lack of “humanization” A. Ensure users understand the design, purpose and functionality of technology tool. B. Provide time for users to learn the technology tool properly. Lack of awareness of tech. benefits Lack of information impacts quality Decrease timely access & retrieval of patient information A. Create and support time for interdisciplinary team to do transformation work needed to integrate evidence-based professional practice B. Provide processes and tools to embed into technology: EBP, scopes of practice, & integrated workflow. A. Timelines for activation are all about technology, not about practice transformation B. Modifying or deconstructing evidence-based content integration. A. Users demand that technology not change what is familiar (e.g. documentation practices) B. Comments about the fear that technology will dehumanize care and dictate practice. Polarity map showing the practice and technology poles and ways to balance the tension between them.

36. Key points about how polarities “work” Both sides of the polarity are important. Most of us have a preference for one side or the other. The more strongly you are attached to one side, the harder it is to see the downside. Polarities are interdependent pairs that need each other over time in order to sustain both sides.

37. Key points about how polarities “work” Polarity thinking helps us understand another person’s point of view. One sided thinking leads to accuracy without completeness. You may be accurate, but not complete in your view. Forcing others to come over to your point of view is likely to create feelings of resistance and resentment. Confirming someone else’s accuracy increases the possibility they will supplement it with yours. The challenge is to find the “rightness” in the other point of view.

39. Key points about how polarities “work” If you over focus on one and neglect the other side, you will get the downside of the one you focus on. If you want to guarantee failure of a change effort, tie it to one pole of a polarity. When dealing with a polarity, the smaller the minority voice, the more important it is to pay attention to that voice. The oscillation between poles is ongoing. The natural tension between both sides is unavoidable, unsolvable, indestructible, and can be tapped.

40. All of the DNP’s in this room are leaders for transformational change for Practice & Technology The challenge of leadership is to be strong, but not rude; be kind but not weak; be bold, but not bully; be thoughtful, but not lazy; Be humble, but not timid; be proud, but not arrogant; have humor, but without folly ~Jim Rohn Polarity Thinking teaches us how to live this everyday

42. Open Dialogue @CPMRCmichelle

43. References Abrahamson K., Arling P., Wesorick B., Anderson J. (2012). An application of the socio technical systems approach to implementation of electronic evidence into practice: The Clinical Practice Model framework. International Journal of Reliable and Quality E Healthcare, 1(1). 13-20. January-March. Clancy, T (2009). Improving patient safety, increasing nursing efficiency and reducing cost through technology supported pull systems. IN: C. Weaver, R. Carr,, C. Delaney,(et al.) (Eds.), Nursing and informatics for the 21 st century: An international look at practice, trends, and the future. (2 nd ed.). Chicago, IL: HIMSS Publications. Elsevier CPM Resource Center (2011). The CPM Framework™: culture and professional practice for sustainable healthcare transformation. (Brochure). Grand Rapids, MI. Hinton-Walker P., Troseth M. (2010). Business coalition: Shaping health reform through technology and science. In: Cowen PS, Moorhead S, (Eds.), Current Issues in Nursing, (8 th ed., 438-448). St. Louis: Mosby, Elsevier. Johnson, B. (1996). Polarity Management: Identifying and managing unsolvable problems. Amherst, MA: HRD Press.

44. References (con’t) Staggers, N. & Troseth, M. (2011). Usability and clinical application design. In Ball, M., Troseth, M. et al (Ed.). Nursing Informatics: Where Caring and Technology Meet 4 th Edition. Springer. Troseth, M. (2012). Informatics & the Future of Nursing Practice. Advance for Nurses. April 27, 2012. Troseth, M. (2011). The TIGER Initiative. In McCormick and Saba (Ed.). Essentials for Nursing Informatics 5 th Edition (in progress of publication). Chapter 27. McGraw Hill. Wesorick, B., & Doebbeling, B., (2011). Lessons from the field: The essential elements for point-of- care transformation. Medical Care, 49(12), Suppl 1, S49-S58. Wesorick, B., Troseth, M., Cato, J. (2004). Intentionally designed automation creates the best places to work and receive care. In Health care technology: Innovating care through technology, 2. San Francisco: Montgomery Research, Inc. Wesorick, B (2013). Essential steps for successful implementation of the EHR to achieve sustainable, safe, quality care. In A. Moumtzoglou & A. Kastania (Eds.), E-Health Technologies and Improving Patient Safety: Exploring Organizational Factors (pp. 27-55).