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The Evolution of the TIGER Initiative

Toria Shaw Morawski / Joyce Sensmeier

INTRODUCTION

This chapter describes a wonderful story of what can occur when individuals committed to a common cause come together and take action. The best part is that this story has no ending—the roots of the TIGER (Technology Informatics Guiding Education Reform) Initiative are already having a ripple effect across the healthcare industry and the work that is being accomplished through TIGER is now being cited, as it will continue to be in the future, as being a significant catalyst for change in addressing the call for healthcare transformation by the Institute of Medicine (IOM, 2001, 2003). These two landmark reports addressed major changes needed for both practicing clinicians and educators. For practicing clinicians, the first report notes, “The use of tools to organize and deliver care has lagged far behind biomedical and clinical knowledge. Carefully designed, evidence-based care processes, supported by automated clinical information and decision support systems, offer the greatest promise of achieving the best outcomes from care for chronic conditions. Systems must facilitate the application of scientific knowledge to practice and provide clinicians with the tools and supports necessary to deliver evidence-based care consistently and safely” (IOM, 2001, p. 12). For educators, the second report called for new ways for health professions to be educated and it identified five core competencies for all healthcare professionals: provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics (IOM, 2003, p. 3). Both of these reports, along with the federal efforts described below to address the need for widespread health information technology adoption, were the catalysts for the beginning of the TIGER Initiative, and its continued evolution.

THE DECADE OF HEALTHCARE TECHNOLOGY (2014)

National Health IT Agenda

In early 2004, the then U.S. President George W. Bush declared the Decade for Health Information Technology and created the Office of the National Coordinator of Health Information Technology (ONC). In May 2004, the then Secretary of Health and Human Services, Tommy Thompson, appointed Dr. David Brailer as the first National Health Information Technology Coordinator. This was an exciting time for health professions committed to the transformational role health information technology (IT) could play in substantial improvements in safety, efficiency, and other health reform efforts. In July 2004, Brailer convened the first national health IT summit in Washington, DC and launched the strategy to give U.S. citizens the benefits of an electronic health record within a 10-year timeframe.

Where Is Nursing?

A very important observation was made at this first ONC event. The nation’s 3 million nurses who comprised up to 55% of the workforce were not represented and/or clearly identified as an important integral part of achieving the ONC vision and strategy. It left many begging the question, “Where is nursing?” There was also a keen awareness that without nursing engagement not only was the National Health IT Agenda at risk, but nursing would be at risk by not acting on a wonderful opportunity to significantly advance the agenda to transform practice and education with evidence and informatics. In his books, Leading Change (Kotter, 1996) and A Sense of Urgency (Kotter, 2008), Kotter describes the impact that having a true sense of urgency can have on large-scale effective change. When the sense of urgency is as high as possible, and among as many people as possible, the greater the successes of leading transformational change efforts will be. Leaders in nursing realized the sense of urgency to begin a grassroots effort following this initial health IT summit and moved to start a movement that would assure nursing was at the table and where key stakeholders/advocates of health information technologies would be integrated into the nation’s healthcare delivery systems and academic programs.

THE BIRTH OF THE TIGER INITIATIVE (2005)

Challenges and Opportunities Facing Nursing

The grassroots leadership efforts began to take action and network with others to determine first steps and gather key individuals to consider nursing’s future role related to health IT. The first official TIGER gathering was held on January 14, 2005 hosted by Johns Hopkins University School of Nursing. A diverse group of nursing leaders across the country engaged in conversation about the skills and knowledge needed by the healthcare provider/nurse of the 21st century. Trends and patterns on topics such as basic skills, critical thinking, change management, evidence-based practice, knowledge workers, curriculum integration, professional practice, interdisciplinary collaborative practice, leadership, global military systems, national standards, clinical documentation, public policy, and more emerged as current challenges and opportunities facing nurses during this informatics revolution. It was noted that the opportunity was more than just considering “informatics”—the focus needed to also be on quality and evidence-based care. There was a unique window of opportunity for TIGER to build on the successes of informatics and to connect more key stakeholders in an effort to move more rapidly forward in guiding true transformation. Lastly, TIGER needed to tap into the power of the 3 million nurses in the workforce and get them engaged in advancing the TIGER agenda. It was decided, at that time, to hold an invitational summit in an effort to bring together a diverse group of stakeholders (professional organizations, governmental organizations, technology vendors, informatics specialists, etc.) to accelerate the sense of urgency and take further action to assure that nurses were able to leverage information technology to provide safe, efficient, and patient-centered care to all. At that time, questions were raised concerning whether or not the summit should include all disciplines to help meet the IOM aims and competencies. While this was recognized as being very important, there was consensus that it was critical to focus on the nursing workforce and then to expand the effort as recommendations were made from the summit.

Setting the Vision for TIGER

The following vision statement and expected outcomes were developed to guide the early stages of the TIGER Initiative.

