Context: Nurses are the primary hospital caregivers. Increasing the effi ciency and effectiveness of nursing care is essential to hospital function and the delivery of safe patient care.Objective: We undertook a time and motion study to document how nurses spend their time. The goal was to identify drivers of ineffi ciency in nursing work processes and nursing unit design.Design: Nurses from 36 medical-surgical units were invited to participate in research protocols designed to assess how nurses spend their time, nurse location and movement, and nurse physiologic response.Main Outcome Measures: Nurses' time was divided into categories of activities (nursing practice, unit-related functions, nonclinical activities, and waste) and locations (patient room, nurse station, on-unit, off-unit). Total distance traveled and energy expenditure were assessed. Distance traveled was evaluated across types of unit design.Results: A total of 767 nurses participated. More than threequarters of all reported time was devoted to nursing practice. Three subcategories accounted for most of nursing practice time: documentation (35.3%; 147.5 minutes), medication administration (17.2%; 72 minutes), and care coordination (20.6%; 86 minutes). Patient care activities accounted for 19.3% (81 minutes) of nursing practice time, and only 7.2% (31 minutes) of nursing practice time was considered to be used for patient assessment and reading of vital signs.Conclusion: The time and motion study identifi ed three main targets for improving the effi ciency of nursing care: documentation, medication administration, and care coordination. Changes in technology, work processes, and unit organization and design may allow for substantial improvements in the use of nurses' time and the safe delivery of care.

Results suggest that the spatial qualities of nurse assignments and unit layout affect nurse strategies for moving through units and affect how frequently nurses enter patient rooms and the nurse station.

ObjectiveTo evaluate sedentary behaviour and physical activity levels in independently mobile older adults with and without dementia living in residential aged care.MethodsSedentary behaviour and physical activity were measured in 37 residents of an aged care facility using an accelerometer worn during waking hours for five days.ResultsParticipants with valid accelerometer data (n = 28) spent 85% of the time sedentary, and 12% in low‐intensity, 2% in light‐intensity and 1% in moderate‐to‐vigorous‐intensity physical activity. Over half of sedentary time was accumulated in bouts of greater than 30 minutes. Physical activity at any level of intensity was performed in bouts of less than 10 minutes.ConclusionResidents were highly sedentary and inactive. In particular, the short duration of each bout of activity amongst lengthy periods of sedentary behaviour was a substantial finding. The study suggests the need to develop innovative ways of breaking up sedentary behaviour in residential aged care.

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The ability to share nursing data across organizations and electronic health records is a key component of improving care coordination and quality outcomes. Currently, substantial organizational and technical barriers limit the ability to share and compare essential patient data that inform nursing care. Nursing leaders at Kaiser Permanente and the U.S. Department of Veterans Affairs collaborated on the development of an evidence-based information model driven by nursing practice to enable data capture, re-use, and sharing between organizations and disparate electronic health records. This article describes a framework with repeatable steps and processes to enable the semantic interoperability of relevant and contextual nursing data. Hospital-acquired pressure ulcer prevention was selected as the prototype nurse-sensitive quality measure to develop and test the model. In a Health 2.0 Developer Challenge program from the Office of the National Coordinator for Health, mobile applications implemented the model to help nurses assess the risk of hospital-acquired pressure ulcers and reduce their severity. The common information model can be applied to other nurse-sensitive measures to enable data standardization supporting patient transitions between care settings, quality reporting, and research.

Mounting evidence describes inefficiencies in the hospital work environment that threaten the safety and sustainability of care. In response to these concerns, diverse experts convened to create a set of evidence-based recommendations for the transformation of the hospital work environment. The resulting Proclamation for Change, now endorsed by multiple health systems and professional and consumer organizations, cites patient-centered design, systemwide integrated technology, seamless workplace environments, and vendor partnerships as the cornerstones of transformational change.

Coopetition, the simultaneous pursuit of cooperation and competition, is a growing force in the innovation landscape. For some organizations, the primary mode of innovation continues to be deeply secretive and highly competitive, but for others, a new style of shared challenges, shared purpose, and shared development has become a superior, more efficient way of working to accelerate innovation capabilities and capacity. Over the last 2 decades, the literature base devoted to coopetition has gradually expanded. However, the field is still in its infancy. The majority of coopetition research is qualitative, primarily consisting of case studies. Few studies have addressed the nonprofit sector or service industries such as health care. The authors believe that this article may offer a unique perspective on coopetition in the context of a US-based national health care learning alliance designed to accelerate innovation, the Innovation Learning Network or ILN. The mission of the ILN is to "Share the joy and pain of innovation," accelerating innovation by sharing solutions, teaching techniques, and cultivating friendships. These 3 pillars (sharing, teaching, and cultivating) form the foundation for coopetition within the ILN. Through the lens of coopetition, we examine the experience of the ILN over the last 10 years and provide case examples that illustrate the benefits and challenges of coopetition in accelerating innovation in health care.

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