Nurse’s Week Gift

Some of the nurses were talking about how nice it was that many restaurants had Nurse’s Week specials. It is wonderful to have people acknowledge the special work we do as nurses and to celebrate this with us each year.

This year, I want to offer all nurses a different gift. Each of us became a nurse for different reasons, and our practices differ dramatically. One commonality I see among nurses is the gift of compassion, not just the “I want to take care of you” style of compassion. It is the “by the book” definition of compassion I see over and over again. According to Merriam-Webster, compassion is defined as the sympathetic consciousness of others’ distress together with a desire to alleviate it. This depth of compassion is seen in nurses around the world every day. This compassion is what gives nurses that sense of accomplishment at the end of a hard day, knowing that they made a difference in someone’s life. To be able to truly alleviate someone else’s pain and distress is an incredible gift. If I had to guess, compassion is the basis that makes nurses the most trusted of professions.

While it is normal to see nurses show compassion to their patients every day, it is rare to see these same nurses be compassionate with themselves. Too frequently, we think that taking time for ourselves or doing something just for ourselves is selfish or unnecessary and should not be valued. Nurses in general, myself included, are not steeped in the tradition that it is necessary to care for yourself.

Rick and Forrest Hanson (authors of Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness) tell us that compassion for yourself is fundamental. By being more compassionate with ourselves, we learn to recognize our own distress and work to alleviate it. This self-compassion feeds our souls; it helps us to find and keep the joy that life has in store for us. In the end, self-compassion gives us the strength to be compassionate to others. Being compassionate with ourselves not only helps us to be more compassionate towards other, it can help reduce compassion fatigue.

We are starting to see more encouragement for nurses to care for themselves. The ANA’s Healthy Nurse, Healthy Nation encourages nurses to take better care of themselves and be good role models for society. The first step in caring for ourselves is to develop self-compassion.

This Nurse’s Week, I ask you to be compassionate with yourself. If you can’t see a way to do this for yourself, do it for your patients, family, and friends. As we experience self-compassion, we will be better prepared to encourage one another; the ripples of compassion will grow to include not only ourselves and our patients, but also our families, friends, and co-workers.

Happy Nurse’s Week to an amazing group of people, I am honored to be a nurse with you.

Washing Hands

Cinco de Mayo

Cinco de Mayo; what does this date make you think about? Many people will think about their favorite Mexican food or beverage. History tells us that May 5th is set aside to commemorate the Mexican Army’s unlikely victory over the French Empire at the Battle of Puebla on May 5, 1062. Cinco de Mayo is not Mexican Independence Day as many believe.

Cinco de Mayo has special significance this year: May 5th is World Hand Hygiene Day! The World Health Organization (WHO) has declared May 5th as World Hand Hygiene Day to encourage patients and family members to join healthcare professionals in the practice of appropriate hand hygiene. According to the WHO, hundreds of millions of patients are affected by healthcare-associated infections (HAIs) every year. More than half of these infections could be prevented if caregivers properly cleaned their hands at key moments in patient care. Everyone has a role in encouraging each other to clean their hands.

Imagine an entire day across the globe to celebrate and remember the importance of hand hygiene. If only we were celebrating the incredible job that we as a species do at effective and timely hand hygiene. Recent data shows that on average, healthcare providers clean their hands less than half the times that they should. Alas, it appears that it is our failure to clean our hands that leads to this observation of World Hand Hygiene Day.

Too often, we only consider the importance of healthcare workers cleaning their hands at the appropriate time to prevent the spread of HAIs. The Joint Commission has stated that hand hygiene is the most important intervention for preventing HAIs. We know one out of every twenty hospitalized patients has an HAI; appropriate hand washing is the solution we somehow cannot succeed at. Hand washing in healthcare is a life-saving activity, but it is not the only place that hand washing is crucial. All of us need to clean our hands at the appropriate times, not only to protect ourselves but to protect our loved ones and society as well.