THE TIGER SUMMIT (2006)

The Invitational Summit

To prepare for the invitational summit, a program committee was formed that planned for over a year for the event. A fundraising committee was also formed to secure funds to support the TIGER Summit and expected outcomes. Over 25 diverse sponsors made contributions to the summit, including grants that were received from the Agency for Healthcare Research and Quality (AHRQ), Robert Wood Johnson Foundation (RWJF), and National Library of Medicine (NLM).

• FIGURE 45.1. Ten-Year Vision. (With permission from the HIMSS TIGER Initiative.)

The TIGER Summit was held at the end of October 2006, hosted by the Uniformed Services University of the Health Sciences in Bethesda, MD. Over 100 national leaders from nursing administration, practice, education, informatics, technology organizations, governmental agencies, and other key stakeholders participated in the interactive two-day event. External facilitators from Bonfire Communications created an open-space experience that included small and large group dialogues; unique graphic art to capture the vision, outcomes of the dialogues and action plans; and the use of an audience response system (ARS) to capture current realities as well as gain consensus. To stimulate imagination and thinking, a Gallery Walk experience was featured on Day One in which participants were able to “walk through” and review cutting-edge technology and clinical decision support systems utilized in the current healthcare environment. The TIGER Executive and Program Committee felt that it was important to build on national exemplars in practice and education today. A total of seven national exemplars were shared including interactive dialogue with participants.

10-Year Vision and 3-Year Action Steps

The TIGER Summit was focused on creating momentum toward consensus on a 10-year vision and a 3-year action plan. The 10-year vision was more clearly articulated by performing collective work around seven pillars and then content streaming the patterns and most salient points. With the seven pillars and rich content as its framework, a 3-year action plan was identified to achieve the 10-year vision of evidence and informatics transforming practice and education. This effort required intense group work and collaboration among the participants.

The last Call for Action before participants left the Summit was for each leader of a participating organization to identify definable action plan goals that they could take back to their organization. Each participant signed the “TIGER Commitment Wall” to show their commitment to the Vision and Action Plans as well as to continue to promote and engage others in the TIGER Initiative.

Following the TIGER Summit a Web site was established to record the several events and actions as well as to post new information. In addition, the Summit report Evidence and Informatics Transforming Nursing: 3-Year Action Steps toward a 10-Year Vision (2007) was published and made available via the Web site. The report provided a summary of the Summit as well as recommendations for specific stakeholder groups: Professional Nursing Organizations, Academic Institutions, Information Technology, Government and PolicyMakers, Healthcare Delivery Organizations, and Health Information Management Professionals/Health Science Libraries. Leaders from five major nursing organizations including the American Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, National League for Nursing, and Sigma Theta Tau International affirmed their commitment and need for the profession to support the TIGER Initiative.

THE TIGER COLLABORATIVE WORKGROUPS (2007–2008)

Several months after the Summit, and after several followup meetings with the TIGER Executive Steering Committee, it was decided to move into phase II of TIGER. Building off the Summit pillar and action plans, nine key “collaboratives” were identified to dig deeper and tap a broader engagement from the nursing community to address the recommendations. Each collaborative was assigned coleaders to facilitate the workgroup and write a report and share the workgroup findings and final recommendations. A summary of the purpose, outcomes, and access to these published reports can be found in Table 45.1.

THE TIGER INITIATIVE (2009–2019)

The TIGER Initiative Foundation (2009–2014)

The years of 2009–2010 kept critical TIGER leader volunteers busy with sharing the collaborative reports as well as seeking new opportunities for further TIGER engagements with key stakeholders, nursing, and other interdisciplinary professional organizations. During this time the foundation was being laid for building out a Virtual Learning Environment (VLE) with collaborating partners such as the National Library of Medicine and the Uniform Services University of the Health Sciences. In July 2011 the TIGER Initiative Foundation was formed as a 501(c)(3) organization operating for charitable, educational, and scientific purposes. This was a significant milestone for TIGER as it provided a structure to grow strategically. A TIGER Web site was established to serve as a central hub for connecting TIGER members and sharing the many activities that occur with the more than 1500 volunteers that have been engaged with the TIGER Initiative.

The HIMSS TIGER Initiative (2014–Present)

The TIGER Foundation was not able to maintain sufficient funding to support a sustainable organization. Thus, on September 22, 2014, TIGER transitioned into the Healthcare Information and Management Systems Society (HIMSS) enterprise, and today is supported by the Professional Development department. HIMSS is a global advisor and thought leader supporting the transformation of health through the application of information and technology. Headquartered in Chicago, IL, HIMSS serves the global health information and technology communities with focused operations across North America, Europe, the United Kingdom, Middle East, and Asia Pacific (HIMSS, 2019a). The HIMSS global scope of work and expertise provided the perfect new home for the initiative.

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