I am one of those people who believe that there are no coincidences. I had the good fortune of sitting beside Liz Armstrong on a flight from Utah to Boston. I had been dropping off a child at Brigham Young University and Liz was connecting in Salt Lake City. From my conversations with her, I learned about the Harvard Macy courses, which led me to attend Leading Innovations in Health Care and Education, taught by Liz and another dear acquaintance of mine, Clay Christenson.

I am one of a few nurses who have had this remarkable Harvard Macy experience. I recall thoroughly enjoying the week of intensive learning and networking with physician educators from all over the world and the one other nurse from Philadelphia. I kept in touch with many for the first months after the conference and I still think of the participants who influenced my thinking even now. As conflict occurs all over the world, I think of those Harvard Macy scholars that I met from those countries. I hope you are well.

Like most, I had read Clay’s work on disruptive innovations. In fact, I had created one. As a palliative care clinician, I see how access to palliative care is extremely limited for most people. I started the first-in-the-nation generalist palliative nursing education program in the country, called AgeWISE, so that frontline nurses can provide palliative care to those who are suffering. True to the concept of a disruptive innovation, it may not be “as good as” but “good enough,” or as I like to think, “better than nothing.” Persons who are suffering cannot wait for systems to figure out ways of providing needed care. These changes have to be figured out on the front lines, in many cases, at least initially. Through funding, I disseminated AgeWISE to 13 Magnet-designated hospitals in the US in a train-the-trainer model, resulting in over 400 nurses being trained to provide better care at end-of-life; fortunately, AgeWISE continues.

My work is not in pre-licensure education, but in post-licensure education. Working at Mass General Hospital and now at Brigham and Women’s, I work to change hearts and minds that will then change practice. Since my experience in Leading Innovations, I have been awarded over $3m in nursing workforce development grants in evidence-based practice, ethics, geriatrics, palliative care, and end-of-life training. I adopted many of the teaching strategies that I enjoyed at Leading Innovations, such as case studies, small group work, and a spirit of openness that allowed all of us to learn from our global colleagues. I use Mezirow’s transformational learning, reflection, mindfulness, and other teaching strategies to promote change that sticks.

As a result of Leading Innovations, I have pursued similar experiences, a Hartford Summer Scholars program, a Change AGEnts grant, and a post-doctoral fellowship with Jean Watson, PhD, RN, FAAN, who is the author of the theory of human caring. I’ve tackled authoring/editing a book, Global Advances in Human Caring Literacy, which will be printed this fall, engaging authors from Israel to South Africa to Peru, and beyond, who all subscribe to this theory so that we can help nurses focus on the essence of our discipline, which is caring. In my organization, I work to build sustainable change. I’ve taken tools from Leading Innovations, like logic models, action plans, and stakeholder buy-in, to make the business case for innovations I wish to promote—not something intuitive for nurses who believe that organizations should just do the right thing. Is that thinking we all share? I believe that thinking at the systems level was one of my biggest take-homes from Leading Innovations, as well as making the business case.

I will be forever grateful for sitting next to Liz just seven years ago. I have been richly blessed by this experience and those that have unfolded ever since. There are no coincidences.



Susan Lee

Susan M. Lee, PhD, RN, an internationally recognized author and researcher, she is a senior nurse scientist at Center for Nursing Excellence, Brigham and Women’s Hospital. 

Dr. Lee most recently served as a Connell Nursing Research Scholar in The Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital. Her program of research focuses on geropalliative care, an emerging specialty and approach to the care of frail, older adults in the last few years of life.