Nursing Innovation: A CNS Shares Her Path to Inventions

Podcast Transcript

Carol Pehotsky (00:04):

Nurses are problem solvers every day, we have to be. But it can seem daunting to channel that problem-solving MacGyvering energy into the effort to build an active, actual physical innovation. I'm joined today by Jane Hartman to learn more about the process she took to move her ideas into actual innovation, and how these innovations are helping change nursing practice.

(00:32):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, associate Chief Nursing Officer of Surgical Services Nursing.

(00:53):

Welcome back everyone. If you remember back from an episode that we aired in October of this year, we had Karen Schaedlich on from the Office of Research Innovation. We talked about turning ideas into innovation, and even then, I talked about that mental hurdle that a lot of us have to go through that says like, "How do you come up with an idea? And then how do you take that idea into something that is real, that makes a difference?" And she talked about the reality is that m- most nurses have at least four workarounds a shift, and I'm still blown away by that information.

(01:23):

And one of the really helpful tips that she shared with us as an audience is, even something as simple as putting a notebook or a piece of paper in your pocket as you're walking through your day, you know, what are the things that get in the way of what you're doing, or that bug you, or keep coming? Just write it down, don't even think about it. And go back to that list, and what are the things that keep coming up? What are you passionate about? And that's where to focus in. What great advice that I know I haven't taken, (laughs) taken advantage of. But I'm joined by somebody today who has incredibly inquisitive and innovative mind, and I bet has done things like that. So, I'm joined today by my longtime friend and colleague, Jane Hartman. Jane is an advanced practice nurse and pediatric nurse practitioner at Cleveland Clinic. Welcome, Jane. How are you?

Jane Hartman (02:04):

I'm great. Thank you for having me.

Carol Pehotsky (02:04):

Of course.

Jane Hartman (02:06):

It's very exciting.

Carol Pehotsky (02:07):

So, it's pretty much an understatement when I say you have an inquisitive (laughs) and innovative mind. You've had a great career with us. Share a little bit, if you will, with our audience about your career in pediatric nursing and, and maybe sprinkle in a little bit of that inquisitive nature, and where it's taken you.

Jane Hartman (02:22):

Yeah. So, as a nurse, I've done many, many workarounds, not thinking that-

Carol Pehotsky (02:23):

(laughing)

Jane Hartman (02:27):

... actually, I could be the solution to the problem.

Carol Pehotsky (02:30):

Yeah.

Jane Hartman (02:30):

So, when Nancy Alpert said to me, she's like, "Why don't you do that?" I'm like, "Hmm, why, why don't I?" So, I did.

Carol Pehotsky (02:38):

(laughing)

Jane Hartman (02:40):

So that's how I came up with the initial idea to get IV tubing off the floor for pediatric patients.

Carol Pehotsky (02:46):

So, talk to me a little bit first though, about your nursing career.

Jane Hartman (02:49):

Oh, my nursing career-

Carol Pehotsky (02:49):

Yeah.

Jane Hartman (02:50):

So, I've been a pediatric nurse for 44 years this year.

Carol Pehotsky (02:53):

Oh, okay. (laughs) Congratulations.

Jane Hartman (02:54):

So, I've been around. Yes. Mostly all at the clinic. I did work at Rainbow Babies & Children's when I first got out of nursing school and there was no thought process about innovation because all I wanted to do is keep my head above the water at that point in time, like all new grads, right?

Carol Pehotsky (02:55):

(laughing)

Jane Hartman (03:10):

But I've always been very scientific. So, when I was a kid, when my friends were taking recorder classes, I was taking science classes in summer school-

Carol Pehotsky (03:21):

Okay.

Jane Hartman (03:21):

... just because I love, like a recipe, I love to bake because I love a recipe.

Carol Pehotsky (03:26):

Okay. (laughs)

Jane Hartman (03:26):

So, when I can change up the recipe to make things better, that makes me happy. And so, there are many things in this world that we do, because that's the way we've always done it.

Carol Pehotsky (03:39):

And that wasn't good enough for your mind?

Jane Hartman (03:41):

No-

Carol Pehotsky (03:41):

All right.

Jane Hartman (03:42):

... it's like, well, why do we have to do it that way? So that's how my mind works. Sometimes I lay in bed thinking, "Well, why is it like that?"

Carol Pehotsky (03:50):

We're going to talk about the High-Line innovation in a moment-

Jane Hartman (03:50):

Mm-hmm.

Carol Pehotsky (03:52):

... but rewind for us, please, at the bedside or in your nurse practitioner practice, what are some of those early moments where you said, "Why is it this way?"

Jane Hartman (04:01):

Yeah. So that's a really good question.

Carol Pehotsky (04:03):

(laughing)

Jane Hartman (04:04):

So, one of the things is when I was rounding for CLABSI and CAUTI-

Carol Pehotsky (04:09):

Okay.

Jane Hartman (04:09):

So CLABSI is a big word- (laughs)

Carol Pehotsky (04:10):

(laughing)

Jane Hartman (04:12):

... in our vocabulary and nursing and especially, and when I was working as a clinical nurse specialist in that role, I saw IV tubing on the floor, on the floor, on the floor, on the floor-

Carol Pehotsky (04:13):

Oh, boy. Okay.

