Patient-Centered Innovation: Involving Patients in Open Social Innovation.

BACKGROUND: Involving patients in the health-care delivery innovation has many benefits. Open social innovation (OSI) presents a fitting lens to examine and advance patient engagement in innovation. OSI offers a participatory approach to innovation, in which diverse groups of participants collaboratively generate ideas and scale solutions on complex social challenges. PURPOSE: This study: (1) describes a pilot application of OSI, in which individuals serving on a hospital's patients and family advisory councils (PFACs) were invited to participate in an innovation contest; and (2) explores the extent to which patients' beliefs about their role in innovation relate to their participation in the contest. METHODOLOGY/APPROACH: We conducted an innovation contest that invited PFAC members to share ideas that would improve patient experiences and then vote on and select the ideas that they wanted to see move forward. We measured patients' beliefs about their role in innovation in a survey before the contest. RESULTS: Twenty individuals submitted 27 ideas. Patients who expressed preference for more involvement in innovation were more likely to participate. CONCLUSIONS: Using OSI may help expand patient engagement in innovation, particularly among those who want to be more involved but do not feel authorized to voice ideas in traditional advisory committees. PRACTICAL IMPLICATIONS: OSI spurred collaboration among patients, clinicians, quality improvement staff, hospital administrators, and other stakeholders in idea generation, elaboration, and implementation. More experimentation and research are needed to understand how OSI can be leveraged to capture patients' voice and incorporate them in care delivery innovation.

Mission possible: open innovation in nursing and patient care services at Massachusetts General Hospital.

OBJECTIVES: Although front-line nurses and staff are uniquely positioned to identify the inefficiencies and gaps in care delivery, formal processes are not always in place to hear from those very employees. DESIGN: We established a scalable process that embodies open innovation principles, to broaden and distribute the innovation locus. SETTING: Massachusetts General Hospital, Boston, MA. PARTICPITANTS: We invited 8800+ nurses and other direct caregivers to participate in organisational problem solving. INTERVENTIONS: We solicited employees to (1) identify pain points and develop solutions and (2) crowd vote to indicate which ideas they want to see implemented. RESULTS: 177 employees submitted 225 ideas, and 928 cast a vote. The 40 participants who submitted top-voted ideas were invited to develop a detailed implementation plan; of those, 27 submitted one. Four ideas emerged as winners. CONCLUSIONS: Formulating a clear call for ideas, securing leadership buy-in and generating excitement about the process were essential to our efforts. Challenges associated with opening the innovation process involved managing a large volume of participants and submissions, and providing on-the-go training to nurses and staff who were not used to being asked to participate in organisational problem solving.

Nurses' confidence in starting a new venture, startup or project in the context of nurse-led hackathons: Results of prehackathon survey.

BACKGROUND: A hackathon framework has been successfully applied to solving health care challenges, including COVID-19, without much documented evidence of nurses' baseline or acquired confidence. PURPOSE: To understand differences in baseline confidence levels in starting a new venture, startup or project in the context of nurse-led hackathons. METHOD: A retrospective secondary analysis of a presurvey of hackathon participants from two NurseHack4Health (NH4H) events held in 2021. DISCUSSION: Male nurses and international nurses were more confident than the U.S.-based nurses. When comparing the 75% of participants who had not attended a hackathon previously to the 25% of participants who had, there was an increased confidence level among non-nurses and among participants with the previous hackathon, datathon, and ideation experience. CONCLUSION: If hackathons can help nurses identify strengths, add new expertise and boost confidence, it may empower nurses to pursue their ideas more effectively, aid professional growth, and provide affirmation of innovator self-identity.

Voices of Fathers During Pregnancy: The MGH Prenatal Care Obstetrics Fatherhood Study Methods and Results.

INTRODUCTION: Despite the growing recognition of father's importance for early family health and well-being, there has been very limited attention to men's own experiences and developmental needs antenatally, and specifically during their partner's prenatal care (PNC) visits. This study explores the feasibility of capturing men's own voices; documents their antenatal experiences and needs; assesses their treatment by Obstetric staff; and enquires about additional paternal information and skills desired and how best to provide them. METHODS: All fathers accompanying their partners to PNC services during two weeks at Massachusetts General Hospital were invited to fill out an anonymous, 15-min, two-part, iPad survey. RESULTS: 430 fathers participated (85% of men approached). Fathers expressed high levels of joy and involvement with approaching fatherhood; but 55% also expressed substantial levels of stress, 26% acknowledged depressive symptoms, and 42% reported limited social support for becoming fathers. Substantial men's health needs were noted: 75% were overweight (including 24% obese); 36% lacked an annual physical; and 22% had unplanned pregnancies. Most men (85%) desired additional fathering skills. Fathers perceived being very positively treated by the Obstetric staff, though 33% were never asked any direct questions. Most fathers (68%) expressed a desire or openness for additional parenting information, across a wide range of reproductive health topics, and were very enthusiastic about antenatal fatherhood initiatives. CONCLUSION: PNC sites provide a valuable locus for ascertaining men's/fathers' voices and could be enhanced to address their extensive antenatal needs and foster earlier paternal involvement to improve infant, family, and men's own health.

