505_NUR

8/2/2019 505_NUR

1/60

505IT Implementation, Change

Management Strategy andLeadership

Presented by:

Lynn Cooper, MS, RN AD/PS, Columbia, MO

Kim Radant, MS, RN AD/PCS Indianapolis, IN

Tina Lund, MSN, RN, CNAA, Nurse Exec, Mpls, MN

8/2/2019 505_NUR

2/60

2

Role of Nurse Executive

Leadership

Strategy

Change management

Fitting IT initiatives into workflow

Managing the related changes

8/2/2019 505_NUR

3/60

Leadership ImplementationStrategies

Lynn Cooper

8/2/2019 505_NUR

4/60

4

Healthcare is a Team Sport

8/2/2019 505_NUR

5/60

5

Leading the Way with IT

Embrace the opportunity to shapetechnology

Fit nursing practice rather than adaptnursing practice to fit technology

Facilitate research on IT applications in

nursing to support evidence-basedpractice

8/2/2019 505_NUR

6/60

6

Key Issues & Trends

Connectivity

Electronic Medical Record Data Standardization

Decision Support Systems

Patient Safety

8/2/2019 505_NUR

7/60

7

Key Issues & Trends cont.

Cost-benefit Analysis

Privacy and Security

Consumerism and Wellness

Net Generation

8/2/2019 505_NUR

8/60

8

Where Are We in VA?

IT Reorganization

Health Systems Committee (NLB)

Information and Data ManagementCommittee (NLB)

Technology development in all NLB

committees

8/2/2019 505_NUR

9/60

9

Office of Nursing Service

2000 ONS Strategic Plan established Goal Group 2Technology and Systems Design

Components: Administrative,

Clinical, BCMA

2001 2007 Established membership on IT committeesimpacting nursing and patient care

2007 Goal Group 2 has redesigned itself to TechnologyConsultant Group

8/2/2019 505_NUR

10/60

10

VA Nursing Outcomes Database (VANOD)

National database of clinically relevantquality indicators

Nursing sensitive

Support decision-making

Benchmarking

8/2/2019 505_NUR

11/60

11

VANOD Indicators

Patient falls

Pressure ulcers

Patient Satisfaction Staff Musculoskeletal Injury

Staff Satisfaction

Staff Mix

Hours per patient day

8/2/2019 505_NUR

12/60

12

Nursing Informatics

a specialty that integrates nursing science, computerscience, and information science to manage andcommunicate data, information, and knowledge in nursing

practice.to support patients, nurses, and other providersin their decision-making.using information structures,information processes and information technology

American Nurses Association 2001

8/2/2019 505_NUR

13/60

13

Nursing Informatics cont.

ANA recognition 1992

ANA certification 1995

Career opportunities: transformingadministrative and education systems,

pioneering telehealth, mobile computing,influencing public policy

8/2/2019 505_NUR

14/60

14

IT: A Means to Evidence Based Practice

IT tools and how they are implemented

Value of tools for staff and care team

members

8/2/2019 505_NUR

15/60

15

Lessons Learned *

Improve Patient Flow

Improve Workflow Process Improvement is a Discipline

Measure Results

Medication Administration Drives Qualityat the Bedside

8/2/2019 505_NUR

16/60

16

Lessons Learned (cont.)

Smart Alerts Improve Care

Provide Ubiquitous Access to Digital Image

Dont Forget OR Plan for the Worst

Infrastructure is Key to Success

* Most Wired Hospitals,Hospital and Health Network, July 2007

8/2/2019 505_NUR

17/60

17

Nurse Executive Strategies

Develop informatics vision and goals

Enthusiasm re: innovation, creativity,

flexibility in planning Guide through change, attention to the

human side of practice

Keep communication lines open Balance high tech with high touch

8/2/2019 505_NUR

18/60

18

Strategies (cont.)

