There I was listening to these nurses next to their patients essentially describing how they were making for their patients, without even flinching. My team and I spent 60,00 miles last year finding and having conversations like these throughout hospitals around America. We heard stories about the devices, the patients that inspired them, the tools, and the process. Our challenge was not finding these examples of making, but rather convincing the nurses who made them that–yes!–silk tape and towels as patient support structures are a healthcare innovation worth noting. It’s the everyday making that’s saving our patients, not just the grandiose ideas that are incubated over 10 years. We call them MakerNurses.
Professor Eric von Hippel at the Sloan School of Management at MIT calls them user innovators. For the last 30 years, he has been studying the phenomenon of when users take innovation into their own hands and improve products. Formally, user-innovators identify product and service needs that cannot be addressed by commercially available products. Instead of waiting for the market to catch up, they take matters into their own hands and modify, adapt and create the solution.
Construction teams make pipe hanger assemblages of steel supports and pipe clamps for pipe installations.
Medical surgeons worked with engineers to make computer-assisted navigation systems for orthopedics. Extreme sports enthusiasts make improved rucksacks for extreme canyoning.
So what’s happening in the nursing unit?
We found out.
Nurses make intricate bandages for NICU patients, modify homes for geriatric patients and create unique Lego models, customized for patients to explain treatment procedures. Nurses create devices that make their jobs easier and that help patients heal. When nurses have the materials and space to make, healthcare is a better place. Over 60% of the nurses we heard from were developing and building products and solutions for their own use. Some of the most creative solutions we heard were developed in collaboration with their patients — either in the hospital or home. What drives this and how can hospitals harness this energy and ingenuity to improve patient care?
We know from von Hippel’s research that user-innovators are benefiting from two growing trends, 1) democratized access to tools and materials to design make products, in large part thanks to the maker movement and 2) the ability to connect, share and learn from other user-innovators via the internet.
Canyon’ers go to travel forums to learn tips and tricks for modifying and making their own equipment. Scientific instrument users publish their modifications and inventions on Tekla Labs Guides.
Nurses, on the other hand, are left out of the information-sharing ecosystem of makers and user-innovators. Somehow, a practicing nurse before World War I had a better innovation ecosystem that one practicing today. How did we get here? In our research, we found that nurses benefited more from sharing platforms of the 1900s than the connected, online forums of today.
In the 1900-1970s, nurses were shaping the medical supply closet and bedside devices used in hospitals and homes. As quickly as they created a new gown to transport NICU patients in an emergency, they submitted the sketch and instructions to the American Journal of Nursing (AJN) for others to learn from, and then continued on with their care. In the 1980’s, those submissions were omitted from AJN, replaced with reviews of commercially available medical equipment. Effectively, this has cut out the user-innovator outlet out of nursing.
When nurses lost the outlet to share their own modifications, adaptations and solutions from the bedside, they went underground. Solutions are now shared only between nurses on the same unit, passed down anecdotally during orientation.
Across the country we are seeing patterns of nurse making, the same solutions spotted in Houston, Texas are being recreated in Community Hospitals in South Shore, Massachusetts. Nurses thrive as user-innovators despite not having access to the virtual megaphone that they had in the beginning of the century. Imagine how much more powerful this stealth community will be with policies, protocols and platforms to support nurse making.