Jane Hartman (04:23):

... I'm like, "What the heck?" So, but that was later on. Earlier in my career, oh, I, I would try to fix things, right? So-

Carol Pehotsky (04:23):

Okay.

Jane Hartman (04:31):

... you know, come up with ideas. So, an example of that is when, I worked at Fairview on the pediatric unit an- in the 80s, we would take little medication cups-

Carol Pehotsky (04:41):

Mm-hmm.

Jane Hartman (04:41):

... and cut them in half-

Carol Pehotsky (04:43):

Okay. (laughs)

Jane Hartman (04:43):

... and we would line the inside with tape so that they wouldn't be sharp-

Carol Pehotsky (04:47):

Okay.

Jane Hartman (04:47):

... and that was how we covered little kids IVs so that they could not-

Carol Pehotsky (04:52):

Oh, so wouldn't pick it.

Jane Hartman (04:53):

... pick it. Yes.

Carol Pehotsky (04:53):

Oh!

Jane Hartman (04:53):

And actually, a colleague of mine has a whole company based on that.

Carol Pehotsky (04:54):

(laughing)

Jane Hartman (04:54):

Yep.

Carol Pehotsky (04:58):

Okay.

Jane Hartman (04:59):

Yes. So that's-

Carol Pehotsky (05:00):

Your own prototype.

Jane Hartman (05:01):

Yeah. (laughs) So we did that without even thinking. We didn't think, "Why do we have to make this?" It never dawned on us that we could make that into something. So-

Carol Pehotsky (05:09):

So, you MacGyvered your own solutions?

Jane Hartman (05:11):

Exactly. Yes.

Carol Pehotsky (05:12):

Okay.

Jane Hartman (05:12):

We MacGyver a lot in-

Carol Pehotsky (05:13):

(laughing)

Jane Hartman (05:14):

... and especially in pediatrics because most things in medicine are designed for adult people.

Carol Pehotsky (05:22):

Oh. Yeah.

Jane Hartman (05:22):

So, we have to MacGyver things to make them fit the pediatric population. Pajamas, (laughs) you would think that wouldn't be a problem, but it is. It's all kinds of things that are pediatric beds, clothing, needles. And especially thinking back to my career in the '80s-

Carol Pehotsky (05:43):

Mm.

Jane Hartman (05:43):

... I mean, there was-

Carol Pehotsky (05:44):

Yeah,

Jane Hartman (05:44):

... you know, it's a totally different ball game now.

Carol Pehotsky (05:46):

But it's a good point, it adds that extra layer on, on what Karen shared with us is that, you know, if you find yourself looking for MacGyvered-type solution, that might be a great next place to think about. If I'm having to, (laughs) to get really creative, I need to either look out there to see is there something else available, and work with my local leadership to see if we can get that device and/or turn internally and say, "We need a better product that doesn't exist."

Jane Hartman (06:13):

Exactly. And I tell my nurses, I, you know, I'm also a facilitator for Magnus.

Carol Pehotsky (06:18):

Mm.

Jane Hartman (06:18):

And I tell them, I said, "If you're doing a workaround, you're innovating."

Carol Pehotsky (06:23):

Right.

Jane Hartman (06:23):

So that's how you change to new products, different products. And for many, many years we've just offered our knowledge and information to medical device companies and say, "Oh, this could be better." And then they go and create it or change it, and when it's actually our idea.

Carol Pehotsky (06:24):

Yeah.

Jane Hartman (06:42):

So intellectual property for me is very important.

Carol Pehotsky (06:45):

Certainly.

Jane Hartman (06:45):

Yes.

Carol Pehotsky (06:46):

And so, innovation can be a project or can be a workflow. So, you've also innovated in that space as well, can you tell our audience-

Jane Hartman (06:54):

I have. Yeah.

Carol Pehotsky (06:55):

... a little bit about the IV protocol you created.

Jane Hartman (06:57):

Right. So that is a process. So, innovations, you know, our process or product, and there's two other, that paradigm changes.

Carol Pehotsky (07:05):

Mm-hmm.

Jane Hartman (07:05):

And so, my process, so when I first took it on the role as a clinical nurse specialist, they had two big problems in the Children's Hospital, one was the Pneumococcal Vaccination-

Carol Pehotsky (07:17):

Mm.

Jane Hartman (07:17):

... that was coming out. And actually, I created a vaccine card for that, but (laughs) that was, (laughs) for it to h- make it easier for nurses to realize when a child needed a Pneumococcal Vaccine.

Carol Pehotsky (07:29):

Oh, okay.

Jane Hartman (07:29):

So, it was a yes, no little thing. It was a little pocket card-

Carol Pehotsky (07:29):

Like algorithm. Okay.

Jane Hartman (07:33):

Yeah. It was a little algorithm pocket card-

Carol Pehotsky (07:33):

Wow. All right.

Jane Hartman (07:34):

... that they used 'cause that was l- self-limiting 'cause once the kids were vaccinated, we didn't need that anymore. However, the other problem was in vascular access. So, we were getting feedback from our parents that we were not doing such a great job with vascular access in the children's hospital. Actually, we had done a survey, and we found out that only 50% of the time we were getting IV access on first attempt success, and we needed to do better. We know it's important for children to have IV access with the first attempt. So, they wanted me to fix it.

Carol Pehotsky (07:35):

(laughing)

Jane Hartman (08:08):

I mean, that's why, they're like, you're, "Can you fix this?"