Postpartum depression screening: Treatment engagement, barriers to care, and change in depressive symptoms.

BACKGROUND: Postpartum depression (PPD) is a common condition associated with childbirth, yet many women do not receive the treatment they need. Despite the growing practice of PPD screening, treatment and clinical outcomes among patients identified as likely having PPD remain unclear. METHOD: Women who were systematically screened and scored ≥12 on the Edinburgh Postnatal Depression Scale (EPDS)-indicative of possible PPD-at their routine 6-week postpartum visit were eligible to participate and were contacted after 3 months for a follow-up interview and assessment. RESULTS: A total of 33 women participated in the study, out of 100 who scored ≥12 on the EPDS. Among the participants, 70% reported they received a referral to a health care provider for PPD, and nearly one-half said that they received psychotherapy and/or were prescribed a psychotropic. The 2 most commonly described barriers to treatment were perceptions of not needing or wanting help and concerns about breastfeeding while taking psychotropics. Nearly 40% of women scored ≥12 on the EPDS at the follow-up interview. CONCLUSIONS: Further systematic research on outcomes after PPD screening is needed to ensure that screening translates into meaningfully improved clinical outcomes.

Implementation of universal screening for depression during pregnancy: feasibility and impact on obstetric care.

BACKGROUND: Given the growing policy and public health interest in the identification and treatment of depression in pregnancy, an understanding of the feasibility, challenges, and implications for resource utilization of the implementation of a universal screening program is crucial. OBJECTIVE: The purpose of this study was to assess the feasibility of large-scale implementation of universal screening for depression in pregnancy and during the postpartum period with the use of the Edinburgh Postnatal Depression Scale. STUDY DESIGN: A prospective observational cohort study was conducted from July 2010 to June 2014 at a large academic medical center. Pregnant women were screened at 24-28 weeks gestation and again 6 weeks postpartum. An Edinburgh Postnatal Depression Scale score of ≥12 was the cutoff for referral to mental health services for diagnostic evaluation and treatment. RESULTS: Among 8985 women who were enrolled in prenatal care at the participating sites, 8840 women (98%) were screened for depression antepartum, and 7780 women (86%) were screened postpartum. A total of 576 women (6.5%) screened positive for probable depression; of these, 69% screened positive antepartum, and 31% screened positive postpartum (P < .01). All women who screened positive were referred for an evaluation by a mental health professional; 79% of the women were evaluated, which was more common antepartum than postpartum (83% vs 71%; P < .01). One hundred twenty-one women (21%) were not evaluated further after a positive screen; primary reasons included declining a mental health evaluation (30%) or transferring obstetric care (12%). Among women who underwent a mental health evaluation, 67% were diagnosed with major depression; 37% were diagnosed with an anxiety disorder; 28% were diagnosed concurrently with major depression and an anxiety disorder; 76% were diagnosed with either depression or anxiety, and 35% were treated with an antidepressant medication, which was more frequent during the postpartum period than during the antepartum period (54% vs 28%; P < .001). After adjustment for maternal age, parity, race, and household income, women who screened positive antepartum were significantly more likely to link to mental health services compared with women who screened positive postpartum (adjusted odds ratio, 2.09; 95% CI, 1.24-3.24; P = .001). CONCLUSION: This study demonstrates the feasibility of universal depression screening during both the antepartum and postpartum periods with the use of the Edinburgh Postnatal Depression Scale as an initial screen followed by mental health referral for further diagnostic evaluation and treatment. The population of women who screened positive and who accepted additional services differed at the 2 time points, which reinforces the utility of screening during both the antepartum and postpartum periods. Although universal screening for depression is feasible, further study of the barriers to mental health evaluation and treatment and the impact of treatment on obstetric outcomes are needed.

Updated parental viewpoints on male neonatal circumcision in the United States.

Through a questionnaire, the authors sought to elicit information about initial attitudes concerning circumcision after reading a summary of the American Academy of Pediatrics (AAP) Policy Statement and, again, after reading a description of recent HIV/HPV studies. Predictors of increased support for circumcision included having a prior circumcised boy and being US born. Predictors of decreased support included being of Hispanic ethnicity and believing that the uncircumcised penis was more culturally normal. After reading the AAP statement, 86% of respondents remained favorable of elective circumcision, whereas 13% viewed it less favorably. After reading the passage about the HIV/HPV studies, the majority maintained their initial level of support. Certain characteristics were associated with an individual's desire to perform circumcision on his/her infant. Despite a slight decrease in support to perform circumcision after reading the AAP policy summary, respondents' initial attitudes toward circumcision were unchanged after subsequent review of recent HIV/HPV research.