Taking a page from Thomas Edison: facilities trying to survive by innovating have a ready source of inspiration at hand.

Thomas Edison's numerous patents and inventions are among the most recognizable of the 20th century. He is credited with a mind-boggling 1,093 patents and inventions, more than any other individual in history. His rich legacy can serve as an inspiration to--and guide for--today's long-term care (LTC) professionals, who face daunting pressures and complexities. Here are some key elements of innovation that lie at the heart of Edison's ideas, and initiatives created by five LTC providers that exemplify their meaning.

Key Element 1: Creating a System of Innovation

"My main purpose in life is to make enough money to create ever more inventions...."

In 1871, Thomas Edison took the earnings from his first invention and leaped into the "innovation business" by setting up a lab whose sole function was to act as a "hothouse for innovation." Within a year it had grown into the largest scientific testing laboratory in the world, and by 1887, it was recognized as the world's first full-fledged Research and Development (R & D) center. This organizational system enabled Edison to simultaneously create many innovations. His own role at the lab developed into that of the innovative leader, as he oversaw the development of each team project.

Jefferson's Ferry, which includes The Bove Center, a 60-bed skilled nursing center with 20 beds allocated for dementia and Alzheimer's residents in Suffolk County, New York, exemplifies this innovation system approach. It instituted daily morning meetings for the management team, in which department heads discuss daily events and coordinate activities. They brainstorm on how to continually improve their quality of care. "Thanks to our commitment to open communication," says Administrator Donald Jacobowitz, "we've come up with a number of initiatives. For our dementia and Alzheimer's residents who are confined to their units, we've started a 'lunch-in' program. Every week, they go to the main cafeteria and are served as if they are eating at a restaurant. We also started a Caregiver Support Group, where caregivers and family members run monthly meetings and share ideas."

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The Bove Center's innovation system is functioning in a way that would make Edison proud.

Key Element 2: Understanding "Innovation"

"I never perfected an invention that I did not think about in terms of the service it might give others ... I find out what the world needs, then I proceed to invent...."

Invention and innovation share the same root, but they differ slightly from each other; the distinction is slight, but important. For example, Edison's very first invention was a voting system that enabled Congress to instantly poll votes. However, because Congress did not purchase this system, it did not qualify as a true innovation. An invention only becomes an innovation if it is implemented, finding a practical use.

This experience taught Edison the importance of first determining whether the market wanted or needed something before he set to work on a specific invention. He made a conscious attempt to peg his efforts to the needs of his environment and evaluated the chances of implementation before committing resources to a specific project.

Elant at Goshen, Inc., a 120-bed nursing home in Goshen, New York, recently replaced paper-based flowcharts with a computer care-tracking system for use by CNAs. The objective was to create a paperless system to monitor and coordinate resident care and minimize human error. "Generally, e-document systems have been for doctors or RNs," says Patti Vuolo, RN, vice-president for Clinical Affairs, "but our system allows CNAs to document the care they provide to the resident via a touch screen displayed on kiosks located in hallways. This system provides for documentation immediately after care is provided, which enhances accuracy." The nurse can check that all care is documented for each shift by accessing user-friendly graphs. This eliminates "missing documentation." The system is integrated with the MDS assessment tool required by the Centers for Medicare & Medicaid Services as part of reimbursement.

For Elant at Goshen, this was an invention for staff operations that definitely qualified as an innovation.

Key Element 3: Establishing Creative Equitability

"Genius is one percent inspiration and ninety-nine percent perspiration."

Often we think of R & D departments as elite groups of "creatives." Edison, however, downplayed the importance of the so-called creative impulse. According to his model of innovation, creativity is a by-product of hard work.

This idea of creativity as a commonplace attribute inherent in everyone, only waiting to be brought out, demystifies the innovation process, making it accessible to all. Establishing a culture of "creative equality" opens up innovation to the entire organization, allowing for a greater pool of idea-generators and innovation-producers.

The Victory Memorial Hospital includes a 150-bed skilled nursing center in Brooklyn, New York. Its Activities and Recreational departments are always looking to create a better environment for residents. Cynthia Neglia, public relations manager, says, "The staff is encouraged to come up with ideas to improve our residents' entertainment, morale, and sense of well-being." Some popular events that took place there recently include: a 1950s theme party, with staff dressed in outfits from that time and an appearance by an Elvis Presley impersonator; an Art Exhibit created by members of a local senior citizens group and displayed at the center along with works of the residents; and a surprise visit by Kathryn Crosby (Bing Crosby's widow and a trained nurse), who spent time with the residents while crooner Crosby's music played in the background.