Carol Pehotsky (08:09):

Here, go.

Jane Hartman (08:10):

I'm like, well, fortunately for them-

Carol Pehotsky (08:10):

(laughing)

Jane Hartman (08:12):

... I am an expert in vascular access. I, I cannot play the piano, but I can start an IV, I'm pretty much any size-

Carol Pehotsky (08:19):

(laughs) We all have our talents.

Jane Hartman (08:20):

... patient. Yes.

Carol Pehotsky (08:20):

(laughing)

Jane Hartman (08:21):

And so, at first, when we started out, I thought, "Well, I, just call me when you need an IV started." Well, I soon realized that. (laughs)-

Carol Pehotsky (08:21):

(laughing)

Jane Hartman (08:29):

... "Hmm, this is just not going to be the solution to that." So, I came up with, first of all, it was a guideline to help direct nurses 'cause I was getting called for IVs, and I'd start the IV and then the patient would be discharged later in the day.

Carol Pehotsky (08:42):

Oh, gosh.

Jane Hartman (08:43):

So, I'm like, they, they're not thinking, they're just thinking of this as a task. So, the vascular access algorithm is a paradigm change to think of vascular access as a process instead of a task.

Carol Pehotsky (08:56):

Okay.

Jane Hartman (08:56):

Because we as nurses love to check off those boxes. And if we don't, we keep doing the same thing over and over and over and over. So, I came up with this guideline, and it was on like a poster. And I was working with John Baker back then, he was the assistant director-

Carol Pehotsky (09:14):

Okay.

Jane Hartman (09:14):

... for, of the Children's Hospital.

Carol Pehotsky (09:15):

Okay.

Jane Hartman (09:16):

And he said, "Jane, there's a lot of words on here."

Carol Pehotsky (09:18):

(laughing)

Jane Hartman (09:18):

I said, (laughs) he said, "I don't think they're going to read this." I said, "Well, it's pretty basic." He said, "Well, let's see if I can make..." So, he, he went back to his office, and he put it into an algorithm form. He said, "Is this what you're thinking?" And I'm like, "Oh my gosh." That was so enlightening and so exciting 'cause then that was the basis. And then, of course, it got around changed many, many times over the course of where we are now. So that algorithm is actually available in Flintbox for other hospitals to purchase.

Carol Pehotsky (09:50):

Wonderful.

Jane Hartman (09:50):

Yes.

Carol Pehotsky (09:50):

And so, so it took, it works through, who should be doing it, how many times?

Jane Hartman (09:53):

Right. So, the, the idea is to pair the right person's vascular access skill-

Carol Pehotsky (10:00):

Yes.

Jane Hartman (10:00):

... with the necessity of the child. So, they get a score. So, we also created the pediatric IV difficulty score, which is part-

Carol Pehotsky (10:07):

Yes.

Jane Hartman (10:08):

... of the algorithm. So, if a child scores 7 to 10, we know that child's a pretty easy start. So that means a novice nurse gets one try-

Carol Pehotsky (10:08):

Okay.

Jane Hartman (10:15):

And if they don't get it on one try, they have to escalate. And then child that scores 11 to 13, they're a moderate difficulty. So, a novice nurse doesn't even get to try-

Carol Pehotsky (10:15):

Mm. Okay.

Jane Hartman (10:26):

... they have to go to someone that's proficient. If they don't get it, then they have to escalate. And a child that s- scores 13 or higher, they automatically need a, an expert 'cause we know that if they don't, we're not going to get it on first try. And that's the gold standard, nobody wants to say, "Oh, well we get it right one out of two times." In pediatrics, you have one try to get it right-

Carol Pehotsky (10:26):

Barely. (laughs)

Jane Hartman (10:50):

And if you don't get it right-

Carol Pehotsky (10:50):

Yeah.

Jane Hartman (10:51):

... then it's not a good show.

Carol Pehotsky (10:53):

No. No.

Jane Hartman (10:53):

So, and, and you know, I want to do what's right. And the pushback I got was, "Well, how, how are we going to learn?" Well, honestly, I don't want you to learn on my 2-year-old, and I don't think you want me to learn on your 2-year-old-

Carol Pehotsky (10:53):

No.

Jane Hartman (11:04):

... so, let's find a way to make this better for everyone. Not set up the nurses for failure. It used to be you get two, you get two, you get two, you get two. And it didn't matter what your skill level was, we didn't think about it, we didn't think of it as a process-

Carol Pehotsky (11:04):

Right.

Jane Hartman (11:18):

... we thought of it as a task. Again, most important thing about the vascular access algorithm is that, think big, think of it as a process, move through the algorithm, and do the right thing for the patient.

Carol Pehotsky (11:29):

Well, certainly. And, and thinking that holistic piece of, I don't even think as an adult, I don't want 10 sticks because five different nurses got two shots at it either. And so really taking that bigger picture, that's wonderful.

Jane Hartman (11:40):

Right. Yeah. When I first came on as a clinical nurse specialist, and realized this was a problem. Actually, one of our pediatricians said, "I want you to put build-in stops in this algorithm."

Carol Pehotsky (11:50):

Mm-hmm.

