1. Thompson, Cathy J. PhD, RN, CCNS, CNE

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Disruptive innovation. It sounds messy, and rebellious. You may have run across this term in the leadership or business literature. Although disruptive innovation seems to be the new buzzword, the concept itself has been around a long time. For example, "creative destruction" defined businesses that took advantage of new technology and was coined by Schumpeter in the 1930s1,2; in 1989, "permanent white water" denoted the turmoil and chaos in a changing world,3(p3) and the use of terms such as reengineering, reinvention, and healthcare reform in recent decades brings visions of change and chaos. However, the goal of disruptive innovation is not to bring chaos but to provide value to underserved markets.1,4-6 The innovation's purpose is to


transform an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation is formed in a niche market that may appear unattractive or inconsequential to industry incumbents, but eventually the new product or idea completely redefines the industry.6([P]2)


Personal computers, cellular phones, and the Internet are examples of disruptive innovation. In fact, the Internet has been identified as the number 1 disruptive force in recent history.7


The theory of disruptive innovation was created by Dr Clayton Christensen from Harvard University and posits that transformation in any industry occurs when small entities disrupt larger ones by focusing on efficient and economical processes and procedures as simpler solutions for complex problems; the disruptors also focus on a new or underserved market of consumers.1,4-6 It is important to note that the impetus behind the disruption is not to improve a product, but to meet consumers' unmet needs.1,6 Because these innovations upset the status quo, they are resisted and frequently ignored by those stakeholders, as inconsequential. However, disruptions can also cause the larger entities to innovate to defend their market sector.1,4-6 The goals of both types of innovations (disruptive and defensive), if successful, lead to positive outcomes for the consumer. Disruptive innovation is not confined to the business world, though; so let us talk about disruptive innovations in healthcare and education.


The passage of the Patient Protection and Affordable Care Act in 2010 was, and remains, the impetus for much disruption in healthcare delivery-and ultimately for nursing education.8,9 The establishment of clinical nurse specialists (CNSs), nurse practitioners, and other advanced practice nurses to address unmet consumer needs has also been labeled as a disruptive innovation in healthcare delivery.10,11 Indeed, CNSs have been at the forefront of disruptive change by challenging the status quo and designing innovative processes and procedures to improve the delivery of healthcare and promote positive patient outcomes. The growth of independent primary care and urgent care clinics in retail establishments (increasingly staffed by nurse practitioners and/or physician assistants) and telehealth applications in rural and remote areas of the country are other examples of disruptive innovation in healthcare.2,9,12 In response to the growing recognition of this phenomenon, the Journal of Nursing Administration is implementing a new column to identify the process and impact of disruptive innovations occurring in healthcare institutions.12


The concept of disruptive innovation is making its way into the world of higher education, too. In higher education, terms such as innovation, curriculum redesign, and paradigm shift inherently signify change and disruption. The truth is that disruptive processes tend to uncover good ideas.13 "Disruptive innovation theory expands your view, increasing the odds that you spot important trends early."13([P]4) Better to be ahead of the curve, rather than behind it! Good ideas are defined as those that are focused on actual needs, deliver consistently on that need, and are economically viable, therefore providing value to the creator and the recipients.13


Educators in medicine and pharmacy are championing disruptive technologies14-17 as effective methods to teach 21st century healthcare professionals. Nurse leaders are also encouraging nurses to embrace disruptive innovations in the academic and clinical settings to stimulate new ideas and leadership for nursing education and nursing practice of the future.3,11,12


Bellack3 entreated nurse educators to make a point to be aware of demographic, technological, and regulatory changes in higher education. She makes the point that, because of the short supply and increased demand for nurses and nurse faculty, nursing education has been seemingly exempt from educational trends and mandates for which other university faculty have had to pay attention. Bellack3 stated, "As nurse educators, we have a responsibility to educate ourselves about these macrotrends and issues. We cannot continue to assume that we are immune to the disruptive and transformational forces that are affecting so many sectors of the higher education enterprise."(p4)


Among the macrotrends and issues in higher education that have and will impact nursing education are demographic and generational shifts, the financial impact of a college education, insufficient resources, regulatory and risk management compliance, awareness and prevention programs regarding student health and welfare, population shifts to urban areas, cultural awareness and integration, and technological innovations.3 Nurse educators must "try to anticipate [trends and issues], manage them, and adapt to them as they occur."3(p4) Familiar as characteristics of innovators and change agents, these are the same principles we teach our students in preparation for working a rapidly changing healthcare world. We need to practice what we preach.


Although the Future of Nursing study18 did not identify "disruption" by name, it recommends that nurses should "achieve higher levels of education and training through an improved education system that promotes seamless academic progression" and should practice "to the full extent" of that education and training as "full partners, with physicians and other health professionals" for the purpose of "redesigning health care in the United States,"(pp29-33) which requires disruption of traditional nursing education curricula and teaching methods to get to those outcomes. The Excellence in Nursing Education Model,19 developed by the National League for Nursing, includes a charge to nurse educators to "transform nursing education" through leadership and to "manage constant change, including technological developments."([P]2,[P]6) As role models for our students, we need to "walk the talk" of change and disruptive innovation.


Technological developments include the use of the Internet-based eLearning offerings, mobile platforms, online learning, haptic devices and high-fidelity simulation, social media, gamification, video conferencing, remote monitoring, virtual learning experiences, and other methods to engage students and create 21st century nurses and team members. Have you tried any of these new methods to transform your courses and curricula? According to Stansbury,20 most colleges and universities have not changed their modus operandi much-required face-to-face classes, hard-copy print textbooks as the major source of course readings, and traditional teaching methods seem to prevail. Stansbury20 questions whether institutions of higher education are "resistant to change" or merely "thriving[horizontal ellipsis]with their tried-and-true methods?"(p1) With private and public support waning, changing student demographics, increased costs, and marketing challenges,21,22 I would doubt many colleges and universities would call themselves thriving. Student engagement, the choice of alternative paths to achieve educational goals, real-life application, and engaged faculty are keys to recruiting and retaining students.20,22


"D[isruptive] I[nnovation] provides nursing professionals with a remarkable opportunity to lead innovation"12(p470) in nursing education, research, and practice. We cannot be afraid of seeking out new instructional and evidence-based methods to offer our students the best education possible. We want our nursing students to be transformational leaders-but many of us are not willing, or perhaps able, to role model these characteristics in our own institutions or to lead when it comes to innovations for our curricula or teaching methods.


Leadership is the ability to make change happen when it otherwise would not. To do this, effective leaders create a compelling vision of a future state. That enables people to see the destination ahead, and understand what role they need to play to achieve that goal. Leaders then build consensus among diverse individuals around that goal. Finally, they motivate everyone to act despite the anxiety they might feel about implementing the changes themselves.23([P]6)


Disruption, like change in general, is uncomfortable, but it is necessary for personal and professional growth. As Halstead24 advises, learn to be a positive disruptor. Dr Victoria Niederhauser stated that


Today's challenges in health and health care will not be resolved with yesterday's solutions; and those who find innovative approaches to solving critical health issues will improve care in hospitals, communities, and other health settings[horizontal ellipsis] we need to bring together unlike-minded people with different perspectives and not be fearful of positive disruption and accelerated pace of change.25([P]7)


The promise of disruptive innovations is exciting; the consequences will not always be positive, but the act will serve nursing and our patients well. We can be the leaders of transformed nursing education models to prepare our students and organizations for the future. In future columns, we will delve into the process of disruptive innovation and look at disruptive innovations specific to academic and clinical environments.




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