Nursing Without Constraints
Kelly Ayala DNP’18, uses her passion for innovation to improve the health care landscape for both patients and providers
By Maddy Scharrer
Kelly Ayala DNP’18, APNP, BSN, started out her nursing career as an intensive care unit (ICU) nurse. One day while working in the ICU, Ayala noticed something that bothered her; all the medicines stored in the refrigerator were in one large pile. She couldn’t fathom why different kinds of medicines — sedatives, paralytics, and other categories — were thrown together. Ayala posed the idea of implementing small bins to separate the medicines in hopes of creating an organizational system for medication storage. She was shocked when she received pushback about the idea.
This bothered Ayala, and she began thinking about how she could make a larger impact in health care. She soon realized she wanted to learn how to read and understand health care literature in ways that could better help patients. As she explored her options, she found that learning how to develop impactful questions and apply information to real-life scenarios was emphasized in the UW–Madison School of Nursing’s Doctor of Nursing practice (DNP) program. As a result, 11 years into her career, Ayala found herself pursuing her advanced nursing degree. Through the DNP program, she was able to combine her interests in complex health care systems and palliative care with her desire to instill change.
After completing her DNP, Ayala felt better prepared to improve outcomes and systems of care. But she felt like something was still missing and worried that she was bored with nursing. She noticed she was feeling restless, and something inside drove her to keep searching for that piece that would complete her puzzle. In her search, she listened to a talk by Rebecca Love, the first nurse to ever give a TED Talk, who spoke about how nurses are innovators. Ayala quickly recognized that she was feeling restless not because she was bored in her career, but because her brain is wired to find ways to problem solve and innovate. It was the final piece to complete her puzzle and help her move forward with a reinvigorated passion for nursing.
Ayala and a fellow participant at the 2019 Nurse Hackathon.
Ayala’s propensity for problem-solving and interest in improving health care systems finally had direction. Love’s message resonated with her, and as a result Ayala set out to grow and develop her problem-solving skills. It led her to find the Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, which helps to elevate nurse innovators into roles as change agents in health care. SONSIEL hosted its first Nurse Hackathon in 2019, and Ayala attended.
The event made everything click for Ayala. “It was the first time that I felt like I was surrounded by people that think like me,” she said. It helped her put the missing final puzzle piece into place and see that problem-solving and innovation are the driving force behind her nursing practice. “I’ve had that [drive for innovation] inside me for a long time, I just didn’t know what it was called,” she added.
The hackathon concept originates from the tech world and involves “a group of people getting together for a compressed period of time to solve a complex problem,” according to Ayala. In their original purpose, hackathons were for computer programmers to get together and advance a software program. SONSIEL’s first nurse hackathon in 2019 was built to help nurses come together to creatively solve problems and find new ways to innovate health.
After the success of the first hackathon, SONSIEL, along with Johnson & Johnson and Microsoft, presented a virtual weekend-long nurse hackathon in 2020 called NurseHack4Health, an event that took place over 56 hours, with over 500 participants, and 32 teams. The NurseHack4Health hackathon operated on the same premise as the original, enabling participants to “improve health care and strengthen their innovation skills.” Nurses teamed up with other health workers and tech experts to search for solutions to health care issues. Ayala’s team focused on remote patient monitoring, creating a platform called “Hear Now” that held recorded messages from loved ones that nurses could play for patients.
After the weekend concluded, teams were able to pitch their solutions to a panel of judges in their focus area, and Ayala’s team won in their category. Out of 32 teams, five winners were able to see their solutions brought to life through access to Microsoft engineers, mentorship and coaching from Microsoft and SONSIEL, fellowship opportunities, access to Johnson & Johnson innovation webinars, as well as recognition on various communications channels.
NurseHack4Health has evolved since 2020, expanding to include smaller “mini hacks”, conferences, innovation activities, and Pitch-A-Thons where nonprofit health systems teams are eligible to receive grant funding to bring their ideated solutions to life. Ayala is a frequent participant in all the NurseHack4Health opportunities.
Nurse hackathons opened Ayala’s mind to the many nursing roles that exist outside of traditional bedside nursing practice. She explained how they tune people in to “nurse innovation that people really aren’t aware of,” and it ignited a spark that inspired her to pursue a transition in her career from ICU nursing to something new.