Jane Hartman (11:51):

And she said, "I, we need to be called if there's a problem." I'm like, "Oh, I didn't even think about stopping to call the doctor, you know?" And she said, "This is the reason why, I was here all night the other night, and a baby got poked 17 times."

Carol Pehotsky (12:05):

Oh, gosh.

Jane Hartman (12:05):

... 17 times. She said, "We need to know," because there are other things, again, we get at- caught in that task, task, task. "Oh my, the next nurse coming on is going to be mad at me, and that kind of thing." And we have to stop that.

Carol Pehotsky (12:19):

Well, congratulations.

Jane Hartman (12:19):

Thank you. (laughs)

Carol Pehotsky (12:20):

But the diff- well, just, yeah. As, as a parent, the, the thought that thankfully touchwood, my child does not need it an IV, but knowing that-

Jane Hartman (12:21):

Yeah.

Carol Pehotsky (12:28):

... if and when she does, she's going to have a whole different experience because of you, that's amazing.

Jane Hartman (12:34):

It is. It's a, it's so gratifying. Can I t- I want to just say one cute little story-

Carol Pehotsky (12:38):

Please.

Jane Hartman (12:38):

So, I was working at Fairview in the newborn nursery seeing a new baby-

Carol Pehotsky (12:42):

Mm-hmm.

Jane Hartman (12:42):

... and it happened to be one of our nurses who works on the vascular access team. And she told me what she did, I said, "Oh, I'm Jane Hartman." She said, "Oh my gosh."

Carol Pehotsky (12:52):

The Jane Hartman.

Jane Hartman (12:53):

She said, "I just looked at your algorithm," that just made me so happy. I, it takes a long time to change a culture-

Carol Pehotsky (13:00):

Mm-hmm.

Jane Hartman (13:00):

... and believe me, you can get very like, oh, why, why bother? Why do this? It takes years and years and years. And now the fruits of my labor are just being recognized a- over time.

Carol Pehotsky (13:01):

It's amazing.

Jane Hartman (13:11):

It is, it's so-

Carol Pehotsky (13:11):

Yeah.

Jane Hartman (13:12):

... it's so gratifying. Really, it's, it's not even about making money, it's about changing to make patient care better.

Carol Pehotsky (13:19):

And so that wasn't enough. (laughs)

Jane Hartman (13:21):

(laughing)

Carol Pehotsky (13:24):

And so, another problem that was bothering you, we, we've mentioned it a little bit. And then a pandemic happens.

Jane Hartman (13:29):

Right.

Carol Pehotsky (13:30):

And you start connecting dots between this problem that was bothering you, and its impact in a pandemic. So, tell us a little bit more about the High-Line-

Jane Hartman (13:38):

Mm-hmm.

Carol Pehotsky (13:39):

... where it started, and then where it went during the COVID-19 pandemic.

Jane Hartman (13:44):

So, it started as my observation that kids drag IV tubing on the floor, and especially little kids that have leukemia-

Carol Pehotsky (13:53):

Oh.

Jane Hartman (13:53):

... 'cause they have central lines that are coming out of their chest-

Carol Pehotsky (13:55):

Okay.

Jane Hartman (13:56):

... so, everything is down. And then we add adult-sized IV tubing-

Carol Pehotsky (14:00):

Oh gosh.

Jane Hartman (14:00):

That's six feet long. IV tubing only comes in one length, six feet. So now you've got little kids walking on to the bathroom. And then they got the parents wrapping it around their hands, hanging on, help- helping them wipe. I mean, I'm like, I'm like, "This is, there's got to be a better solution to this." So actually, I had talked to Nancy about it, and she said, "You know, why don't you invent something?" I'm like, "Oh." because one of our GI docs, uh, Vera Upert, she's like, "Why isn't there something to keep this IV tubing off the floor?" And then when I said that to Nancy, she said, "Well, you would invent it," so-

Carol Pehotsky (14:35):

(laughing)

Jane Hartman (14:35):

I went into my-

Carol Pehotsky (14:37):

Oh well, [inaudible 00:14:38]- (laughs)

Jane Hartman (14:37):

... I'm like, "Okay." So, I went into my office and in my drawer, you know, of the forks and the s- you know, v-

Carol Pehotsky (14:38):

(laughing)

Jane Hartman (14:44):

... you know what's in your dust drawer?

Carol Pehotsky (14:46):

Oh, no. (laughs)

Jane Hartman (14:46):

... salt and pepper, all kinds of stuff. I found a badge holder with a retractable cord-

Carol Pehotsky (14:46):

Okay.

Jane Hartman (14:53):

... 'cause I was thinking, I want something that moves, and a piece of twill tape. I have no idea why that was in there. And, um, stainless steel metal ring, and those three things were the beginning of the High-Line.

Carol Pehotsky (15:04):

Okay.

Jane Hartman (15:05):

(laughing)

Carol Pehotsky (15:06):

I'm having a hard time picturing that-

Jane Hartman (15:07):

Yes.

Carol Pehotsky (15:07):

... you'll have to humor me. (laughs)

Jane Hartman (15:08):

Yes. So, what I did is, I took the badge holder, and I put the metal ring through the loop that actually holds the badge. And then when you submit an IDF, you have to have something to show them, you know, uh-

Carol Pehotsky (15:23):

What's an IDF?

Jane Hartman (15:24):

An idea, yeah. What the idea is.

Carol Pehotsky (15:24):

Okay.

