Evidence-Based Practice: Is It Blocking Nursing Innovation?

By Rose O. Sherman, EdD, RN, FAAN

Earlier this month, I went to a conference on Innovation with nurse leaders from throughout the country. As we talked about the need for disruptive innovation with health reform, several nurse executives observed that the focus on evidence-based practice and data driven decisions was limiting their ability to try very new and innovative things. “Whenever the topic is raised about trying something new especially if there may be the risk of failure involved”, one seasoned nurse leader observed, “objections immediately are surfaced, data and evidence are demanded. People seem very risk and innovation adverse because what is being discussed is not a current best practice.”

The Tension between Evidence-Based Practices and Innovation

This nurse leader raised a very important issue because true innovators are often out there on the “bleeding edge” where no one has ventured before. In his groundbreaking book The Innovator’s Prescription, Clayton Christensen proposed that today’s health care system screams for disruptive innovation. Despite the need, developing new innovations is not without challenges. It can be difficult to get nurses to think creatively. One negative byproduct of our recent focus on evidence-based ideas is that truly creative thinking is often not grounded in current evidence.

The late Steve Jobs is widely regarded as one of the most innovative people who have ever lived along with the greats such as Albert Einstein, Benjamin Franklin and Thomas Edison. He described his philosophy by using a quote of ice hockey player Wayne Gretsky who said ” I skate where the puck is going to be, not where it has been”. Apple under Steve Jobs did not conduct either market research or focus groups prior to introducing new products. He believed that if it is truly revolutionary…they won’t be able to help you design it. This idea is an important one when it comes to innovation. To truly change nursing practice, we will need to unlearn the legacy of models of care that we have perfected and researched over time. And as we move through the change, we may or may not have evidence to support our ideas.

Questioning our Assumptions

Evidence-based information is important in decision making but it is also important to question our assumptions when we look to innovate. Assumptions can be driven by personal biases, an overly optimistic/pessimistic attitude, old evidence or a failure to explore other perspectives on issues. Some key questions include:

What am I not considering in this situation?
What do those with opposing viewpoints believe?
How do my younger staff view this issue?
Is it possible that I am wrong in my thinking?
Have things changed and I am not aware of new evidence?
How is my own life story affecting how I think about this situation?
Could my own reluctance to change be impacting my viewpoint on this?
Do I feel threatened when presented with new information?
If I came into this situation with no experience, would I make the same decision or hold the same viewpoint?
How would I react if I found out that the basis of my thinking on a key issue was totally wrong?

Starting with Small Bets that may not be Evidence-Based

Most people at some level do care deeply about what others think of their ideas. As an outcome, we often stick to safe suggestions and ideas. One solution is to start small with pilot projects. There is an interesting book by Peter Sims (Little Bets) that examines how small bets can lead to very innovative, breakthrough ideas. At the core of this experimental approach, little bets are described as concrete actions taken to discover, test, and develop ideas that are achievable and affordable. They begin as creative possibilities that get refined over time. Sims points out that taking these little bets are particularly valuable when trying to navigate amid uncertainty, create something new, or attend to open-ended problems. As nurse leaders, we often focus on wide-spread systems changes to solve problems. Sims makes a strong case that taking small bets to test out new ideas is often more effective in leading to the type of innovation that is needed in healthcare and other industries today. These small pilot project then can help build a new foundation of evidence that we will need to promote organizational acceptance.

Read to Lead

Christensen, C. (2009) The Innovator’s Prescription: A Disruptive Solution for Health Care. New York: McGraw-Hill.

Tom and David Kelly (November 15th, 2012). The Fours Fears Blocking You from Great Ideas. Podcast Interview with the Harvard Business Review.

Lehrer, J. (2012). Imagine: How Creativity Works. New York: Harcourt Publishers.

Sims, P. (2011). Little Bets: How Breakthrough Ideas Emerge from Small Discoveries. New York: Free Press.