Since identifying this passion and utilizing her problem-solving skills at the hackathons, Ayala has used her nursing expertise to innovate in two start-up companies. First, she worked as the founding nurse practitioner for Pair Team, where she had a hand in developing the company’s high-risk primary care program. From there, she began her new role as the regional director of a virtual care startup.
“I just started looking for places that were interested in hiring a nurse practitioner that likes to be creative and structure clinical work that serves patients and moves the needle on health,” Ayala said of her new position. She was hired by her current organization to create and execute a fully virtual care model piloting in Wisconsin and now expanding into neighboring states. Ayala completed literature reviews utilizing the skills gained from her School of Nursing DNP education and created visual workflows to bring the virtual care program to life.
Ayala at the 2024 Utah Student Nurse Association’s keynote address
Not only is Ayala leading in the start-up, she’s also hoping to use her innovative mindset to improve how patients receive virtual care. She noted that virtual care can be a very useful tool for patients to grow a trusted partnership with medical professionals, but that it’s not accessible to everyone.
“Where it’s problematic is for people who don’t have access to the internet,” Ayala said, and she is committed to eliminating this barrier. Utilizing experience from her previous position where she discovered that health care devices can have cellular connections, she knows that health data can be transmitted through cellular lines to databases. This technology, Ayala explains, eliminates the inequity of when patients don’t have access to the internet, and she is implementing a similar system into her current work. Ayala was recognized for her commitment to inclusive practice, winning a national award for equity in practice in 2023.
Along with eliminating this barrier for those who lack internet access, the cellular connection also simplifies the process. With this connection, patients do not need to input their data into the system on their own nor take notes and attempt to communicate with their care teams; rather, the patient commits to using the devices and the data transmits automatically and is shared with the various care partners.
Ayala’s innovative projects do not stop there. With one of her nursing colleagues, she has developed Streamline Flow, a care system that focuses on preventing patients from “falling off their care plans.” She has worked on developing the company at night over the past seven years, and while thus far it has been unpaid, her dedication is about to pay off. Streamline Flow had its first implementation site in February of 2024. In its pilot, Streamline Flow was implemented into an assisted living facility for eight weeks. During the run, 65 patients with 92 diagnoses were cared for under the technology, which serves as a safety net for both staff and patients.
Streamline Flow (SLF) is a centralized platform to track and manage patient care plan adherence regardless of diagnosis. SLF reduces patient leakage, loss to follow up, and improves adherence to care plans, thereby improving outcomes. “We’re trying to change practice, essentially, and think about longitudinal care for patients and in a very nurse-driven way,” Ayala said.
Her dedication to this business stems from the idea that “those who are successful in health tech are the ones that just keep going, and I don’t know of a better group of health care workers that just keep going more than nurses.” That dedication has paid off as Streamline Flow’s implementation test was successful. Now that the technology has been proven to work, the next step is industry wide implementation across health care systems, providers, and care teams along with using the patient side of the application. The program can be used anywhere care is provided and will be revolutionary in the health care realm.
Streamline Flow has already begun gaining attention. They were featured in a Johnson & Johnson newsletter, which highlighted how Ayala and her team are “solving patient care gaps.” Ayala also explained the team will have the incredible opportunity in late October to attend the HLTH Event 2024, a health care innovation event, alongside 29 other nurse-led companies for the first “nurse innovation pavilion.” Companies in attendance were chosen by Nurse Approved: Nurse Expert Product and Innovation Evaluations. An article by Nurse.org featured Streamline Flow and the other participating companies.
Looking back, Ayala notes “there were signs all along” pointing toward her innovative nursing ambitions. Her DNP project focused on understanding why referrals for suspected lung cancer were so challenging to receive, interpret, and ultimately schedule, along with where improvements could be identified to speed patients toward diagnosis and ultimately treatment.
With the help of her advisor, Linsey M. Steege, PhD, School of Nursing associate dean for research, professor, and Gulbrandsen Chair in Health Informatics and Systems Innovation, Ayala was able to get a taste of what was to come in her nursing career. She noted having an engineer on the nursing faculty was “cutting edge,” and it allowed Ayala to tap into her innovative side for the project.
When Ayala remembers the lengths she had to go to during her fight for bins in the ICU medication fridge, she recognizes it as her first push for change. After initial hesitancy, she continued to fight for better organization and talked to more people until she was able to get the correction made. A drive for discovery and continuous advocacy, Ayala realized, is “what it’s going to take to instill change in health care.” She added, “It’s going to take everybody allowing others to flex their innovation muscles and not stifle those with creativity and drive.”