Jane Hartman (15:26):

So, I taped it to the wall-

Carol Pehotsky (15:28):

Okay.

Jane Hartman (15:28):

... and I said, "The ring will go over the IV pole-"

Carol Pehotsky (15:32):

Okay.

Jane Hartman (15:32):

... and then the twill tape was attached to the little alligator clip-

Carol Pehotsky (15:36):

Okay.

Jane Hartman (15:36):

... and that made a loop, and then that would become the holder for the IV tubing.

Carol Pehotsky (15:40):

Ah, okay. All right.

Jane Hartman (15:41):

So, I did that and submitted. And they were actually pretty good about it, but they weren't getting it. So, then they said, "We need different materials." So, they let me go to medical engineering and get some parts and pieces, and-

Carol Pehotsky (15:54):

What was that like? (laughs)

Jane Hartman (15:56):

Uh, it was really interesting-

Carol Pehotsky (15:57):

Okay.

Jane Hartman (15:57):

... they were really great. They were like here-

Carol Pehotsky (15:58):

Yeah.

Jane Hartman (15:59):

... because I explained to them what I wanted. If you're not a nurse, you don't get it, and they weren't getting it, and I, I very-

Carol Pehotsky (16:05):

I'm struggling, and I am one. (laughs)

Jane Hartman (16:08):

(laughs) There was no nurses in innovation then-

Carol Pehotsky (16:08):

Yeah.

Jane Hartman (16:10):

... and they do have two actually-

Carol Pehotsky (16:12):

Mm-hmm.

Jane Hartman (16:12):

... which is fantastic. So, after that, and we tried to put something together and it just didn't work, they said, "Well... They, so I got rejected twice, but I was sitting at an innovation dinner 'cause once you have an IDF, they let you come-

Carol Pehotsky (16:26):

Oh.

Jane Hartman (16:26):

... and do these dinners and they're pretty nice.

Carol Pehotsky (16:28):

Okay.

Jane Hartman (16:28):

So, (laughs) so I was sitting next to Sarah Stamp, who actually-

Carol Pehotsky (16:32):

Mm-hmm.

Jane Hartman (16:32):

... works in innovations. And I said to her, I said, "I'm so disappointed that you're not taking my idea for the IV tubing holder." And she said-

Carol Pehotsky (16:40):

You are resilient and persistent, my friend-

Jane Hartman (16:40):

I know. (laughs)

Carol Pehotsky (16:42):

... I love it. (laughs)

Jane Hartman (16:43):

I really don't take no for an answer very well. And she said, "Not yet."

Carol Pehotsky (16:48):

Ah, the power of yet.

Jane Hartman (16:50):

Ah. I said, "I didn't know that there was a not yet." So, then I went home, and I said to my son, "I need a 3D printing of my idea." So-

Carol Pehotsky (17:01):

Okay.

Jane Hartman (17:02):

... he said, "Mom, what do you want?" So, I explained it to him, I gave him some IV tubing, I told him what I wanted. He went home and did a 3D printing and brought it back. And then I resubmitted that to innovation. Ah-

Carol Pehotsky (17:14):

Aha!

Jane Hartman (17:14):

... now we're speaking their language-

Carol Pehotsky (17:16):

All right.

Jane Hartman (17:16):

... now we have a CAD drawing.

Carol Pehotsky (17:18):

Nice.

Jane Hartman (17:19):

And then that changed everything.

Carol Pehotsky (17:21):

And where was that along the way of the pandemic and (laughs)-

Jane Hartman (17:25):

Okay. So yeah. So, then we- so with, with that, then they gave me-

Carol Pehotsky (17:26):

Mm-hmm.

Jane Hartman (17:29):

... a $5,000 grant-

Carol Pehotsky (17:31):

Okay.

Jane Hartman (17:31):

... and a medical engineering made me 25 prototypes, so this is now prototype number four that we're working on.

Carol Pehotsky (17:37):

Okay. Okay.

Jane Hartman (17:38):

I was going to do a nursing research study in the Children's Hospital to see if nurses liked it if it actually kept IV tubing off the floor. It was more-

Carol Pehotsky (17:47):

So, feedback plus.

Jane Hartman (17:48):

Correct.

Carol Pehotsky (17:48):

Okay.

Jane Hartman (17:49):

Yes. And anytime you're doing an innovation, you really do want to do research-

Carol Pehotsky (17:49):

Sure. Of course.

Jane Hartman (17:54):

... 'cause you want to prove that it works.

Carol Pehotsky (17:56):

Yeah.

Jane Hartman (17:56):

If it doesn't work, nurses aren't going to use it. If it's not valuable to nurses, they won't use it. So, we wanted to make sure it was going to be valuable to them. So, I had 25 of these made for my $5,000. The purpose was to hold one IV lines because-

Carol Pehotsky (17:56):

Okay.

Jane Hartman (18:12):

... I was to get that IV line off the floor for these, particularly these, uh, HEMON kids that were on chemotherapy.

Carol Pehotsky (18:18):

Okay.

Jane Hartman (18:20):

And so, literally had IRB approval, was getting ready to start the study, and I saw the pictures coming out of our ICU and I said-

Carol Pehotsky (18:29):

(laughs) Wow.

