1. Harkins, Deborah MBA, BSN, RN, CCRN

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There is excitement in the air. People are dressed to the nines in long gowns or tuxes; it is a beautiful evening in Los Angeles. We walk up the grand marble staircase into a stunning room adorned with chandeliers and find our seats for dinner. The lights go down; the ceremony begins. There are introductions by the master of ceremonies and glimpses of celebrities in the audience, categories are announced, and awards are presented. Our anticipation mounts as our category is read and short film clips from each of the nominees are shown; it is almost surreal to see our work on the screen. The winner is announced and suddenly my colleague is rising from her seat to accept our Freddie Award. This would have been completely overwhelming had we not accepted an award from the New York Film Festival less than a year before!! As a nurse, I never imagined experiencing this.

Figure. Deborah Hark... - Click to enlarge in new windowFigure. Deborah Harkins, MBA, BSN, RN, CCRN

All because of an injury prevention project.


All because of passion for what we do.


All because a group of committed people had some very innovative ideas.


In 1998, at the University of Michigan Trauma Burn Center, we faced a 17% increase in pediatric burn admissions. Analyzing data from the trauma burn registry, we realized many of these injuries were flame burns resulting from high-risk behaviors, frequently involving flammable liquids or accelerants.


My colleague and I were at dinner one night, discussing this disturbing trend. Our concern turned toward prevention education and in a couple of hours we mapped out a new injury prevention program for juvenile fire setters. The program was a multidisciplinary collaboration and targeted children who intentionally set fires as well as those who were just curious or played with fire. We presented our ideas to our medical director and received the green light to move forward. Eleven years later we continue to offer a very successful and powerful 1-day program that is family-centered, interactive, and hospital-based. Straight Talk1 takes an innovative approach to intervention by involving all members of the community from firefighters to the court system to the trauma burn team to burn survivors. Children aged 8-17 years are referred via the health system, schools, fire departments, or judiciary systems. A parent is also mandated to attend to ensure that both child and parent together are educated as to the medical, financial, legal, and societal impact of fire-setting behavior. The program emphasizes individual accountability and responsibility associated with their actions. We also developed a train-the-trainer package helping other burn centers institute Straight Talk in their own facilities.


To assess the impact of our program, we studied participant outcomes. In an article published in the Journal of Trauma, we compared fire-setting recidivism rates for those juveniles who attended Straight Talk versus a random control group of juveniles with no intervention. Data showed recidivism rates of 0.08% for the 132 children who attended our program versus 36% for 102 children in the control group.2


An offshoot of the Straight Talk program involved discussions with a film crew to create a video documentary that would compliment our injury prevention program and function as a stand-alone educational product. The purpose of the film was to reveal the hardships of burn injuries from community, staff, and patient perspectives. The film, "In an Instant," exceeded our expectations; taking the viewer inside the burn center, on location with the fire department, and at home with patients and families. "In an Instant" uses a case study approach to reveal the struggles by courageous patients and families from admission through recovery.3 This film is used in a variety of community venues and is the winner of Freddie Award 2003, Cine Award 2002, and New York Film Festival 2002.


All because of an injury prevention project.


All because of passion for what we do.


All because a group of committed people had some very innovative ideas.


The Michigan Trauma Nurse Council (MTNC), a network representing trauma centers throughout the state of Michigan, had similar success realizing a need for a statewide elderly injury prevention program. Given a lack of centralized resources, the group took an innovative approach to funding, development, and research. The MTNC obtained grant money from the Michigan Committee on Trauma and MTNC members' committed resources from their own institutions such as statisticians, IRB processes, gerontology expertise, and more. Their efforts culminated in 4 independent modules that encompass key areas of elderly injury prevention: Falls, Pedestrian Safety, Home Safety, and Motor Vehicle Crashes. The results of their diligence and hard work were recently published in the Journal of Trauma Nursing. Titled "Senior Lifestyles and Injury Prevention: Evaluating the Effectiveness of an Injury Prevention Program for Older Adults"4 (SLIP), the research revealed significant participant improvement between pre- and posttest scores for the motor vehicle safety and fall- prevention modules, while no significant changes were noted with the pedestrian or home safety modules. Following the development, implementation, and research of the SLIP program, the MTNC discussed how this toolkit of slides, speaker notes, and surveys could benefit others. Their conclusion? Give the program to the Society of Trauma Nurses (STN) to add to their education portfolio. I am excited to say the final product has been updated and is ready to launch. Please visit for more information. The STN is very grateful to the MTNC for their generosity and their amazing contribution to the domain of injury prevention.