If you work in healthcare, you know there are five moments (according to the WHO) that you need to wash your hands:

  • Before patient contact
  • Before aseptic tasks
  • After body fluid exposure risk
  • After patient contact
  • After contact with patient surroundings

If you are a patient or have a loved one in the hospital or other healthcare facility, there are key times for you to wash your hands as well. These moments are not as widely broadcast but are essential in the prevention of HAIs. The CDC list patient/family hand hygiene moments as:

  • After using the restroom (use soap and water)
  • Before eating (use soap and water)
  • After touching bedrails, bedside tables, remote controls, or phone
  • Before touching your eyes, nose, or mouth
  • After touching doorknobs
  • After blowing your nose or sneezing
  • Before and after changing bandages

Hand washing, also known as hand hygiene, has two separate methods. First, washing your hands with soap and water; second is the use of an alcohol-based hand sanitizer. If the hand sanitizer contains at least 60% alcohol, alcohol-based hand sanitizers are more effective and less drying to your hands than using soap and water. This is true except after using the bathroom, times when your hands are visibly soiled, or when caring for a patient with C. difficile. At these times, soap and water is the best option because the C. difficile spores are not removed by alcohol-based hand sanitizers.

When completing hand hygiene with soap and water or alcohol-based hand sanitizers, be sure to clean your fingertips, thumbs and between your fingers. Hand sanitizer should be used in a quantity to keep your hands wet for 20 seconds. Hand washing should include take at least 20 seconds as well, with 15 seconds spent rubbing hands together.

Whether you are a healthcare provider or a healthcare consumer, you can impact HAIs through appropriate hand washing. It is time to wash out HAIs and improve all our lives.

Happy World Handwashing Day!!!!

SBIR STTR America's Seed Fund

Why the Small Business Innovation Research and Small Business Technology Transfer Grant Programs are Irreparably Broken

Innovation is at the heart of America. It’s called “American ingenuity,” and the very systems that are designed to grow it are crushing it. Subsumed by academia to work on worthless projects and stripped of all relative value, the programs that were set aside by the government to encourage the one area of the economy where most innovations come from are being used to fund side projects of professors rather than support and encourage real innovation. It’s a way to support salaries and augment the income of professors.

In this post, I’m going to reveal the painful process that we tried to go through to get a grant and the ludicrous responses that we got – ludicrous until you understand what the system is designed to do and how no one has stood up to change the status quo. In the process, I’m going to reveal our ideas with the full understanding that someone can decide to copy it and do it without us all on the hope that someone will realize the power of the idea and help us find a way to fund it.

To be fair, I recognize that there will be some who will say that this is just another sour grapes post. We didn’t get funded, so we’re going to complain about the system. However, what you need to know is that the post was germinated before we knew whether we would be funded or not. More importantly, the structure of the problem was revealed through a coach – a long-time veteran of the process – before our grant began and was reinforced by another former member of our state’s team for helping businesses get funded. This is a deep-seated problem that insiders can’t expose, because they’re too into the system to publicly share their concerns. To expose the rotten underbelly of the system, I need help you see the system from our point of view.

Our story

AvailTek LLC has two owners. Terri Bogue and Robert Bogue. Terri is a clinical nurse specialist with a specialty in helping healthcare systems prevent healthcare-associated infections (HAIs). She has a national practice consulting with organizations to help them reduce their infection risk.

Speaking about myself in the third person for a moment, Robert, on the other hand, has written over 25 books, numerous courses, and too many articles to count. He’s been a technologist who has done software development, networking, and application-level solutions development for decades. He’s spent the last 14 years as a Microsoft MVP – an award that’s reserved for select individuals who share their passion for technology with the global community. He’s traveled the world speaking and teaching about software development.

If you were going to put together a two-person team for creating educational technology to help reduce healthcare infections, you’d be hard-pressed to find a team that’s more able to execute. The expertise you can’t find in one person you can find in a team that are partners in every sense of the word.