Facilitate research on IT applications innursing to enable EB informatics practices

Encourage tech-driven training

Promote nursing informatics expertise inclinical practice

8/2/2019 505_NUR

19/60

Change Management

Kim Radant

8/2/2019 505_NUR

20/60

20

The more things change, themore they stay the same.

The character of nursing is

8/2/2019 505_NUR

21/60

21

The character of nursing ischanging

Traditional roles and values are undergoing intensive scrutiny, criticalreevaluation and constructive alteration.

Concepts, standards, and objectives of nursing care are being reviewedand revised.

Long established principles of comprehensive patient care are beingaugmented and reinforced as the result of studies and research.

The magnitude and tempo of these social and professional trendsdemand continued changes in planning for nursing care.

We need to be sensitive to changes, interpretative of their significance,industrious in initiating constructive action, and flexible in reevaluating

our concepts and philosophy in reference to these changes.

8/2/2019 505_NUR

22/60

22

Program Guide for NursingServices, April 10, 1957

How can we encourage

8/2/2019 505_NUR

23/60

23

How can we encourageearly-adoption?

Factors that influence adoption

- Opinion Leaders

- Champions

- Experts

8/2/2019 505_NUR

24/60

24

Why dont people use it?

- Translation Science- Changing Healthcare Behaviors

Using what we know is right!

8/2/2019 505_NUR

25/60

25

Translation Science

Understanding the mechanisms by whichpeople uptake and use knowledge.

Testing the effect of interventions aimed atpromoting the rate and extent of adoptionof evidence-based practices by nurses,physicians, and other healthcare providers(Titler and Everett, 2002).

8/2/2019 505_NUR

26/60

26

Translation Science (contd)

Describing organizational, unit, andindividual variables that effect the use ofevidence in clinical and operational

decision-making

From Bench to clinical trials

Research findings to patient care.

8/2/2019 505_NUR

27/60

27

Applying research results to practice

It takes how long?

Why on Earth would this take so long?

Is it the same for evidence related to IT

change?

8/2/2019 505_NUR

28/60

28

Factors to consider

Education alone is not enough

How similar is this to patient education andchallenges related to altering healthcare

behavior?

J h K G lb ith

8/2/2019 505_NUR

29/60

29

John K. Galbraith

Professor of economics at Harvard University

Faced with the choice betweenchanging ones mind and proving

that there is no need to do so,

almost everybody gets busy on theproof.http://www.biographybase.com/biography/Galbraith_John_Kenneth.html

8/2/2019 505_NUR

30/60

Behavior change happens mostly by speaking topeoples feelings. This is true even in organizations

that are very focused on analysis and quantitative

measurement, even among people who think ofthemselves as smart in an MBA sense. In highlysuccessful change efforts, people find ways to helpothers see the problems or solutions in ways that

influence emotions, not just thought.

Quote by:Dr. John Kotter

Harvard Business School

8/2/2019 505_NUR

31/60

31

How do we make it easier and

encourage early adoption??

8/2/2019 505_NUR

32/60

32

The Basics

Appropriateness of equipment

WorkflowNo layering

Small Trials/Large Trials

Changing health habits/translating evidence to

8/2/2019 505_NUR

33/60

33

Changing health habits/translating evidence topractice Yin and Yang?

It is important to identify, achieveand celebrate some quick, positiveresults for the vital emotional liftsthat they provide.

8/2/2019 505_NUR

34/60

34

Dr. John Kotter: Short-term wins areimportant. Victories that nourish faith in thechange effort, emotionally reward the hard

workers, keep the critics at bay, and buildmomentum. Without sufficient wins that arevisible, timely, unambiguous, and meaningfulto others, changes efforts invariably run into

serious problems.

Changing health habits/translating evidence topractice Yin and Yang? (Contd)

8/2/2019 505_NUR

35/60

35

Whats a Nurse Exec to do?

Charting the course/setting the Vision

Emotional Persuasion: Convey passion

Figure out the appeal/why should I do this?

