114: Ready to Level Up
31:55 Share

See You Now is a podcast highlighting the innovative and human-centered solutions that nurses are coming up with to solve for today's most challenging healthcare problems. Created in collaboration with Johnson & Johnson and the American Nurses Association and hosted by nurse economist and health tech specialist, Shawna Butler. Welcome to See You Now. I'm Shawna Butler. It's great to have you along for another profile in our Moment of Awareness series.

Stories of problem finders and solution seekers, of inventors, hackers, wave makers and path breakers, innovators and intrapreneurs. Stories that capture the moments of concern, of empathy, outrage, distress, frustration, wonder, triumph, and the journey of problem solving, invention, trial and error, and trial and error of convincing, conviction and creativity.

Let's get started.

Around the world, millions of children each year undergo surgeries requiring general anesthesia. And along with it, the universal and incredibly understandable experience of anxiety. A peak moment of that anxiety occurs with anesthesia induction, which is commonly administered through a mask. And placing a mask on or near a child's face can be the most stressful moment for that child.

Despite the best efforts of the medical team and parents to prepare a child for the experience, many youngsters are fearful, cry, try to escape, anything to resist the mask and the strong smell and the unknowns that come with it.

It's a stressful experience for kids, parents, and staff, and studies have shown that high anxiety before surgery is associated with poorer outcomes after surgery that include nightmares, regression, temper tantrums, separation anxiety, and distrust of medical personnel. And sometimes these behaviors can last for months afterward.

In this moment of awareness, nurse practitioner, researcher, and innovator, Abby Hess, shares her experiences witnessing countless children in distress during the pre-surgery process.

her clever and Mary Poppins-like creativity to rethinking the mask as part of a game, and the collaborators and mentors she learned from and turned to, to sustain her commitment to inventing a game that shifts the focus from something scary to something that's calming and fun, and improve the entirety of the surgical experience and outcomes.

I'm Abby Hess and I'm a nurse practitioner, a clinical researcher, and an intrapreneur at Cincinnati Children's Hospital. As a nurse practitioner with anesthesiology, I see patients preoperatively prior to them undergoing anesthesia and having surgery. As a researcher, I study interventions for decreasing anxiety for kids before they have surgery.

My third role as an entrepreneur is unique. Many people are familiar with entrepreneurs, someone who starts their own company or business. And as an entrepreneur, I lead innovation from within the company where I already work. And so I've had the opportunity to develop a new medical product in collaboration with my hospital's innovation ventures team. And I'm currently working to develop structure to support others innovating within our medical center.

And so I really love having these three separate but connected roles because I have the opportunity to care for patients, identify challenges in the clinical setting, and develop solutions through research and innovation. I realized that there was a problem years before I thought of a solution.

So I started working with the Department of Anesthesiology back in 2012, and I instantly noticed how anxious parents and families are about going back to the operating room and having surgery. And this experience, it can be scary as an adult, right? You can imagine how little kids may feel in this moment. You know, you roll back into the operating room on a stretcher. You're in an unfamiliar environment. There's strangers surrounding you. They put a mask on your face that has a strong smelling air.

It makes you feel weird and you experience a loss of consciousness and fall asleep. So when kids get anxious in that moment and sometimes start fighting the anesthesia mask, it can be really difficult for the kids, their parents and for staff. And we have lots of interventions that help in this moment. But high anxiety is something that we still see really frequently with kids who are about to have surgery.

We know from research that high anxiety before surgery is associated with poor outcomes after surgery, like higher reports of pain, delirium when waking up, and negative behavioral changes after going home. And some patients even have anxieties and fears for years after having a difficult experience with surgery. And so I really wanted to find a way to help make this better for my patients.

But it wasn't until my friend's son came for a surgery that I had an idea of what could maybe help make this better.

He was three years old and typical for his age, he was hungry and grumpy and tired and just wasn't particularly excited about anything the day that he was having surgery. And a lot of times little kids who feel like this aren't particularly cooperative when they go back to go to sleep with the anesthesia. And so he did great with the surgery. And I later asked his mom, how did he tolerate the anesthesia mask? Because he seems like he wasn't in the greatest mood. And she actually said he did awesome.