Further, with 12 years in business, we’ve demonstrated staying power. We’re not doing what we’re doing on a lark, or because we can’t find jobs and need something to do so we don’t have to tell our friends that we’re unemployed or looking for work. This is a conscious – and often difficult – choice for us.

However, the very things that make us good at business and creating solutions are the very things that make it impossible to get a project funded. Even if we could literally save ten thousand – or more – people from dying from HAIs, and we can demonstrate costs savings in excess of a worker’s salary each year, it’s not enough in the minds of the academics who preside over the process of awarding funding.

Grant Structure

Most folks have never had the displeasure of writing for a grant proposal. It’s a displeasure, because it’s expected to be academic writing with strict page limits, citation requirements, and the general requirement to try to make the whole work sound more difficult to understand than it needs to be. I’ll focus my attention on the Small Business Innovation Research (SBIR) program here, because that’s the program we applied to; however, the Small Business Technology Transfer (STTR) is similar, only having the additional explicit requirement to have an academic institution as a part of the application process.

Writing for the grant was an exercise in trying to fit the important pieces into cramped confines, and at the same time writing in a precise way that made it clear exactly what we were talking about. Other areas didn’t have page limits, or were so much larger than was needed that we felt bad, because we couldn’t fill the pages. Our citations list was pages long. We knew no one would ever read even a fraction of our citations, but they were there, because you could get extra space in the main areas if you didn’t have to explain things too deeply.

In our case, the key to the solution was in our ability to train environmental services workers on how to clean hospital rooms effectively. We’d leverage augmented reality in the rooms they clean, watch their performance, and nudge them into better behaviors. Expressing that in the structure wasn’t easy – even for a seasoned writer – mostly because of the writing requirements.


Imagine for a moment if you had to cite a reference to everything – or every other thing – that you said. What if every time you said anything material, you had to find a research paper that validated your statement? That’s what writing is like for the grant. You can’t make assumptions or generalizations. It’s like the old quote, “In God we trust, all others bring data.” Of course, what they don’t say is that research in general isn’t always correct. In fact, much of the research printed in journals couldn’t be replicated by anyone else.

However, citations are what’s expected in academia. You’re supposed to cite your references. In the real world, citations are rare. They’re the occasional pointer to help the reader understand in more depth, if they choose to. They’re clarifications.

In the end, the need to cite everything makes it easier for academics – because it’s what they’re used to – and harder for innovators, who are frequently without good access to journal articles. Even with the connections that we have, finding all the research wasn’t easy.

Iteration and Adaptation

While citations are annoying, they’re not structurally incorrect, they’re just a barrier that must be overcome. On the other hand, the idea that you have it all figured out, and you know exactly how you’re going to perform the innovation is structurally wrong. Edison didn’t know exactly how to create a lightbulb when he started; no one did. He had a goal and some ideas but no specific path to reach the objective. That’s the point of innovation: a solid direction – a tack – but not an answer on exactly how to do something. After all, if you knew everything there was to know, you wouldn’t need a grant to help refine the idea into the sharp point of a solution.

In the end, this was the undoing of our proposal. I refused to write the proposal like we knew exactly what we were doing. I wrote that we knew the structure of the idea and the science behind why it would work. The problem was I wasn’t willing to spell out in detail exactly how we were going to teach.

This seems reasonable on the surface, that they might resist someone without a finely-defined approach. However, it leaves out the awareness that we cannot plan into innovation. You cannot know what you don’t know until you know it. The point of the exercise is to learn and adapt and create something that works in reality – not on some drawing board somewhere. However, the feedback we got was that we didn’t have a specific plan for how we were going to do everything.

The Feedback

It would be funny if it wasn’t so tragic. Each round of the process you get feedback from a few reviewers. These are the folks who presumably read your proposal and were qualified to respond to it. However, the comments were so bad as to be laughable. They requested that we explicitly detail out what we’re going to do – while at the same time maintaining the strict page limits. But those weren’t the comments that were the most troubling.

