Shared Governance Models Optimize Outcomes, Adoption and User Perception

Transcription

1 Shared Governance Models Optimize Outcomes, Adoption and User Perception Nicole Martinez BSN, RN DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Nicole Martinez, BSN Has no real or apparent conflicts of interest to report HIMSS

3 Learning Objectives a. Understand the structural framework that promotes shared governance. b. Identify how to create a stakeholder end user group that enhances dialogue to achieve meaningful results. c. Understand the mechanisms for enhancing dialogue within your organization to promote adoption. d. Learn how to develop decision support mechanisms within your current EMR using identified algorithms

4 A Lesson Learned

5 Background Our Vital Statistics large, academic medical center in an urban location strong collective bargaining unit Total of 650 licensed beds, 70- ICU beds across 6 units In 2006 implemented electronic documentation in all 6 adult ICUs Transitioning from paper-based processes and documentation. The implementation was executed over 2 years per an implementation plan. The organization supported this initiative with a significant financial investment.

6 The Iceberg Hits Within 8 weeks of the implementation concluding, all adult ICU staff were back on paper documentation The electronic module was removed 5 months later the organization experienced a work stoppage for the nursing collective bargaining unit The difficulties experienced by the staff during the electronic documentation initiative was cited as a major issue that influenced the vote

7 The Ship Begins to Sink As a result of the work stoppage all electronic documentation is removed from the organization All staff must be retrained 6 months after the work stoppage at significant cost to the organization

8 What Went Wrong? Cultural Values Assessments Leadership support End user involvement

9 Cultural Values Cultural Values Assessments Essential to Success 1. Organizational culture 2. Change readiness 3. Values that were important to key stakeholders

10 Leadership Support Decision to obtain EMR system was based upon financial history and not the end user analysis and this was made public Leadership was divided on the need for the initiative Lack of support from all levels of nursing leadership

11 End User Involvement- Wrong End Users Nurse educators from the ICU s were the primary stakeholders at all design sessions Testing was done by med/surg nurses already familiar with the system ICU staff nurses were not involved in the process ICU physician staff was not involved in the process

12 What could have saved this ship? 1. Involve the right key stakeholders: At the right time On the right areas 2. Using the Magnet Model as a change management tool.

13 Using the Magnet Model as a Change Management Tool Magnet Model consists of 5 elements: 1. Transformational Leadership 2. Structural Empowerment 3. Exemplary Professional Practice 4. New Knowledge, Innovation, and Improvements 5. Empirical Quality Results

14 Saving The Ship- What happened next? Transformational Leadership Organizational change Leadership valued the changes related to the EMR Leadership put strong effort into explaining to staff the importance of the initiative by sharing their vision of the future

15 Magic Bullet to Success Structural empowerment through formation of a Sunrise Clinical Manager (SCM) End User Council What made this group different? 1. The executive power to approve all decisions related to the EMR was delegated to the bedside nurse through this forum 2. Physician leadership formally abdicated executive power decisions to the SCM end user group

16 Paving the Path to Structural Empowerment Mission Statement Developed Expectations shared with everyone One rule: We will build it exactly as you want it with one caveat, you must use the existing EMR, but we will create whatever you want within that structure Staff accepted the responsibility to take homework back from meetings to peers and obtain feedback and report back to the team

17 Engaging the Right End User at the Right Time The SCM end user council identified peers that would act as the representation at the design sessions The team members of the staff reported back every two weeks to their colleagues on the status Leadership supported team members by obtaining replacement staff so the nurses could be out of staffing.

18 Structural Empowerment Through Communications End User webpage on hospital intranet Internet mailbox communication All documents posted for transparency Education links Education posted in Power Point and interactive modules

19 SCM End User Council Webpage

20 SCM Intranet Communication Mailbox

21 Structural empowerment Created a mailbox on the intranet where any staff member could questions, comments, and concerns 24/7 Leadership made a commitment to address each message within 72 hours and to post it online so that everyone had access Reports on all of the messages were shared at the end user meetings, collective bargaining meetings, and executive leadership meetings to grow trust

22 SCM End User Group Council Mission Statement Purpose Serve as an educational resource for promoting the advancement and expansion of knowledge for the practice of Informatics. Raise awareness of the importance of care provider role in clinical information system acquisition and deployment. Serve as a forum that will promote and advocate for nursing care and practice that is supported by the implementation of technology in the clinical environment. Promote improvements in the delivery of patient care through the use of technology. Will monitor, evaluate and recommend enhancements to clinical applications.

23 SCM End User Group Council Mission Statement Communicate with all levels of nursing to establish and build a nursing informatics knowledge repository. Provide a forum for staff to offer feedback regarding the technology incorporated into the clinical environment. Staff will have the opportunity to present new ideas and discuss areas in need of improvement. Provide expertise, leadership, and guidance in the promotion of activities, initiatives and collaborations within the specialty of nursing informatics. Collaborate with medical informatics group, and others, to build and sustain a unified voice to achieve organizational goals and initiatives.

24 Education- Any Way You Want It!

25 Exemplarily Professional Practice Staff collaborated with their physician colleagues to identify the best practice for their documentation Key physician stakeholders were identified as champions They reviewed the nurses decisions and suggested revisions, however the final decision was with the nurses

26 Process Improvement: Medication Reconciliation Point of Entry Med Rec Process- ED Patient arrives In ED Pt. Historical medication names entered in EDIM Name dose route frequency last dose taken Pre adm phone call Point of Entry Med Rec Process- Same Day Patient booked for same day procedure Pt DC home from ED Pt admitted as inapatient Pre admission phone call RN enters home meds in SCM Pt admitted as Same Day MD in ED completes Med Rec in EDIM and prints prescriptions from EDIM Process complete Unit Clerk transcribes the EDIM home meds into SCM Admitting nurse enters pt. historical meds in SCM Admitting MD completes the Med rec for admission in SCM ADM Process complete ADM Process complete Pt discharged home Pt transferred to floor Prescriptions hand written by discharging MD Pt discharged home Discharging Nurse enters RX as DC session med Prescriptions hand written Discharging MD completes Med Rec for DC in SCM Med Rec pulled into Nsg DC instructions and DC summary(service s) Med Rec pulled into Nsg DC instructions and DC summary(servic es) Process complete Process complete

27 Process Improvement: Core Measure- Information at Discharge Example of our structured note for discharge with selectable disease specific templates

28 Process Improvement: Influenza Screening Tool When order- is selected an order is placed behind the scene. When the month and date is entered a significant event is automatically placed behind the scene.

29 New Knowledge, Innovation, and Improvements Staff stakeholders identified processes and workflows to enhance their practice. Automated clinical decision support mechanisms and enhanced workflows for: Influenza Vaccines Pneumococcal Vaccines DC instructions including HF information Electronic Medication Reconciliation Timely documentation

30 RN Sat Survey over last 5 years Participation improved over 40% Job satisfaction scores improved nearly 17% Medications Reconciliation compliance above 90 % compliance for 4 years since inception of electronic medication reconciliation Empirical Outcomes

31 Empirical Outcomes

32 Key Strategies Identify the right end users Empower end users to make the right decisions Create structures that empower and support their goals Celebrate Success Thank your end users

33 Thank You! Nicole Martinez, BSN, RN Director of Nursing Informatics ext 3284