And I was kind of surprised. I was like, wow, what did the medical team do? How did they get him calm and make that easy for him? She said they didn't have to do anything. I knew that his favorite story was the three little pigs. And so I told him when he put on the anesthesia mask, he would get to become the big bad wolf.

and he would have to huff and puff and blow the house down. And so when he got back to the operating room, he took the mask from the anesthesiologist and he huffed and he puffed and in a few big breaths, he was asleep.

I was so amazed by what my friend was able to do in this moment because a lot of times our medical staff can find ways to help calm kids. But I was amazed that a parent who was really in this unfamiliar and high anxiety moment was able to so effectively engage, entertain, calm, and support her child. And I immediately began thinking, what if I could create this type of experience for any parent or child and give parents a tool to help make this type of engagement really easy?

I immediately got out my phone and I started looking up games on the iPhone that required breathing. And I saw that a few actually already existed. There's one where you breathe into the microphone of your phone and these little ants, they're crawling down the tablet screen and you have to blow them away. And there are ones like where you blow bubbles and things like that.

And I couldn't initially use this type of game in practice because it would need to connect with our anesthesia equipment and be optimized to help support calm breathing. But I thought this idea could really be a game changer. And at that point, I really hoped that someone would develop this, but I never actually thought that I would be the one to get to create it. There were two things that made me start to think about maybe I could be the one to actually create this.

One of them was that I shared this idea early on with my cousin who was a graphic designer and he encouraged me to make a prototype. And I immediately was like, I don't know how to make prototypes. I don't even know what that is. How do I do that? And he said, you know, you don't have to have like

a specific degree to be able to make a prototype, you know, you can just take the things that you have and put it together and begin to iterate and build and make something more than what you have right now. And so I took an anesthesia mask and I taped an iPhone headset to it and then pulled up this little game and then gave it a try. And I was like, oh, wow, this game's really fun now that I could actually play it and see how it works.

So I thought that was really cool and it kind of made this whole concept real to me, but I still didn't really know how to develop it because I'd never done anything in product development and I didn't have funding. It was a single conversation that made me believe that it would be possible for me to create this.

We had a new research director at Cincinnati Children's who had just started in the Department of Anesthesiology, and we were having a conversation about what I wanted to work on in the future in research. So I opened up my backpack, I handed him this early prototype of the breathing controlled app, and I shared that every day in the clinic, I see kids who could benefit from this idea, and I really want to create something that could connect with anesthesia equipment

and is optimized to help our kids have the best experience possible when they're undergoing anesthesia induction. But I have no idea how to do this or if this could even be considered a research project or what to do next. And he could have said, "Oh, that would be really hard," or that there'd be too many steps, or you've never done this before. But what he said was, "This is an incredible idea, and we're going to find a way to get it funded."

A few months later, he sent me the opportunity to apply for our hospital's innovation grant. And so I started looking over this and I saw intellectual property, FDA classification, commercialization partners. I hadn't learned about any of that in nursing school. So I was like, this is going to be super challenging. I'm not really sure how to approach this.

You know, but being a nurse, I was already incredibly comfortable collaborating across different disciplines and learning new skills and technologies. This is something that we do constantly in clinical practice. And so my research mentor helped me make connections across my hospital. And so I met with experts who were willing to help me and together we wrote this grant.

And in 2016, I was the first nurse at Cincinnati Children's to be awarded a $100,000 innovation grant.

The innovation that we were able to create, it's called Easy Induction and it's a breathing controlled video game. So you picture a standard tablet and then you flip it over and on the back of the tablet case there's a little breathing sensor that you can connect your standard anesthesia equipment to. So all you have to do is connect the anesthesia mask using standard medical tubing to the back of the tablet and then you're ready to play.

The mask really becomes like a game controller then. So when kids breathe into the mask, they can win different challenges like blowing up balloons or flying a hot air balloon across a canyon. And the storyline in the video game is, so there's this little elephant and they're trying to get to a birthday party at the zoo. And it's intentionally designed to help kids engage at key stress points or anxiety points in the process. So they practice with the mask in the pre-op area. There's another little game as they transition back to the off

and then they get to play the last level when they're breathing the gases to go off to sleep. So rather than experiencing fear and uncertainty as we're rolling back to the operating room, kids actually, a lot of them look forward to this last level because they're thinking of something positive and fun that they get to do and they really focus in on that.

