Marilyn Williams is involved in the management of frail elderly patients in inpatient and outpatient settings, performing evaluations of their functional and mental status, and making recommendations for further evaluation and treatment. After observing that care for patients with dementia and their families typically focused either on case management or on providers, Williams decided to blend the two, creating continuity across the continuum of care for the frail elderly.

Under the innovative system, a patient care coordinator is in each of six clinic modules. Typically a nurse, the coordinator helps the modules' 10 to 12 physicians on workup, then is available to patients and families for questions or problems.

"The basic system was in place, but it wasn't standardized," Williams said. "Neither was the expertise. My role was to assist with ongoing development and education." The program received one grant to help develop the patient care coordinator position as a single point of contact and another grant to look at outcomes.

Williams conducts core team meetings during which coordinators in the clinic and the homebound programs get together to share resources and troubleshoot problems. She also started an informational support group for the caregivers of people with dementia, again to help standardize knowledge.

She considers her most innovative program to be a swallowing screen she developed for post-cerebrovascular accident patients to be used by nursing staff. The template became part of Kaiser's regional guidelines, was presented at the National Gerontological Nursing Conference in Las Vegas and accepted for publication by Nursing 2002.

"We saw a need and developed something within nursing rounds. It is a standardized assessment tool that works and is very teachable. For the patient, nurses are so much more accessible than an outside consultant. If the patient is asleep, the nurse can just come back later."

Williams attributes her ability to think creatively partly to the teaching she received at the University of California. "When I entered the master's program, they told us we'd never think the same. The faculty are some of the movers and shakers of the nursing profession. It starts with the faculty. Some programs are more likely to foster innovation than others."

She also credits the people with whom she works. Her superiors give her a lot of latitude, and the institution is team-oriented.

The biggest challenges are keeping an innovative effort going and evaluating the results, Williams said. "A lot of people who like to think outside the box don't like the numbers part. Keeping it going takes a lot of cheerleading and a lot of juggling. You aren't typically doing just one project."

Both her environment and her co-workers motivate Williams. "It is hard to be creative all by yourself. The whole is greater than the sum of the parts."

Innovation, she said, is simply original thinking. "In the health care profession, that means an original way of thinking to improve patient care."