The point of the grant program is to create innovation. It’s in the name. However, under the category of innovation, in the weakness section, one reviewer literally wrote the sentence, “This has never been done before.” Clearly the reviewer wasn’t able to understand the word “innovation.” How can you have innovation that has been done before? It’s in the definition of the word.

There were comments that the business was small and only included Terri and I as full-time employees. (That’s not technically correct, but let’s not let that get in the way.) The point of a small business grant is to help small businesses. The Bureau of Labor statistics has 74% of all businesses having fewer than 10 employees. 54% of those businesses have fewer than five. Why would you be comment (in the negative category) that there are only two employees? Doesn’t that miss the point – again?

Other comments included things like claiming that we had pasted in a fake arm in our mock-up of the user interface. Little did they know this was literally Terri’s arm with a glove and a microfiber cloth – not some clipart. The reviewer clearly made an incorrect assumption.

Then there was the thinly-veiled attempt to explain that we weren’t academic enough. Terri has a Master’s degree and I have a Bachelor of Science. Neither of us have a Doctorate. One of the comments called for us to have an “educational methodologist.” I’ve been doing education for decades and have delivered all types of educational programs. Never once have I heard someone call for an educational methodologist. I’ve done instructional design. I’ve taught cognitive load and adult learning concepts. The friends we have who are in academia said that the role doesn’t exist. It’s just a way to say that you didn’t have a PhD in education or psychology on the team – without saying it.

The Timing

The program is about innovation. A few times a year (roughly quarterly) there are submission deadlines. You submit your proposal and they get back to you. The problem is that they take longer than a quarter to get back to you. Consider that most proposals require at least one revision – certainly those proposals from people who’ve never done the process before. That is, those who are innovating and not continuing to be frequent fliers to the system will probably need to do a revision. The review process extends from one deadline beyond the next one. So, you have to expect to spend a few months building the proposal, more than three months waiting on the first response, then wait until the next cycle and submit again to wait three months for that review cycle. For those of you doing the temporal math in your head, it’s over a year. To get funding on an innovation you must wait more than a year.

Small Business

While our small business has been in business for a dozen years, most small businesses fail in only one or two. Perhaps there are no innovations from people who start businesses that fail. However, my belief is that businesses succeed in no small part due to luck. While Pasteur said, “Chance favors the prepared,” there’s certainly something to be said for not having bad luck. Think about the businesses that leased their office space starting in late August of 2001 in the World Trade Center. Full of hope they were going to change the world, until the world changed, and they were at the epicenter.

The process is so bureaucratic and fossilized that it is unable to understand that most small businesses can’t wait a year or 18 months to know if there’s some funding at the end of the rainbow. On the other hand, if it’s not really a business at all but is instead a way for a professor to make some money on the side, well, there’s all the time in the world.

What to Do

The solutions to the problem are simple. Instead of a review board made up of academics, replace them – all of them. Innovation doesn’t come from the “professional” scholars. It comes from the tinkerers and the amateurs who are burning with a passion to make the world better.

The first group of people who could be on the review board are the service core of retired executives (SCORE) that the Small Business Administration uses. While they’ll have the corporate bias of saying no, they won’t be looking for a way to get their projects funded next time. The point is that they’re retired, and they’re looking to give back.

The core of the review board should be entrepreneurs who have innovated. Whether the market ultimately accepted the innovation or not, those people who were able to deliver on the innovation should be evaluating those most likely to succeed. It’s not about what the market will accept. It’s about the innovator’s ability to deliver.

Why It Won’t Happen

So, while it’s simple, it won’t happen, and here’s why. The measurement criteria for success is the number of papers published. For that, you need academia. When you measure success by the wrong criteria – the creation of more research instead of by innovations making it to market – you necessarily get the wrong result. You get what you measure. You get papers, not innovation. You get academic rigor instead of entrepreneurial improvisation.