Jane Hartman (18:30):

... "Oh my gosh." And I ran up to Nancy's A- Albert's office, I said, "Nancy, look at this picture." And she goes, "Oh, we can help."

Carol Pehotsky (18:38):

Yeah.

Jane Hartman (18:39):

And she made one phone call to Kelly Hancock, and the next day we were in our, we were a go-

Carol Pehotsky (18:39):

Was then our executive nurse, yeah. Yeah.

Jane Hartman (18:45):

Yes. And we were a go after that.

Carol Pehotsky (18:45):

Okay.

Jane Hartman (18:46):

The next morning, I met with engineering, and for prototyping with innovations. And on top of that we started 3D printing all these cradles, and just hand tying them together to silicone and stretchy material to help out the nurses in the ICUs. So, we would hand-do these, so at-

Carol Pehotsky (19:05):

Sure, this is a, here uses if it helps.

Jane Hartman (19:07):

(laughs) Exactly.

Carol Pehotsky (19:08):

Here we go. Okay.

Jane Hartman (19:09):

And I would walk in with like 300-

Carol Pehotsky (19:09):

Mm-hmm.

Jane Hartman (19:11):

... and they would be gone in a minute, they all wanted them. Uh, because as you know, we put the pumps in the hallway-

Carol Pehotsky (19:17):

Mm-hmm.

Jane Hartman (19:18):

... and the IV tubing, and there was at least seven lines-

Carol Pehotsky (19:22):

Yeah.

Jane Hartman (19:22):

... I mean, it was just enormous. And the nurses were very innovative, they put them in pool noodles.

Carol Pehotsky (19:28):

(laughing)

Jane Hartman (19:28):

I thought, "Wow, that's actually-

Carol Pehotsky (19:28):

That's clever. Yeah.

Jane Hartman (19:30):

... that's pretty clever-

Carol Pehotsky (19:30):

It's super clever.

Jane Hartman (19:31):

... just to kind of keep them together.

Carol Pehotsky (19:33):

Yeah. Yeah.

Jane Hartman (19:34):

The thing is that different doors open differently. Believe me, not all I-

Carol Pehotsky (19:39):

All the ICU doors?

Jane Hartman (19:40):

Yes, the ICU doors-

Carol Pehotsky (19:41):

Oh, sure.

Jane Hartman (19:41):

... some slides, some go like that, you know.

Carol Pehotsky (19:41):

Yeah. Yeah.

Jane Hartman (19:43):

So that was challenging. But the nurses really used them. And, uh, I was in the house like in an evening one time, and I was over on the G elevators, and I was chatting with one of the nurses who said, "Oh, do you work in the ICU?" And she said, "Yeah." I said, "Oh." I said, "I'm Jane Hartman, I invented the High-Line."

Carol Pehotsky (19:43):

(laughing)

Jane Hartman (19:59):

And she looked at me, I said, "You know, the, the m- the little things that keep your IV tubing off the floor." She goes, "Oh my gosh," she said-

Carol Pehotsky (19:59):

(laughing)

Jane Hartman (20:06):

"The f- when I know I'm getting a patient, uh, the first thing I do is go get some High-Line so that I have them set up in the room."

Carol Pehotsky (20:12):

There you go.

Jane Hartman (20:12):

So-

Carol Pehotsky (20:13):

So certainly not a controlled research study.

Jane Hartman (20:16):

No. But-

Carol Pehotsky (20:18):

(laughs) But, okay.

Jane Hartman (20:18):

... it was-

Carol Pehotsky (20:18):

Okay.

Jane Hartman (20:19):

... because what we did, we got expedited approval f- through IRB-

Carol Pehotsky (20:22):

Okay.

Jane Hartman (20:23):

... to now study the High-Line in the ICUs.

Carol Pehotsky (20:26):

So, you're still able to get that feedback?

Jane Hartman (20:27):

Yes, yes. So, we have a published article.

Carol Pehotsky (20:30):

Okay.

Jane Hartman (20:30):

Yes.

Carol Pehotsky (20:31):

People were getting creative on top of that. So, what kind of feedback did you get from your end users then?

Jane Hartman (20:35):

Well, the first time when, when we just had the single, uh, holders.

Carol Pehotsky (20:39):

Yeah.

Jane Hartman (20:39):

... that, the first thing the nurses said, it's like they need to hold more than one line.

Carol Pehotsky (20:39):

Fair. Yeah.

Jane Hartman (20:42):

Because I actually, we used them on our first patient that had COVID here.

Carol Pehotsky (20:46):

Really?

Jane Hartman (20:47):

And they used like eight of them.

Carol Pehotsky (20:49):

Oh, I'm sure. Yeah.

Jane Hartman (20:49):

Yeah. That they said, "These are great, but there, they need to be more." So, we took all the nurses' feedback, they were very, very helpful. And that's one thing when I do speak about innovation and me, I did just present in Scotland, and I said-

Carol Pehotsky (21:02):

[inaudible 00:21:02]

Jane Hartman (21:02):

... "Nursing feedback absolutely essential that you pay attention to that." Nurses, they will let you know, (laughs)-

Carol Pehotsky (21:09):

We're not shy.

Jane Hartman (21:12):

They, they're not shy. (laughs)

Carol Pehotsky (21:12):

(laughing)

Jane Hartman (21:12):

Yeah. They'll let you know, it's like the worst thing in their mind, "We're not going to use that." Or, you know, if it's valuable to them.