Each of these events happened because a staffer had an idea.

Key Element 4: The Value of Restlessness

"I believe that restlessness is discontent, and discontent is merely the first necessity of progress."

Today, innovation is considered an integral part of product development, thanks to Edison. Smart organizations understand the necessity of continually reinventing and improving operations and processes. Even if your facility has "best of breed" operations now, it may not remain so indefinitely. By establishing a culture of restlessness, and being unwilling to accept what exists at the moment, staff members are driven both to find solutions to obvious challenges and to seek out areas of incremental improvement of processes and operations that currently function at an acceptable level.

The telegraph machine was a critically important communication device, yet because of his restless willingness to tinker, Edison developed his first successful invention, an improved stock ticker called the "Universal Stock Printer," which funded his first small laboratory.

The Hebrew Home for the Aged at River-dale in Riverdale, New York, has long offered comprehensive services and programs to its clients. Looking to refine its eldercare, however, the facility recently unveiled a new building that it believes will serve as a model for the construction of future nursing homes. "Our objective was to create a building that doesn't look or function like the conventional model of a nursing home, yet provides all the care needed," says Malka Margolies, communications director. "The first noticeable change was to eliminate the nursing station and replace it with private rooms that are sort of 'hidden' in the decor. Every floor is divided into four neighborhoods, with one kitchen and a dining area for every two neighborhoods. There is a library and spa on every floor. We also have the first aquatic therapy swimming pool in New York, if not the whole country."

In this way, an already reputable and well-established long-term care organization upgraded itself.

Key Element 5: The Value of Incremental Innovation

"I never pick up an item without thinking of how I might improve it."

Edison understood that innovation does not consist solely of new inventions; incremental innovations can be equally important. In fact, most of his patents and inventions were incremental innovations applied to his phonograph, battery, and electrical circuit devices.

As important as risk taking and striving to achieve great product/service innovations are today, striving for incremental innovations to present-day processes is similarly worthwhile. Just as Edison's incremental innovation to the lightbulb led to the centralized power system, today's initiatives may lead to innovations highly useful to the 21st century.

The Oceanside Care Center of Oceanside, New York, had to adjust the care it provided to its 100 residents because of changing demographics. The emergence of assisted living homes has led to major changes for the facility, in that today's nursing home residents tend to have higher care needs. As a result, Oceanside increasingly housed residents with Alzheimer's disease and dementia, along with numerous other serious diagnoses, says Kellie O'Connor, director of Admissions and Marketing. "We found," she says, "that these patients could not get their psychosocial needs met in the larger group activities we typically ran."

With only a limited amount of space available to create a separate environment for these residents, staff decided to turn the existing Family Room into a space for the Tender Loving Care (TLC) group. This program allows three to five staff members to work with approximately 12 residents in a familiar environment with activities that include music and cognitive and memory stimulation games. The team meets three times each week to discuss new patients.

This idea was conceived through an interdisciplinary team approach that saw a way to adjust to the needs of a new and growing resident population by reinterpreting its well-appointed Family Room.

Key Element 6: Innovating the Next Innovation Process

"Surprises and reverses can serve as an incentive for great accomplishment. There are no rules here, we're just trying to accomplish something."

What will it take for your facility to arrive at its next Innovation Process? For Edison, the only absolute was a commitment to achievement. For CNAs, it is a commitment to effectively using a facility's resources to create the best possible environment for residents--a commitment, in short, to change.

Edison was all about seeking change, about resourcefulness and about risk taking. Although few, if any, will ever surpass his incredible record of invention, every LTC professional can emulate his way of thinking. After all, reimagining the organization's Innovation Process isn't just a smart choice, it's the only choice for the healthcare professional.

Yael Sara Zofi is founder and CEO of AIM Strategies[R] (Applied Innovative Management[R]), a New York City-based consulting firm focused on bringing applied behavioral science techniques to managing businesses. She works with healthcare professionals in the areas of leadership development, management training, executive coaching, and team effectiveness. A professor at New York University, she designed and taught the courses "Leadership and Business Transformation," "Leadership and Management Skills," and "Management Principles and Ethical Practices." Saro Varjabedian is Office Coordinator and creator of communications for AIM Strategies. For more information, phone [phone] or visit www.aim-strategies.com. To send your comments to the authors and editors, e-mail [e-mail].

BY YAEL SARA ZOFI AND SARO VARJABEDIAN*

* The authors would like to thank Susan Meltzer for providing suggestions and editing this article.