- The cool is that this quick intervention that kids really enjoy, it incorporates some of our most powerful interventions that we already use, like calm breathing, storytelling, mask desensitization, parental engagement in the process and positive rewards. And it turns it into something that's simple and fun and easy to implement and practice.

Our patients, our families, and our clinicians have been at the center of the project at every stage of development. And I think that's really what made it successful. In 2017, I had the opportunity to work with the Live Well Collaborative. And this team is a nonprofit academic industry research incubator. And they combine design thinking methodologies with multidisciplinary talent. And that helps us to translate our insights into consumer-based innovations.

And so students from the Live Well Collaborative from the design school at the University of Cincinnati and professors team up with the medical team to come up with new innovations. And they teach the clinicians about this human-centered design process, and they provide you with a team that has expertise. And that really transformed how I think about healthcare design and interventions. So that's something I've really continued to carry on with me from this project.

because it's so important as you're designing something new that you have the perspective of your patients and your families and your staff because they're ultimately the ones who are going to be using the product. And that's something that the team taught us early on when we worked with them on the design and that we've continued to integrate at every phase as we've developed this product.

Innovation's a marathon, not a sprint. You know, you get funding and you're like, "I'm gonna change the world in six months." And it takes so much longer than that. But about two years into this project, after our team got the initial grant, we finally had a prototype that we could use in the clinical setting.

And I can still remember walking into the room, this little eight-year-old girl, she was so anxious. She was clinging to her dad and just told me that she was so scared to go back to the operating room. So I talked with her for a few minutes about her concerns. And then I let her know a lot of kids are scared and feel this way. We actually created a new game to help make this easier.

And so she was a little bit skeptical, but was kind of like excited. And she was like, yeah, I'll give that a try. So she tried the easy induction game in pre-op and shared that she really wanted to play it again when she fell asleep. And I can still remember, you know, I was back in the operating room. She kind of rolls around the corner on the stretcher. She's actually holding the anesthesia mask on her face. And she told the team when she came into the room, I'm ready to play.

And this was a statement that I had never heard from an anxious child who was about to have surgery.

Having the breathing controlled app in this moment, it kind of felt like a superpower, right? It was amazing to see how combining my expertise as a clinician and this game could help this patient feel calm and in control during this moment that is often filled with so much fear and anxiety. And I could share stories all day now. I have dozens of similar stories from both my own experience and my colleagues.

Every time I hear how this positively impacted a patient or a parent, it really makes every moment of this innovation journey worth it.

What's amazing with the game is that it gives them something that they're comfortable with. It gives them continuity between the different areas because when you don't know what to expect, it's super scary. But when you have even one thing that is predictable that you feel comfortable with that you might actually think it's kind of fun because it's a new level of a video game, that just totally shifts the focus for kids and it makes it so much easier. Having the opportunity to work in healthcare innovation

I didn't really have background in any of the different areas for the teams that I was working with. You know, when you think about different areas for product development, design, engineers, computer programmers, business expertise, these are all areas that were pretty new to me. So

One thing that was really amazing was that our hospital has an innovation ventures department, and so that's our hospital's commercialization office. And so within that team, they have a wide array of expertise that can help support commercialization. So I had the opportunity to work with many of their different team members across the innovation process.

And I think some of the foundational skills and characteristics that you have as a nurse translate really well to working in the innovation space. One thing that is so important in innovation is having empathy, understanding the problem deeply and having a desire to solve it, which is something that nurses intuitively have.

Understanding the processes and the workflows and having the ability to collaborate across many different disciplines, that's also so important in innovation and it's something that nurses do all the time. And then developing creative and individualized solutions.

And so the ability to combine all these skills that you have as your foundation and then continually learn what the other team members bring to the table, helping share what you bring to the table and really keeping the focus as the patient and being able to create an optimal outcome or experience for them. That's really one of the fun parts and cool parts about getting to be a nurse doing innovation.

Everybody on the team was always so excited to see how this worked in clinical care and that was really what motivated and got everybody on board and really excited about working on the project.