Carol Pehotsky (21:17):

Yeah.

Jane Hartman (21:17):

Again, yes. I've also done research on the algorithm as well.

Carol Pehotsky (21:21):

Yeah.

Jane Hartman (21:21):

Yes. And the pediatric IV difficulty score, all those have research articles associated with them.

Carol Pehotsky (21:27):

Sure. So, it's not just a feel good thing, it's a-

Jane Hartman (21:29):

Right. S-

Carol Pehotsky (21:30):

... feedback is taken in, and so that feedback that you got-

Jane Hartman (21:33):

Mm-hmm.

Carol Pehotsky (21:33):

... any iterations on that High-Line product based on that feedback?

Jane Hartman (21:37):

Uh, well, the multiple lines easy to use.

Carol Pehotsky (21:40):

Mm-hmm.

Jane Hartman (21:40):

When we actually did finally get the prototypes from a prototyping lab, we color coded-

Carol Pehotsky (21:45):

Oh.

Jane Hartman (21:46):

... so that they would be able to follow their lines-

Carol Pehotsky (21:46):

Nice.

Jane Hartman (21:49):

... if you have a presser and you want that to be in red-

Carol Pehotsky (21:51):

Ah.

Jane Hartman (21:51):

... then you follow that all the way through, 'cause sometimes you'd have to use more than one set. So, you'd have to have-

Carol Pehotsky (21:52):

Sure.

Jane Hartman (21:56):

... use a set in the room and a set outside the room to kind of make like a, almost like a clothesline kind of thing. And the other thing was that we offered it to other health systems-

Carol Pehotsky (22:06):

Mm-hmm.

Jane Hartman (22:06):

... and we sent them-

Carol Pehotsky (22:07):

Oh, even before it was commercially available.

Jane Hartman (22:08):

Oh, yes. Yes. So, to help out with COVID-

Carol Pehotsky (22:08):

Yeah.

Jane Hartman (22:11):

... I sent it to several states-

Carol Pehotsky (22:13):

That's wonderful.

Jane Hartman (22:14):

and, um, more than once to, uh, New Jersey, Detroit, the East coast, the West coast, I mean, yeah. I mean, we offered help to them. Yes.

Carol Pehotsky (22:23):

And it is now commercially available.

Jane Hartman (22:24):

Well, it's not-

Carol Pehotsky (22:26):

Okay. (laughs) Not yet.

Jane Hartman (22:27):

(laughs) That's one thing about innovation is that-

Carol Pehotsky (22:28):

Yeah.

Jane Hartman (22:29):

... you know, there's lots of ups and downs. And we had a company that was going to commercialize it, and they have since declined. So now we are looking to commercialize it still, and that's okay.

Carol Pehotsky (22:41):

That's okay.

Jane Hartman (22:41):

... you know, sometimes when you have a letdown, it turns into something positive.

Carol Pehotsky (22:45):

That's right.

Jane Hartman (22:45):

Right. And that's what happens, especially in innovation, there's a great book called What Do You Do With An Idea?

Carol Pehotsky (22:51):

Okay.

Jane Hartman (22:52):

And it's a kid's book, but it, it explains very nicely the ups and downs of innovating 'cause people will call you crazy. People will say, "That's the craziest thing I ever had. That's stupid." That kind of thing in this book, and it's just so delightful. But at the, the last page, like what you do with an idea, you change the world.

Carol Pehotsky (23:12):

I mean, (laughs)-

Jane Hartman (23:12):

(laughing)

Carol Pehotsky (23:15):

... listen, I'm not often speechless-

Jane Hartman (23:17):

(laughing)

Carol Pehotsky (23:17):

... but I don't think I can follow, follow up with that. You, you have changed the world, Jane Hartman, when I think about the infections you helped prevent-

Jane Hartman (23:25):

Mm-hmm.

Carol Pehotsky (23:26):

... and the incompatible medications you prevented-

Jane Hartman (23:29):

Mm-hmm.

Carol Pehotsky (23:30):

... with the High-Line and the s- the needless sticks you prevented. Congratulations-

Jane Hartman (23:30):

Thank you.

Carol Pehotsky (23:34):

... what a life well-lived.

Jane Hartman (23:35):

Yeah. Thank you, I-

Carol Pehotsky (23:37):

I'm getting choked up over here.

Jane Hartman (23:37):

I'm still working on it-

Carol Pehotsky (23:37):

Yeah.

Jane Hartman (23:39):

I'm still innovating.

Carol Pehotsky (23:40):

Yes. So, we are very blessed here at Cleveland Clinic to have an innovations department. We have listeners who are nursing students-

Jane Hartman (23:47):

Mm-hmm.

Carol Pehotsky (23:48):

... mid-career and career-

Jane Hartman (23:49):

Mm-hmm.

Carol Pehotsky (23:49):

... who aren't at Cleveland Clinic.

Jane Hartman (23:50):

Mm-hmm. Mm-hmm.

Carol Pehotsky (23:51):

You've inspired them too.

Jane Hartman (23:52):

Uh-huh.

Carol Pehotsky (23:53):

And they don't have an innovations department-

Jane Hartman (23:55):

Mm-hmm.

Carol Pehotsky (23:55):

... what advice would you give them?

