Challenging The Way We Work Health Information Technology (HIT) Working for Us Dunedin Dialysis Laboratory Summary System Donkin B. Dunedin Hospital, Southern District Health Board, Private Bag 1921, Dunedin 9016, New Zealand
Challenging The Way We Work •
Describe – ID prob. – Req. change
•
Managed process – Concept sol’n tool design testing training transition implementation
•
Evaluation – Outcomes / Comment lit
Challenging The Way We Work • HIT +ve imp – Nsg care & P/O – Pt safety / QofC (Waneka & Spetz, 2010)
– Biochem mtg • 92 dialysis patients (52 HD / 40 PD) • Wide geographical area • 7% NZ 4.0m (285,000)
Challenging The Way We Work Prob. ID / Need for change •
Practice •
Access 3 lab sites – Each patient – Each test group – Drill down results
• •
Transcribing Implications – RN time (RTC; NPJ)
•
Risk – right results, right patient
Challenging The Way We Work Questions: “..how…be done better?” “..how automate process existing electronic systems?” “.. system orientated, less person dependant?”
Challenging The Way We Work Faster data collation & robust data
Challenging The Way We Work Process •
Concept design testing training transition implementation • Min risk: • Right patient • Right tests • Right data / time
• Safe pt management • clinical risk • serv. risk
Challenging The Way We Work Process •
Concept design testing training transition implementation
• Automate – Use existing HIT platform •
work
•
time
Challenging The Way We Work Process •
Concept design testing training transition implementation
• Discuss CNM • Emphasise time risk safety efficiency
– Prototype approval
• Find / discuss with right IT Application Developer
Challenging The Way We Work • Smart! - align organisational goals – Statutory Obj • “...improve, promote and protect health population.” • “...promote effective care and support.”
– District Plan • “…maintain and enhance capability deliver quality health services.” • “…manage risk.”
Challenging The Way We Work Process •
Concept design testing training transition implementation – Replicate look / feel • Format • Access
– Security / privacy – Cost staff / budget
Challenging The Way We Work Process • Testing – 3/12 Feb – April 2010 – Page structure • Format & display
– Data accuracy • Inclusion / Omission • Transfer errors • Corruption
Challenging The Way We Work Process • Development & testing • Involved other staff – “show and tells” • Feedback shaped syst – Spec details code (+ date & time) – Improved pt demographics name & NHI (+ DOB) – Customise display period
Challenging The Way We Work Process • Training – 9 staff – 8 weeks 2010 training – Face – face basis • • • •
Display Explain screens Demonstrate Task performance
Challenging The Way We Work Process • Transition – May - Jun 2 syst run side by side (final quality check)
– Audit of all trial test results (test database) • 100% correct
Challenging The Way We Work Process • Implementation – Change took place from July 2010 • Test data cleared • Data real time • Staff informal refreshers
Challenging The Way We Work • Evaluation – Outcomes / Discussion • Benefits of the change • Disadvantages • Literature
Challenging The Way We Work Outcomes • System generated – Customised – Reports – Database
• Enhanced access & availability – Secure
• Uptake – Previously 1/3 staff gen. rpt • Max to date 5/6 83% • Case load allocation
Challenging The Way We Work Outcomes • Efficiency & effectiveness – 1-2 wk/dy gen. rpt – Now 40 min – Hardcopy optional
Challenging The Way We Work Outcomes • Sig risk reduction – Transcribing – Manual calculations – Adj Ca++ / URR
• Patient focused – Meeting delays – timely decisions to CKD management Implementation of decisions sep process!
• Transferability – ICU
Challenging The Way We Work Outcomes • Disadvantages – Result availability: tags – Specimen collection dates – Security – PTH data
Challenging The Way We Work • HIT impact - recognised lit: – doc qual – doc time – error – nsg satis – pt care (?) (Waneka & Spetz, 2010)
Challenging The Way We Work Outcomes • User survey – Internet (confidential, anonymous) – 8 invitations • 6 completed responses • RR 75%
Challenging The Way We Work Survey • Awareness for DLSS development? 100% Y
• Consulted during the development? 100% Y
• Listened to: able to influence development? 100% Y
Challenging The Way We Work Survey • Reason for change to DLSS well communicated?
Need for Change
4 3.5 3 2.5
Number
2 1.5 1 0.5 0
Ext w ell
Well
Could've Not so w ell Really poor been better
Responses
Challenging The Way We Work Survey • DLSS training was done well?
Training
3
2.5
2
Number
1.5
1
0.5
0
Absolutely
Good
Just ok
Responses
Could have been better
No w ay
Challenging The Way We Work Survey • Training: what could have been done better? – 2/6 commented • “…to have spent more time on training due to my mediocre computer skills…” • “…but by the time…I had forgotten how to do it…had to be reminded …have ok since .”