You know, I think in innovation, you're in a new space. So you're constantly learning new things. And a lot of times, every time you step into a new area, you feel like a novice again, which is a hard place to be, right? So for the first few years of this project, we were constantly learning new things and we had to navigate lots of barriers. But the project was making steady progress. I think one of the big challenges for me was a couple years into this project,

Both of my project mentors left our department for other opportunities around the same time. And I kind of felt like the support that I had for doing innovation work kind of walked out the door with them just because they had been so involved with the project and so supportive and had given me a lot of help in navigating the challenges.

And so at that time, I really struggled to kind of find the right next steps for the project. I struggled to rebuild my team. And then not long after that, in early 2020, COVID happened. And so we stopped doing all elective surgeries. Everything in the world changed in an instant. And really nothing felt certain. Once we got to the point where we had

some sort of a handle on things with COVID. I really tried to stay positive and keep going with the project, but I kept meeting resistance really at every turn, just with the project itself and how to approach the next steps and how to fit this type of innovation project into the system that wasn't necessarily designed for video game development.

which is kind of a different process than a lot of academic research and what we typically do. And so we ran into lots of barriers and I really leaned on families and friends and coworkers who gave me a lot of support and kind of reminded me like, you know, this is a challenge. Like you just keep going, you're doing great. And

And very slowly we started to make progress. And I think what was key in that was finding mentors both inside my organization and outside my organization who could jump in, who understood innovation, who were super excited about the project and could help me rebuild my team and really just help rebuild my confidence as a nurse innovator.

whether you're an intrapreneur or an entrepreneur, when you run into barriers, that's a challenging spot to get past. And I think a lot of people question like, should I keep going? Am I the one to do this? How do I keep moving? So I think continuing to find people who had been in that space before, who had navigated it and could help me to do the same, that was so important as we

tried to figure out the next steps. And of course, I'm so glad that we did keep going, but looking back on it, you're like, man, that was really challenging in some moments to figure out how to move forward. So now with the product, we have it in routine clinical practice, so we're able to use it at Cincinnati Children's regularly. We also licensed the product to a company called Little Seed. They're a small startup in Columbus, Ohio, and they are currently working with multiple hospitals as early adopters.

and they plan for a commercial launch. It's really been amazing to work with their team because they are just as committed to the mission of this work as I am. Like, they're just super excited about the product and how it can have such an impact on our families and our patients. They also have the business skills to be able to take it forward.

So it's been a really cool partnership. It's a lot of fun to work with them and to learn from them. And we're just super excited to be able to make this available to any patient that could benefit.

Getting to share this story was so exciting. I got to work with our marketing and communications team and they put together a media release that shared that we had a commercialization partner that we were licensing this to. And like, great, they're going to put that out there. You know, we'll get to share the story. And that's awesome. Within a few days of them sharing that, we were contacted by WKRC Radio.

NPR, several local TV stations, USA Today. So almost immediately, I had to sort of learn how to communicate this story in a public way and really represent the hospital. And that was super exciting, but it also was like, oh wow, there's like more to learn here and more to learn really, really quickly.

I think that it's so important though, whatever opportunities were given, that we work with people who've done that before, who are able to give us that support and training because that's the only way that our stories get told. And so I had to push myself far outside my comfort zone.

to be able to do that but I think that it is just it's such a cool thing to represent Cincinnati Children's Hospital this amazing partnership that we had between a nurse innovator and colleagues from across the organization and getting to share what's possible for frontline innovation and

Every time I see the impact that this has for patients and families and even my own colleagues' kids and my own family, that's what I'm most proud of from this project is seeing it transform this experience and these outcomes for patients.

Towards the end of this project, I was so excited that we had found a commercialization partner. But because healthcare innovation is really a unique and growing space, I wasn't really sure what my next direction would be in innovation from a career standpoint.

So I became interested in developing a system that supports others who are looking to innovate in the healthcare setting because there are so many challenges, particularly when you're in the idea phase and you're just trying to get to something that could really be a solution that could positively impact

patients. It takes a lot of support and a lot of education and mentorship to be able to move through all of those early phases of innovation. And so I kind of had this rough idea of what I thought would be interesting, but I didn't really know what to do next with that. Back in 2021, the American Nurses Association put

put out an open call for nurses who would be interested in being a part of the Innovation Advisory Committee. And so I immediately was like, that sounds super cool. Technology and devices, working with nurses from across the country who are in this innovation space and working on all different types of challenges. That sounds awesome. So I applied to be a part of that committee and then was offered the opportunity to chair that committee. I was super honored, but also was like, I

I've not even chaired like a hospital committee, how am I going to chair a national committee? But again, kind of like I've done throughout this innovation process, I reached out to our chief nursing officer at Cincinnati Children's and just had a conversation and said, "I'm really excited about this. I want to do this. What advice do you have?" And she connected me with our vice president of patient services to support and mentor me as I was taking on this leadership role.