All because of an injury prevention project.


All because of passion for what we do.


All because a group of committed people had some very innovative ideas.


Merriam-Webster defines innovation as the introduction of something new, a new idea, method, or device.5 Just the mention of innovation invokes ideas of a no-holds-barred approach, creative powwows, lack of rules or guidelines, and disruption of the "structured" business milieu. All of this is rare in the healthcare environment. IDEO, a design and innovation consulting firm,6 is a front-runner in helping innovation "happen." Their culture is about multidisciplinary collaboration and having fun. They work to explore and define how people interact with objects, space, services, and each other. IDEO is known for creating apple's first mouse, designing the Palm V and crafting the first stand-up no-squeeze toothpaste container. They have a niche in healthcare, working with Kaiser Permanente to overhaul the patient experience and reengineer nurse staff shift changes. IDEO believes that the whole is greater than the sum of its parts, intentionally hiring polymaths, people who have expertise in a number of areas. Their space is a relaxed environment where hierarchy is frowned upon and playing with toys is encouraged. Their success comes from incorporating their clients into IDEO's innovation process using unusual techniques such as "bodystorming," "behavioral mapping," "quick and dirty prototyping," "deep dives," "unfocus groups," "shadowing," and "be your customer."7


Desouza et al8 outline discrete stages of the innovation process on the basis of findings from a study of more than 30 US and European companies identified as having robust innovation processes. The stages include idea generation, mobilization, screening and advocacy, experimentation, commercialization, and diffusion and implementation. The authors eloquently describe the strengths and weaknesses associated with each stage. Here are some excerpts of the weaknesses as most often they are the barriers to success that many of us experience. Perhaps pointing out some of these stumbling blocks will provide insight on your own organization's processes.


* Employees are unsure what constitutes an idea.


* Idea generators are unclear about how to communicate ideas.


* The value of ideas is often not recognized.


* Employees are nervous about sharing ideas because evaluation is unclear.


* Little feedback, support, or constructive criticism is available.


* Evaluation process is unclear and subjective.


* Egos play a large role in the idea evaluation.


* Focus is on short-term impact and revenues or local context.


* A lack of resources or incentives exists.


* Experimentation is on an employee's own time, without standard processes.


* Failure, risk, and resource expenditures are emphasized.


* Weak evaluation of market trends decreases likelihood of success.


* Process is draconian and top-down with little regard for existing processes.


* Old processes persist and unlearning is slow and is not encouraged.



I encourage you to look at your trauma center or health system from a different angle. Try to incorporate innovation into some of your processes or ideas. You never know what is possible. Heck, maybe Capitol Hill could use some of these techniques as they debate healthcare reform. As Einstein said, "We cannot solve our problems with the same thinking we used when we created them."




1. Straight Talk. Accessed September 20, 2009. [Context Link]


2. Franklin GA, Pucci PS, Arbabi S, Brandt MM, Wahl WL, Taheri PA. Decreased juvenile arson and firesetting recidivism after implementation of a multidisciplinary prevention program. J Trauma. 2002;53(2): 260-266. [Context Link]


3. In an Instant. Accessed September 21, 2009. [Context Link]


4. Koestner A, Walters MR, Mattice C, Manion P, Seguin C. Senior lifestyles and injury prevention: evaluating the effectiveness of an injury prevention program for older adults. J Trauma Nurs. 2009;16(2): 87-92. [Context Link]


5. Merriam-Webster Online. Accessed September 18, 2009. [Context Link]


6. IDEO.[Context Link]


7. The Power of Design by Bruse Nussboun. Accessed September 20, 2009. [Context Link]


8. Desouza KC, Dombrowski C, Awazu Y, et al. Crafting organizational innovation processes. Innov Manag Policy Pract. 2009;11.1:6-28. [Context Link]