Technology implementation in the clinical setting isn’t a project but rather a transformation of the delivery system. As healthcare services in the United States and United Kingdom (UK) embrace technology to drive reforms in quality and efficiency, growing opportunities exist to share experiences between the two countries. Today, many global nursing dialogues are sharing lessons about community-care delivery models, nursing governance and adoption, interprofessional communication tools, and patient portals.
Now is the time to share practices in nursing informatics globally. This is essential to the success of the journey toward health information technology (HIT)-enabled transformation. Although many nurses might focus on differences in payment models and delivery methods between the United States and the UK, significant commonalities and experiences exist that each country can share with the other. These were explored in June 2013 by a group of UK nursing leaders who visited the United States.
Nursing informatics immersion study
The 2013 UK Nursing Informatics (UK NI) Leadership U.S. Immersion Study was a joint effort by the Healthcare Information and Management Systems Society (HIMSS), HIMSS Europe, and Cerner Corporation. These partners launched a year-long initiative aimed at promoting UK nurses’ role in implementing and using information technology (IT).
A hosted nursing-leadership delegation trip to Chicago culminated the initiative. A 10-person delegation of nursing informatics leaders was selected from across the UK to meet with U.S. nursing informatics leaders, visit key U.S. healthcare facilities that use nursing informatics to deliver care, and meet with other providers, suppliers, and government leaders. The delegation explored innovative technology, met with nurse executives, and spoke with nursing informatics colleagues at three Chicago healthcare facilities, all of which have achieved Magnet Recognition® from the American Nurses Credentialing Center. Many Magnet® attributes became apparent to the delegates during these visits. (See Understanding the Magnet Recognition Program.® be clicking the PDF icon above)
Each of the three facilities had a specific focus:
- Advocate Illinois Masonic Medical Center: Connecting the community through informatics
- Northwestern Memorial Hospital: The connected patient
- Ann & Robert H. Lurie Children’s Hospital of Chicago: Technology architecture and design.
Introduction of robust and sophisticated clinical information systems has prompted significant transformation in health care and focused greater attention on patient safety and outcomes. Healthcare systems are under increasing pressure to improve efficiency while standardizing and streamlining
organizational processes and maintaining high-quality care. The current knowledge explosion in health care requires clinicians to learn about and integrate information systems into their already demanding daily practice.
As part of the nursing informatics immersion study, several key concepts common to both the U.S. and UK nursing professions emerged. These include a culture of inquiry, shared governance and accountability throughout the organization, visible nursing leadership, and real-time data reporting through the use of quality dashboards.
Culture of inquiry
Working closely with bedside clinicians and the IT department, the nursing informatics team is responsible for development, implementation, and support of new systems. It’s also instrumental in fostering a culture of inquiry among the workforce. Giving frontline staff access to data provides a scholarly approach to change and transformation that emphasizes evidence-based practices and research.
Shared governance and accountability
The shared governance model gives clinical nurses a voice in determining nursing practice, standards, and quality of care. This empowers nurses to use their clinical knowledge and expertise to develop, direct, and sustain their professional practice. Interprofessional councils and committees allow the nursing informatics team to contribute to and share accountability for decisions made about patient-care delivery. Patients also participate in councils to bring their unique voice.
Visible nursing leadership
Presence of fully engaged nursing leaders with a shared vision aligns with the Magnet philosophy and the Magnet model component of structural empowerment. Professional practice flourishes under influential leadership, creating an environment where innovation is encouraged, adopted, and sustained. Although the three organizations the delegation visited had different leadership models, an underlying theme was the need for a clinical leader, such as chief medical information officer (CMIO), chief nursing information officer (CNIO), or director of informatics. Nursing informatics leadership is integral to help promote and drive the organization’s clinical vision and provide the underpinnings for a successful roadmap.
Real-time data reporting with quality dashboards
Quality data are informing practice at the bedside through real-time dashboards at each facility. The electronic systems were designed to monitor and capture adherence to indicators required by government and nursing standards. One of the facilities had unit-based quality message boards that informed patients and families of monthly quality outcomes.
The immersion study found that organizations that empower their staff structurally by using interprofessional shared-governance models have the capacity and agility to deliver clinical decisions and transformation to keep up with technology. Another key finding was that supporting leadership roles, such as chief clinical information officer (CCIO), CMIO, and CNIO, champion the clinical voice and bridge the gap between the IT department and clinical staff. (See Delegates’ comments by clicking the PDF icon above.)
Clinical transformation is a continuous process that involves assessing and continually improving the way patient care is delivered at all levels. It occurs when an organization rejects existing practice patterns that deliver inefficient or less-effective results and instead embraces the common goals of patient safety, improved clinical outcomes, and quality care through process redesign and implementation. By effectively blending people, processes, and technology, clinical transformation occurs across facilities, departments, and clinical fields of expertise. Constant measurement and analysis of how practice has developed or changed from the point of delivery is crucial for ongoing quality delivery. Analysis of clinicians’ workflow is needed to determine if the current amount of direct care being delivered is enough to provide not only good outcomes but also compassionate bedside care.
Christel Anderson is director of Clinical Informatics at HIMSS in Chicago. Cathy Patterson is a nurse executive at Cerner in London, England.