So, the system is fundamentally broken. It simply can’t produce what it’s designed to produce. You can’t get innovation in a system designed to prevent it from happening, which measures results based on papers instead of products.

A Word on STTR

STTR is even more challenged in some ways, because it presupposes that there is innovation happening inside of academia that needs to be transferred into the commercial markets. My observation is that this happens automatically, whether or not it’s incentivized externally. The university wants to make licensing revenue on the ideas and so will encourage the use of the intellectual property.

STTR follows the same rough process, with different page limits, but I can only assume with the same crazy (or crazy-making) approach. The tragic humor is that the system designed to get innovations to market is overseen by people who have spent their lives in academia and don’t really know how to get things to market.

Our Idea

If you’re interested in partnering on what we’re working on, send me a note. I’m happy to share what we’re going to do in more detail.

Sick Man in Office

Personal Bioterrorism – Going to Work with the Flu 

Every day, thousands of bioterrorists go into work.  They are normal people like you and me, but they are also harboring a biological contaminant that kills up to 650,00 people.  Despite this threat, little is being done to stop these bioterrorists and protect our health. 

As the prevalence of the flu increases, we have come to expect hospitals to implement flu restrictions for visitors.  This may mean that people younger than 18 years old or anyone other than immediate family members are not allowed to visit patients in hospitals.  This restriction is implemented to help reduce the risk of the flu for patients, visitors, and staff.  These restrictions can be bothersome, but in general, they have become an expected part of the flu season. 

The flu, also known as influenza, is a respiratory illness caused by one of the multiple and ever-changing influenza viruses.  These viruses infect the nose, throat, and lungs, making them very different from stomach illness we all grew up calling “the flu.” 

Influenza has a season that is unpredictable and varies by year and geographic location.  It typically starts in late fall and continues through winter, although sometimes it can continue through the spring.  The flu is not just a bad cold, the flu can result in hospitalizations and even death.  According to the World Health Organization, up to 650,000 people die of respiratory diseases linked to seasonal flu each year. 

The flu is spread by tiny droplets that spray when people cough, sneeze or talk.  These droplets can land in the mouth or nose of nearby people, causing them to develop the flu themselves.  Less commonly, you can contract the flu by touching an object or surface that the flu virus has landed on and then touching your own mouth, nose, or eyes.  The flu is contagious beginning one day before symptoms develop and up to seven days after becoming sick.  The period of greatest risk of spreading the flu is the first three to four days after symptoms begin.  Once exposed to the flu, symptoms begin within one to four days if you are susceptible to the specific influenza virus. 

One way we can protect ourselves from the bioterrorists is by getting a flu vaccination.  While the vaccination will not guarantee you will not get the flu, it does mean that, if you get the flu, it should be less severe than it would be had you not been immunized.  Remember, the flu can cause hospitalizations and death for a significant number of people. 

At this point, you should be wondering how the flu relates to bioterrorism.  Bioterrorism is the deliberate release of viruses, bacteria, toxins or other harmful agents to cause illness or death in people, animals, or plants.  When you have the flu, you are releasing the influenza virus with every cough, sneeze, and possibly every word you speak.  Many of us continue to work, shop, and interact with others when we have the flu.  Some of this feels like a necessity; we are expected to show up to work, we have important meetings, we may not have the time available to take off work, we need to keep our jobs.  This is all true; however, showing up to work or meetings or other events places everyone you interact with at risk to contract the flu.  Knowing that we are contagious each time we interact with others we put them at risk of illness, thus the idea of working with the flu as bioterrorism. 

The second way we can protect ourselves from the flu is by encouraging our friends, coworkers, and family members that caring for their health and those they come in contact with is more important than the work they do.  Too frequently we are taught that not missing a commitment or a day of work/school is imperative.  This has led to all of us taking medication to treat the symptoms of the flu so that we can do the things we need to do without feeling as ill.  While we may feel better when we take these medications, they do nothing to reduce the risk of spreading the flu.  While we are told that work and attendance is extremely important, we also are told that we need to be compassionate and caring to our fellow man.  Somehow these two beliefs come into conflict when we are sick.  We feel compelled to work, and we do not want to make others sick.  How do we balance these issues? 

