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Healthcare Innovation Development Through Bedside Discovery and Doctoral Education


Healthcare innovation is a growing force in both the healthcare and technology spaces today. Nearly daily, we read and hear about new innovations emerging into the marketplace to address complex problems facing our patients, families, communities and populations. Yet how these innovations can come to be identified by individuals — the innovators — is less often discussed. In many cases, the discovery is grounded in a process that spans many years and multiple career steps.

In the nursing profession, the first career step is often in a direct care role. By being with patients and seeing the challenges faced, nurses often find problems (or opportunities) that have yet to be solved. However, in many instances, more knowledge and education preparation are often needed in order to begin to effectively solve that complex problem.

Innovation materializes in new products, services and processes. Culturally, we tend to define innovation by its tangible and visible outcomes. But to reach those tangible outcomes, one must ideate on how to improve or disrupt the status quo. Innovators see opportunities in existing problems and work to solve them. One academic degree trajectory where problem solving is inherent within the study plan is in a doctor of philosophy, or Ph.D., program.

While not overtly discussed in such a manner, the Ph.D. is a degree program aimed at problem solving using a guiding framework and rigorous scientific methodologies to solve an identified problem. The very first thing that one does within that degree is identify a problem of interest. Typically, this challenge is what draws someone to that program. From there, the problem becomes the student’s topic of focus. Ph.D. students immerses themselves within that topic to formulate a research question that requires the scientific method of discovery to answer and generate new knowledge and solutions.

In my academic appointment at UConn School of Nursing as the DeLuca Foundation Visiting Professor for Innovations and New Knowledge, I’ve reconnected with a colleague who was a post-doctoral fellow while I was a Ph.D. student at Duke University. Dr. Ruth Lucas is a tenure-track assistant professor at UConn’s School of Nursing and exemplifies the value of a Ph.D. on problem solving and research discovery toward innovative new solutions.

Prior to her Ph.D., Lucas was a bedside nurse who observed mothers breastfeeding their infants during the nightshift while at the hospital. She also noticed variability between the capability of mothers to successfully breastfeed their new infants. Lucas was surprised to see that mothers were expected to manage the behavior of another human being, the infant, instead of understanding what was supporting or limiting the infant’s effort. This observation led Lucas to research the current literature on this phenomenon.

The standard evidence-based assessment of infants’ effort is maternal perspective of infant satiation, infant weight gain after a feeding, or clinical expert assessment/opinion. There is no objective measurement of infants’ effort during breastfeeding. As a result, there is no guidance for targeted clinical intervention at a point of failure during breastfeeding. We cannot discern if it is maternal or infant issue that is interfering with infants’ effort.

While working at the bedside supported Lucas’s identification of a problem, she wanted to understand what was happening at a deeper level. This was the catalyst to pursue a Ph.D. program in nursing. I asked her to explain how her doctoral degree preparation helped her to understand the problem and begin to work toward a solution:

As a nurse researcher, we are trained to systematically identify a problem, focus on a gap, and come up with a solution. However, we (e.g., nurse researcher) are not focused on a medication intervention or pharmacological intervention. Instead, we focus on resources that are available and based on the individual. Thus, as nurses, we think about interventions based on resources (or lack of resources) interfacing with the individual in their environment and ability to communicate.

Lucas’s research led her to invent a device that can objectively measure infants’ effort in real time without interfering with breastfeeding. A device that can measure an infants’ ability to create and sustain intraoral pressure can help a clinician know if the problem is positional, physiological or dysregulation of maternal milk flow, or infant neurodevelopment. The solution focuses not on the ability of a woman to be a good mother, but instead on a partnership of learning between mother and infant with breastfeeding.

The science of breastfeeding needed someone who understands the clinical needs of the mother and infant at birth but also bridges disciplines of neurology, developmental psychology, bioengineering and system analytics to be able to develop an effective, non-invasive devise. Being trained as a nurse researcher with bedside and personal experience has uniquely prepared me for this research.

A greater implication of breastfeeding science is to turn the assumptions into a research question. If breastfeeding is a dyadic behavior, how do we identify systematically how to intervene? How would we be able to ask and answer that question if there is no device to measure an infant’s breastfeeding effort?

Lucas is just one example of someone who saw a pattern emerging around breastfeeding in her bedside nursing role. Those observations and assessments led her to gain a deeper understanding of what is happening to the mother and the infant. By advancing her knowledge through a terminal doctoral degree in nursing, Lucas discovered the need for a measurement tool for clinical assessment and intervention and potentially to evaluate infant’s early neurodevelopmental regulation. Today, she’s working to bring the patent-pending device to market.

With that understanding in mind and such an emphasis on innovation in healthcare today, perhaps we should be discussing the Ph.D. degree in a way that future innovators might consider as they encounter complex healthcare problems in the marketplace in need of solutions. This may be a new tool to measure a concept, device, approach, application or role within healthcare. Thus, as you consider your career development and identify problems affecting the health and well-being of individuals, families, communities and populations at large, perhaps consider if a Ph.D. might provide you with the problem-solving knowledge, approach and creativity to develop an impact over time. The future of our healthcare delivery might just depend on your future invention.

Tiffany Kelley, Ph.D., MBA, R.N.

    Dr. Tiffany Kelley is Founder and CEO of Nightingale Apps, a health information technology company offering mobile applications to nurses working in hospital settings. She is also Founder and CEO of iCare Nursing Solutions LLC, which addresses the contemporary informatics needs of nurse leaders in health care organizations.

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