Challenging The Way We Work Survey • Easy features: – Accessing results – Adding results – Report display +editing – Add / remove pts
Ease of Use
3
2.5
2
Number
1.5
1
0.5
0
Really easy
Easy
A little tricky
Responses
Very tricky
Impossible
Challenging The Way We Work Survey • Ease of use - room for improvement? – 3/6 commented • “…more practice…not take long to find this… easy to use.” • “…more practice needed limited time available…” • “…not all (Adj Ca++) are being corrected…”– operator issue addressed ↑ training
Challenging The Way We Work Survey • What difference, has DLSS made …way … access / use patient test results? – 5/6 commented
Challenging The Way We Work Survey • “…easier” • “Handy, quicker / improved access…home visits” • “Great no…handwriting” • “Reduces chances…error” • “Less nursing resources…” • “Great…see trends in (monthly)…results” – no change … lack of familiarity with system – “…still look up i-Soft…”
Challenging The Way We Work Survey • Comments reflect lit – +ve integration HIT Invol staff plan / devel / impl: flex Illus. pt benefit Impt adeq training ($ needs asst’s)
– Staff satisfaction present HIT perceived ease use Integrates nsg wk flow (Waneka & Spetz, 2010)
Challenging The Way We Work Survey • Comments reflect lit: – ? RN want in HIT • • • •
Ease of use Flexibility Effectiveness Benefit → safety ??
Challenging The Way We Work Critique • Frances Hughes – ID drives innovation • Equity • Safety • Effectiveness • Cost constraints ($ / ) (Merritt, 85. Deutsh, 85. as cited in Huges, 2010)
Challenging The Way We Work Critique • Def. Tech innovation – “…knowledge, skills, methods, techniques to accomplish a task.” – X just technology innovation • Sp Technology Transfer – Prod / proced new to organisation – (DU) improve exist proced, processes (US General Accounting Office, 2005)
Challenging The Way We Work Critique • ? take successful change
• Organisational cult: – Opp’ys: recognised & encouraged
• Leadership facilitate (!) • Permission giving (Druder, 86. Blohowiak, 92. Radka, 02 as cited in Huges, 2010)
Challenging The Way We Work Critique
• Barriers
– Nature comm’n • • • • •
Quantity / Timing / Relevance Personal contact Focus right people Language (? Change agent) Right leadership - impt nsg leadership! (Ref JONA)
– +ve response
Challenging The Way We Work HIT Working for Us
• Conclusion – DLSS e.g. decentralised Tech Tx Proj • ID prob local level • Develop local solutions • Addresses issues
$, / , – Increased staff participation in new process vs. prev
Challenging The Way We Work HIT Working for Us
• Conclusion – Challenges? – sustain uptake – Audit data – ?HIT imp → RTC? – Diff show HIT +ve nsg sens pt outcomes (Waneka & Spetz, 2010)
Challenging The Way We Work HIT Working for Us
• Conclusion – Do diff? • Planning – haphazard use info • Training – x over est. simplicity
Conclusion Hope encourages you, your colleagues to ask “why do we do it that way?” and to be innovative!
Challenging The Way We Work HIT Working for Us
References 1. 2. 3. 4. 5. 6.
Copnell, B., & Bruni, N. (2006). Breaking the silence: nurses’ understandings of change in clinical practice. Journal of Advanced Nursing, 55(3), 301-9. Hughes, F. (2006). Nurses at the forefront of innovation. International Nursing Review, 53(2), 94-101. Strategos (2003). What are the barriers to innovation? Survey of 500+ executives. Retrieved from http://venture2.typepad.com/innovationnet/2004/08/what_are_the_ba.html The CEO Refresher (2010). Change Management – Five colossal mistakes to avoid. Retrieved from http://www.refresher.com/aanlchange.html US General Accounting Office (2005). Principles of innovation and change. Retrieved from http://www4.uwm.edu/cuts/bench/princp.htm Waneka, R., & Spetz, J. (2010). Hospital information technology systmes impact on nurses and nursing care. Journal of Nursing Administration, 40(12), 509-514.
Challenging The Way We Work HIT Working for Us
• Limitations – Clinician as change agent – Self reporting – Dom voice lit
– Change r/t technical care & treat – Less r/t pt comfort – Obs lit and crit from lit (Copnell, B., & Bruni, N. 2006)
Challenging The Way We Work Critique • ID 15 rules Tech Tx – My Top 5 1. 2. 3. 4. 5.
Comm’n is everything Comm’n / Tech Tx X easy Most respected opinion that of peers! X make life easier wont get used Showing & telling more impt. just showing or telling
Centralised
Decentralised
iPM
DLS
Control / Power
High level: vertical
Admin Tech ex
Control / Power
Low level: horizontal
Among gp members; peer network
Need ID
High level
“Push” down effect: change / solutions
Need ID
Local (gp, peer)
“Pull” effect: change / solutions
Local adaptation
Low degree
Inflexible
Local adaptation
High degree
Flexible
Information and training
High degree
Formal
Information and training
Low degree
Informal
Uptake
Low
↑Complexity, Uptake
High
↓ complex,
distance, delay: training and use
local, less delay
Challenging The Way We Work Critique • Huges 8 types innovation – Historical – Research – Clinical – Business – Educational – Technological – Policy
