Improving the acute care practice environment through technology
Article Outline
Linda Burnes Bolton, PhD, AAN President
Over the last 10 years, multiple solutions to the nursing shortage have appeared in the literature. A common theme emerging from studies including the Institute of Medicine landmark report Keeping Patients Safe: Transforming the Work Environment of Nurses, 2004 is the need to focus on the demand side of the shortage.1 Other reports authored by the American Hospital Association, Joint Commission on the Accreditation of Healthcare Organizations, and the Robert Wood Johnson Foundation (RWJF) have recommended actions aimed at the practice environment level to retain nurses and improve patient care safety and quality. The American Academy of Nursing’s (AAN’s) contribution to the improvement of nursing practice is examining opportunities to improve nursing practice through technology.2, 3, 4
Ideally, new medical/surgical unit technologies should free up nurses to spend more bedside time with their patients. Unfortunately, this is rarely the case, mainly because technology needs-assessments usually fail to incorporate the viewpoints of nurses and other frontline workers. A gap exists between technology products deployed in American hospitals and the products’ utility. Although nurses are resourceful enough to work around inefficient technologies, the work-arounds can create a less-than-optimal work environment that can drive nurses away from the hospital setting, exacerbate the nursing shortage, and undermine patient safety.
To address these safety and workforce issues, AAN’s Workforce Commission, in partnership with the American Organization of Nurse Executives (AONE), has launched a new project: “Technology Targets, A Synthesized Approach for Identifying and Fostering Technological Solutions to Workflow Inefficiencies on Medical/Surgical Units,” supported by an 18-month, $358,000 grant from the RWJF. Technology Targets extends the Commission’s work, which began several years ago when the AAN sponsored a ground-breaking conference where staff nurses, technology vendors, and futurists agreed that current methodologies for assessing technological needs failed to encompass the frontline perspective.
The Workforce Commission then refined a methodology for analyzing workflow and work processes from a technological perspective, called “technology drill down.” After pilot tests demonstrated that the process resulted in useful data, the Workforce Commission invited a number of healthcare technology companies to take a look at the data; industry leaders suggested that more data, gathered from multiple and diverse hospitals and systems, would create a compelling case that would convince industry, as a whole, to develop innovations that meet nurse-driven needs. Accordingly, the Workforce Commission designed the aforementioned Technology Targets project.
Technology Targets represents an opportunity for linking and leveraging data from 25 technology drill-downs with findings from 2 other RWJF-supported projects: Transforming Care at the Bedside (TCAB), and a Time and Motion study.
Technology Drill Downs
Technology drill downs focus on medical/surgical unit workflow from a systems-wide perspective and engage not only RNs, assistive personnel, and unit clerks but also department members from across the entire health care team (including, for example, pharmacy, materials management, social work, and respiratory therapy) whose work processes all impact patient care and delivery. This interdisciplinary perspective provides a unique opportunity for analyzing these processes to see where and how they can be improved to create more efficient health care environments. Moreover, the process allows for the involvement of key decision-makers such as chief nursing officers and chief information officers as well as such environmental experts as clinical engineers, human factors’ engineers, and architects before time and financial investments in technologies are made, when they need to be informed by the day-to-day realities faced by frontline staff.
Participants identify processes that need to be changed to reach an ideal state and available technologies that could fill the gaps. They also identify specific requirements for new technologies and discuss how these technologies could reduce waste, add value to nurses’ time and create efficiencies in overall workflow and work processes.
Cedars-Sinai Medical Center recently hosted the first technology drill-down, where approximately 25 participants—nurses, respiratory therapists, case managers, clinical engineers, nutritionists, pharmacists, respiratory therapists, and facility designers/planners—spent nearly 2 days envisioning an ideal work environment, identifying gaps between the current and ideal state, and recommending technologies that could close the gap. The 4 most important areas that participants identified as ripe for potential technology solutions included: (1) patient education and communications, (2) software, (3) patient admissions, and (4) medications.
Transforming Care at the Bedside
Transforming care at the bedside (TCAB) seeks change and improvements in safety and reliability, care team vitality, patient-centeredness, and increased value. The goal at TCAB sites is to develop, test, and spread effective strategies and processes that transform the care experience of patients in hospital medical/surgical units, as well as the experience of health care professionals who care for them. The project seeks to highlight and strengthen the link between the quality of care patients receive and the work environment in which their caregivers function.
Time and Motion Study
This is a national multi-site investigation measuring direct and indirect medical-surgical unit nursing time, quantifying the impact of numerous interrelated environmental variables upon nursing hours per patient day (NHPPD), and providing baseline data against which to assess outcomes from new electronic health record systems and newly designed nursing units.
The TCAB, time and motion studies, and technology drill downs are taking place across a range of hospitals and health care systems, which will allow for an analysis of cumulative data according to setting. The anticipated returns of such a synergistic project are tremendously exciting. We will have accumulated a wealth of knowledge to improve work processes and launch discussions with technology partners to create products based on the identified priorities of frontline caregivers. The Workforce Commission will convene a coalition comprised of technology manufacturers, educators, clinicians and researchers to guide their work over the next 18 months. The project-deliverables are:
It is our hope that through this work we will capture industry’s attention and prompt the development of technologies that not only improve workflow processes but return nurses to the bedside to provide safe, quality, evidenced-based, value-added care. The Commission will produce a policy paper on the benefits of investing in care delivery technology to meet the increasing demand for care despite the continuing shortage of nurses and other health professionals.1, 2, 3, 4
References
- . Keeping Patients Safe (Transforming the Work Environment of Nurses) . Washington, DC: The National Academies Press; 2004;
- . In Our Hands . Chicago, IL: American Hospital Association; 2002;
- . Health Care at the Crossroads (Strategies for Addressing the Evolving Nursing Crisis) . Oakbrook, IL: Joint Commission on Accreditation of Healthcare Organizations; 2003;
- . Health Care’s Human Crisis (The American Nursing Shortage) . Princeton, NJ: Robert Wood Johnson Foundation publications; 2003;
PII: S0029-6554(06)00129-1
doi:10.1016/j.outlook.2006.04.001
© 2006 Mosby, Inc. All rights reserved.