Look for early adopters and opinion leaders

Dr. Dean Ornish: Facts are important but not alwayssufficient. Radical, sweeping comprehensive changes

are often easier for people than small, incrementalones?

http://www.fastcompany.com/magazine/94/open_change-or-die.html

Dr. John Kotter: Go for small successes?

Rewarding the Successes

8/2/2019 505_NUR

36/60

Leadership Case Study

Strategy

ChangeManagemen

t

Workflow

Leadership Tina Lund

8/2/2019 505_NUR

37/60

37

Expansion/Replacement Project

ICU Clinical Information System

(CIS)

Strategy

ChangeWorkflow

Leadership

8/2/2019 505_NUR

38/60

38

Role of Nurse Executive

Senior driver for theproject vision

Co-author of the

Management Definitionguide (MDG)

Commitment of projectresources

Consider implications

of change

Assure integratedimplementation acrossservice lines

Assure commitment ofeducation and stafftime dedicated totraining

Communication to allkey stakeholders

8/2/2019 505_NUR

39/60

39

Background

Increased use of Clinical InformationSystems in ICU

http://www.picis.com/ http://www.medical.philips.com/

CIS will/must enhance workflow

8/2/2019 505_NUR

40/60

40

MVAMC CIS History

1990 - CareVue implemented in ICUs FY03 Chief Biomed approached Nurse Executive

regarding replacement project

Team meetings began 10/24/02 Vendor brainstorming inquiry 1/03 MDG completed 3/03 Funding request submitted 12/03 Funding received 6/04

Site visit to Mayo 2/05 V21 site visits to SF & Palo Alto 4/05 Vendor review onsite 6/05

CIS U d /R l t

8/2/2019 505_NUR

41/60

41

CIS Upgrade/Replacement

MANAGEMENT DEFINITION GUIDE

Purpose: Project Description:

The existing product in ICUs and 3K will be outdated and unfixable vendorsupport to the software/equipment ends 12/2002.

To replace/upgrade the current CIS/Carevue documentation system .

To implement the new system in ED, OR/PACU.

Implementation of a documentation system that has interaction with VistA/CPRSand the capacity for data repository ..

Cost of the Status Quo: System and equipment failures more frequentlyuntil unrepairable. Failure to implement will result in return to a paper documentation

systemnegatively impact the efficiency of nurses, physicians,

Quality of documentation will be affected, .ramifications for JCAHO and otheraccrediting standards and regulations.

The use of electronic documentation is a State of the Art recruitment tool .cease. Patient Safety and decision-making may be adversely impacted as the current system

builds in decision making and safety flags The current system provides a comprehensive visual display of patient information

that is readily accessible to multiple clinicians and this would not be possible in apaper format.

8/2/2019 505_NUR

42/60

42

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Vision and Objectives: Vision:

Electronically provide documentation of complete patient informationat the point of care.

To implement an electronic system for clinical staff that is portable tothe VA Midwest Healthcare Network

Objectives: Enhance patient outcomes by delivering reliable, up-to-date patient

information at the point of care Maintain quality of care through use of standardized documentation

process and guided clinical decision-making tools Enhance patient safety/prevention of adverse events through the

provision an integrated clinical database that provides ongoing up-to-date assessment, treatment, medication and clinical information at the

point of care. Continuous Quality Improvement Measures:

Documentation audits to measure completeness of the electronicMedical Record

Same level of assessment and data capture in intensive care settingsto meet same standards of care.

8/2/2019 505_NUR

43/60

43

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Scope: Business Impact:

The project will change how electronic documentation is accomplished-. If anupgrade is implemented, the impact to current users will be minimal in timefor training on changes. A new system will require more training time forcurrent users. New users will need to revise work processes surrounding

documentation and participate in more intensive training. Availability ofelectronic documentation additional areas will greatly improve availability ofpatient information house-wide.