Jane Hartman (23:57):

Oh, wow. So, the first advice I would give you, and that, I got this actually from Tim Brown, he's the CEO of IDEO, which is a design company-

Carol Pehotsky (24:07):

Oh, yeah.

Jane Hartman (24:07):

... in England actually.

Carol Pehotsky (24:07):

Mm-hmm.

Jane Hartman (24:08):

And I wish I had heard; he actually spoke at the Cleveland Clinic.

Carol Pehotsky (24:12):

Yes.

Jane Hartman (24:12):

And he, it was fantastic. And the one of the things that he said, he said, "Don't try to sell something until you have a small prototype, because it might not work." And I thought, "That is great advice." If I had done that at the very beginning, had a working prototype, I just didn't know. You learn as the process goes on-

Carol Pehotsky (24:12):

Yeah.

Jane Hartman (24:33):

... and I did learn that I did need a working prototype that had a CAD drawing, that people can understand. And so, with that small prototype that I had, my son made, I showed the nurses.

Carol Pehotsky (24:34):

Mm-hmm.

Jane Hartman (24:45):

And they're like, "That's a great idea." And that's what kept me going, because I would tell nurses, and they would all say, that's a great idea. No one said, that's as stupidest idea, no nurse said that.

Carol Pehotsky (24:45):

Mm-hmm.

Jane Hartman (24:57):

Now, I heard that from many other people-

Carol Pehotsky (24:57):

(laughing)

Jane Hartman (24:59):

... but nurses, n- none of them said, that's a stupid idea.

Carol Pehotsky (24:59):

Yeah.

Jane Hartman (25:02):

So, they, they really helped me move forward.

Carol Pehotsky (25:06):

So, help, it helps have an innovation department, but even if your place doesn't have one-

Jane Hartman (25:06):

Oh, yes.

Carol Pehotsky (25:09):

... keep writing down those ideas and asking those questions and asking your colleagues and getting that feedback and persistence.

Jane Hartman (25:16):

Yeah. Oh, you have to be persistent. Yeah. You can't take no for an answer, I-

Carol Pehotsky (25:20):

For sure.

Jane Hartman (25:21):

... and every- anyone who's ever worked (laughs) with me know that I do not take no for an answer very well.

Carol Pehotsky (25:21):

(laughing)

Jane Hartman (25:27):

... or at all.

Carol Pehotsky (25:27):

At all.

Jane Hartman (25:28):

Yeah. Uh, and Mary Beth Modic says, "If someone says no to you, just find somebody else." (laughs) that's-

Carol Pehotsky (25:36):

(laughs) Well, we're, we're coming to the end of our time together, and at the end, I like to ask a fun question to help our audience get to know you as an amazing human being, as well as a subject matter expert. You had mentioned that you like to cook and to bake.

Jane Hartman (25:49):

Mm-hmm.

Carol Pehotsky (25:50):

So, I'm curious, what's your favorite thing to make and how have you tweaked it up?

Jane Hartman (25:53):

Okay. Well, this is great. So just an FYI didn't, I made my, uh, son's wedding cake.

Carol Pehotsky (25:59):

Oh. Oh, my.

Jane Hartman (25:59):

So, I mean, yeah. That, and I've learned a, a lot since then. Like, I, I actually am making another wedding cake in May for a very good friend of mine, but I love to bake cookies. So, I make oatmeal cookies as my specialty. And I have learned how to make those exactly perfect, so I cooked them on a stone-

Carol Pehotsky (26:18):

(laughs) Oh.

Jane Hartman (26:18):

... I know the exact amount, I use parchment, I watch my timer. So, when the stone gets hot, it might be 14 minutes to start with, and then the second batch will be 12, and then we'll go down to 10-

Carol Pehotsky (26:18):

(laughing)

Jane Hartman (26:30):

... I mean, yeah. I mean, I've always been very scientific about that. It's not like, oh, 14 minutes, put the timer on and walk away. No. Yeah. So, you learn. And I love to make many cookies, but people want my oatmeal cookies. I'm like, "Can't I make something else?" (laughs)

Carol Pehotsky (26:46):

I mean, you can make anything for me.

Jane Hartman (26:46):

Yeah. (laughs)

Carol Pehotsky (26:46):

(laughing)

Jane Hartman (26:49):

I am, and me and my college roommate are doing a cookie table for my dear friend, and we're doing 150 dozen cookies for this wedding.

Carol Pehotsky (26:58):

Wow.

Jane Hartman (26:59):

Yea.

Carol Pehotsky (26:59):

How long will it take you to make that many cookies?

Jane Hartman (27:00):

Well, yeah, we're going to do 25 dozen, 6 dozen each. So, it just depends on the type of cookie, so like, I'll make like oatmeal cookies that will take me three hours to do my oatmeal cookies.

Carol Pehotsky (27:01):

Oh, my.

Jane Hartman (27:11):

So, three times, however many we have to do. So, but fun.

Carol Pehotsky (27:16):

Yes.

Jane Hartman (27:16):

Yes.

Carol Pehotsky (27:17):

Well, thank you so much for joining me today.

Jane Hartman (27:18):

Oh my gosh, what a blast.

Carol Pehotsky (27:20):

(laughing)

Jane Hartman (27:20):

Thank you so much for having me.

Carol Pehotsky (27:25):

As always. Thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(27:59):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.