TIGER on the move: Vision - Action - Collaboration

Creating the vision 

Technology Informatics Guiding Education Reform (TIGER) was introduced to the American Academy of Nursing (AAN) Fellows at the November, 2006, annual meeting when results of the Invitational Summit held in Bethesda at the Uniformed Services University were first shared. At the summit, >100 nursing leaders (including AAN leadership) accepted the challenge of creating 3-year action steps toward a 10-year vision to transform the profession. They represented all dimensions of the profession, such as: nursing administration, practice, education informatics, technology, organizations, government agencies and other key stakeholders. Consistent with the Institute of Medicine (IOM) report on patient safety, the TIGER vision bridges the “quality chasm with information technology,” enabling nurses to “use informatics in practice and education to provide safer, higher-quality patient care.”1 According to McBride, “the truth of the matter is, professional nursing has long held goals that were never fully achievable before the informatics revolution currently taking place.”2 The energy of the TIGER leaders during this past year has been focused on developing collaborative activities with nursing leaders and organizations across the profession, in addition to sponsors, vendors, and interdisciplinary health informatics organizations.

Finding a structure for continuing the TIGER initiative 

The TIGER organizers never intended for TIGER to become “just another nursing organization,” so efforts have been ongoing to find longer-term funding support to achieve the TIGER vision. In order to initiate the action steps, communicate TIGER activities, and develop strategies for collaboration and explore possible structures for the TIGER initiative, Donna Dulong, BSN, RN, was appointed as Executive Program Director. Explorations began with many of the 29 sponsors of the summit, and one national organization emerged ready to collaborate with TIGER for longer-term support. The Alliance for Nursing Informatics (ANI), a joint venture between HIMSS (Healthcare Information Management Systems Society) and AMIA (American Medical Informatics Association), developed a plan for the TIGER initiative to become a special program within ANI. As of this writing, the tremendous support of ANI will allow the TIGER program to continue through 2008.

Development of collaborative teams & next steps 

Seven pillars were initially identified for the TIGER vision guiding the development of the 3-year action steps for the nursing profession.3 These were: (1) Management & Leadership, (2) Education, (3) Communication & Collaboration, (4) Informatics Design, (5) Information Technology, (6) Policy, and (7) Culture. These pillars not only helped shape the summit discussion and the TIGER Summary Report, but have now influenced the shaping of 9 collaborative TIGER teams described later in this article (see full report www.tigersummit.com, 2007). Subsequently, the TIGER executive committee has successfully shifted leadership to leaders and organizations through the development of “nine collaborative teams.” Through the use of a survey, nurses prioritized these topics in terms of interest to their affiliate organization, and elected to join one or more of these teams. Below are the 9 collaboratives (not necessarily in priority order):

American Academy of Nursing (AAN) Fellows are encouraged to visit the TIGER Website www.tigersummit.com to follow the progress of these collaboratives and volunteer to serve on one of the teams where there is passion and/or expertise.

One of the first tasks identified for each collaborative team is to clarify the definition and scope of the project, then develop an inventory and analysis of existing resources such as: publications, research, organizations, subject matter experts and gaps. Other responsibilities of the teams include: obtaining access to subject matter experts and constituent targets, conducting 2 educational Web-based audio conferences, developing 1 national conference presentation, developing a comprehensive white paper-type document (modeled after the TIGER Summary Report), defining topic-specific evaluation criteria, submitting articles for publication and dissemination amongst broader TIGER audience, and writing a chapter in the 4th Edition of the Nursing Informatics Series Where Caring and Technology Meet. Additionally, the culture pillar, gaps and overlapping issues will be addressed by tracking threads and principles across these 9 collaboratives.

Leaders for each of these groups are being finalized at this writing and the official kick-off for the collaboratives was held during the Summer Institute in Nursing Informatics, hosted by the University of Maryland in July, 2007. Collaborative teams began their meetings during the summer of 2007.

The TIGER initiative and implications for academy members 

As a professional nursing organization and thought leader, the AAN can continue to support the integration of technology into education and practice. The Academy hosts the Nursing Informatics Expert Panel. In addition, the Academy should highlight informatics capabilities at our Annual Meeting and Conference. Individually, Academy members who are in the educational arena can work to adopt informatics competencies for all levels of nursing education and encourage faculty members to participate in faculty development programs in informatics. Academy Fellows in healthcare delivery organizations can partner with local educational institutions to offer informatics tools and curricula that support and enhance the use of technology and informatics in practice. With the goal of all Americans having an interoperable electronic health record by 2014, in addition to joining relevant TIGER collaboratives, Academy Fellows should participate and encourage other nursing leaders to be active in state and federal initiatives underway to achieve this goal.

Technology Informatics Guiding Education Reform (TIGER) continues to be on the move. Watch for future TIGER sightings, actions, and results from the collaboratives during the next months and years!