Staying home and taking care of yourself when you are sick is the best thing you can do for yourself and those you come in contact with.  This gives your body the time and rest it needs to recover and prevents the spread of the flu.  What about the stress of missing work?  Some employers have started allowing extended sick time when employees have the flu.  While this is not widespread currently, it definitely is a benefit to the employee, the company, and society.  Requiring or even encouraging people to work with the flu supports bioterrorism in your own community.  We must find ways to support one another and our society. 

The flu can be a very serious illness.  Preventing the spread stops the bioterrorism that is rampant in America today. 


737 – The Faces of HAI

This morning I was talking to my husband and shared that I was a bit nervous about my flight later in the day. His immediate response was that it was safer to fly than it was to be in a hospital. While I know that is true, and I was happy that he has become so well-versed in healthcare-associated infections (HAIs), the thought did not make me feel any better.

By the time I arrived at the airport, I forgot this conversation. Suddenly, as I was lined up to board the plane and heard that the airplane was a 737, I not only remembered our conversation but I really started thinking about the impact of HAIs. Months ago, as I was reviewing the data related to HAIs, I calculated the number of people that died each year in the United States related to HAIs compared to the number of people on a 737. The average 737 seats 150-200 passengers. In the United States, 75,000 people die as a result of HAIs each year. My calculations resulted in the fact that the number of people that die from an HAI is equivalent to a 737 crashing and everyone on board dying every day of the year.

As I contemplated the impact of HAIs not only on hospitals and patients, I started to wonder about the impact to families, friends, and society in general. I looked around at the people waiting with me to board the plane. They all had families and friends, they all had plans for their futures, and some might have significant impact on our society through their work, innovations, and lives.

If our plane crashed, it would be a major news story. All the people related to or friends with any one of the passengers would be impacted. Society would miss the positive impact that the passengers might have had. Could it be that the person responsible with curing cancer or some other burden on our society would die before they had the opportunity to discover the cure?

I traveled down this pathway to try to gain a better understanding of the impact HAIs truly have on our society. I started to wonder: what kind of impact does one person have? I started with Robin Dunbar’s research, which theorized “Dunbar’s number”, a suggested cognitive limit to the number of people that a person can maintain stable social relationships with. Dunbar’s number is most frequently quoted to be 150. That is a start to the number of people impacted by the death of a single person.

Beyond social relationships, each person has a family that will be impacted by the death of one of its’ members. If you only consider a limited version of family, from the individual’s grandparents to their grandchildren, and only allow for two children in each family, you quickly arrive at a number close to 40, excluding cousins, aunts, and uncles. If you include your parents’ siblings and their children, you quickly arrive at approximately 70 people impacted by the death of a family member.

Combining family and friends the death of one person easily impacts the lives of 200 people in some degree. My plane crashing today is very unlikely. If it does, the 150-people sharing this journey will impact 30,000 peoples’ lives. That is really sad, the fact that I am writing this today signifies that my plane did not crash. The impact of one life or one plane crash is staggering.

The impact of HAIs is greater than the impact of this one airplane crashing. It is much more closely related to the impact of 365 airplanes of this same size crashing in a single year.

When you consider the individual people, who contract an HAI and die each year, each with family, friends, plans for their future, and undiscovered potential, the impact is significant. When you include the family and friends of these people, you quickly realize that there are over 15 million victims of HAIs each year in the United States.

If one 737 crashes today, the nation demands to know why. How can we not feel that it is a national crisis that the number of people who succumb to HAIs is equal to a 737 crashing every day?

My husband was incredibly insightful this morning. It is much safer to fly than it is to be a patient in a hospital. We all have work to do to find better ways to keep patients safe every day.