I recently had the opportunity to write an article with my colleagues from the American Nurses Association's Technology and Device Committee titled Patient Care Device Technology Transformation: Nurses Seek Partners to Achieve Patient Care Excellence.

And what we shared in this article was that patient care technology and devices are really embodiments of our care processes. So they have to seamlessly promote best practices. If not, the products can hinder the process, which can actually compromise patient care.

And this is particularly important to keep in mind as we integrate more complex technologies like AI and machine learning, because these types of innovations could dramatically help or do the complete opposite if they're not designed correctly. And so when I think about technology and devices, nurses intuitively understand our patients,

processes, workflows. And so for healthcare innovation, these are really critical insights to ensure that the best care is delivered. And so

So our technology devices team over the two years that we worked together developed a vision. And what we share is that nurses practicing in all facets of care are an integral part of the patient care technology and device ecosystem, acting as leaders in the research, design, development, selection, implementation, and improvement of such technologies and devices.

What I love about this vision is that this isn't just theoretical. Our committee members have put this into action and so many other nurses working in innovation have as well. And when I think back on my journey at Cincinnati Children's across all the different phases of innovation,

I've had the privilege of working with phenomenal teams who really embraced my expertise as a nurse practitioner and combine this with their expertise in design, engineering, computer programming, business, among other areas. It just takes so many different disciplines working together to design a

effective healthcare innovations. And when we all understand and respect each other's expertise, we create partnerships where innovation can thrive. And this really helps us to create the best solutions. Innovation requires

a unique approach that needs to work within the existing healthcare system, but it requires a structure that's really different than our other types of processes. Innovation has to be agile, creative, transformative. And so when we think about how do we build an innovation structure that works alongside all of the other things that we do that often have to have very strict protocols and procedures, with innovation you have to work to intentionally build a structure

that is able to be more flexible and be able to help support the outcomes that you're looking for with innovation. In the same way that our patients need nurses to deliver care to create the optimal healthcare system in the future, we need nurses to be key partners to help us transform the current system. The great news is that there are already so many nurses working in healthcare innovation who are making a big impact.

And nurses are the largest group of healthcare professionals in the world. And so I really believe that when nurses and healthcare organizations and industry and government, you know, when everyone recognizes the critical need to have nurses engaged as key partners in creating the future of healthcare, that every one of us will benefit.

Abby Hess is a nurse practitioner, intrapreneur, and clinical researcher at Cincinnati Children's Hospital and an assistant professor at the University of Cincinnati. Clinically, Abby works with the Department of Anesthesiology, blending patient care with research and innovation projects focused on reducing preoperative anxiety.

She also partners with Cincinnati Children's Chief Innovation Officer to support clinical innovation and empower frontline clinicians to drive meaningful change in healthcare. Abby co-chairs the American Nurses Association Innovation Advisory Committee for Technology and Devices. She was awarded the first Johnson & Johnson Nurses Innovate Quickfire Challenge

supporting the creation of a patented breathing-controlled video game device that's designed to ease anesthesia induction anxiety and introduce gameplay for a more relaxed and even fun experience for kids before surgery. So they roll into the OR saying, I'm ready to play, and wake up ready to level up.

You can find more information and links in our show notes at cunowpodcast.com, where you can check out our entire CU Now library of award-winning episodes. For CU Now, I'm Shawna Butler. Thanks for listening.

Nurses are transforming healthcare through innovation, compassion, and leadership. And Johnson & Johnson is proud to continue its 125-year commitment to champion nurses through recognition, skill building, leadership development, and more. The American Nurses Association is dedicated to building a culture of innovation

Nurses improve the lives of patients and communities through innovative thinking, empathetic connection, scientific rigor, and sheer determination. ANA is proud to support and advocate for our nation's most valuable healthcare resource, our nurses. For more information on See You Now and to listen to any of the earlier episodes in our library, visit seeyounowpodcast.com.