Nursing staff will need to learn either a new system or productupgrade/enhancement. A combination of vendor supported classroomtraining and hands on training will be needed bedside. New users will requiremore comprehensive and intensive training.

Systems Impact:

The project will require the purchase of new hardware and software. The project requires review of monitored bed areas in consideration of

equipment needs and staff use.

8/2/2019 505_NUR

44/60

44

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Business Assumptions: The IRM Technical Services Group will assist with installation & maintenance The IRM TSG will install the enhancement and test all equipment ... A CIS project team will provide overall project oversight. A CIS training team will provide training.

Clinical staff will participate in reviewing and selecting product.

V23 IT workgroup will review/approve project. Finance and Capital Assets Sub-council approval for funding.

Technical Assumptions: The project will involve modifying or replacing existing systems. Equipment compatible with current workstation hardware, software. The project will involve work area modifications

Workgroup Assumptions: Determination of replacement/upgrade specifications Review data storage and retrieval for archiving data Ability to interface with CPRS Dialogue with community and/or VA electronic documentation systems .

Determination of V23 facilities interest in implementation of a similar system Explore contractual benefit for group purchase

8/2/2019 505_NUR

45/60

45

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Evaluate available systems for electronicdocumentation

Security Impact:

Current computer and access security will bemaintained.

Issues

Staffing must be maintained at above adequate levelsto allow for staff to attend training, or to learn the

enhancement. Education and support must be available 24 hours a

day.

8/2/2019 505_NUR

46/60

46

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Sponsorship / Development Participants:

Role Description Team Member(Names, Titles & Departments)

Authorizing/

Initiating Sponsors

Individual/group who has the power to initiate and

legitimize the change for all of the affected targets.

Steven Kleinglass, Medical Center

Director

Sustaining Sponsors Individual/group who has the political, logistical andeconomical proximity to the targets.

Dr. John Drucker, MD, COS

Tina Lund, Nurse Executive

Process Owner/

Change Agent

Individual/group who is responsible for implementingthe change.

Tina Lund, Nurse Executive

Change Target/

Participants

Individual/group who will experience or be affected bythe change.

Staff RNs

Physicians

Respiratory Therapists

Project team Cross-functional team that will design the system andwork processes or implement the project.

Subject Matter Experts:

Clinical & Technical

IRM

Partnership

8/2/2019 505_NUR

47/60

47

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Requirements

User Requirements

Software that is easy to learn, similar to current product, easy to use (point andclick), easy to configure/change and easy to maintainSystem that is accessible at the bedside, throughout the hospital, and offsite/remote sitesProduct that has the capability for data retrievability and generation of reportsTotally paperlessMust display information, not just dataMeets staff support needs 24/7

Technical Requirements

Interfaces with VistA and bedside devices, patient monitors, ventilators, infusion pumps,Integration with medical images/PACS and other clinical images like ECGsProduct and Vendor stability that is serviceableGood back up system/storage with ability to easily access archival dataCan be upgradedUtilization of existing infrastructure or hardwareMeets JCAHO/HIPPA requirements for documentation and confidentiality

8/2/2019 505_NUR

48/60

48

MANAGEMENT DEFINITION GUIDE (MDG) Contd

Estimated Investment / Resources:

InvestmentArea

Description ImplementationCosts

Annual RecurringCosts

Capital Expenses Equipment:Includes hardware and software.

$1.5 Million

Vendor Resources

VAMC Resources(estimated at rate of$65 per hour)

Staff time for analysis, projectcoordination, implementationand support

Vendor Support Annual supportWarranty and upgrades

Staff Costs FTEE Administrative Support

Total Costs

CIS Replacement Requirements

8/2/2019 505_NUR

49/60

49

CIS Replacement Requirements- Brainstorming Session

Flowsheet documentation of assessments andtreatments

Progress Note Configuration

Reports VistA/ CPRS Requirements

ADT Interface

Flowsheet configuration IV Drips

Cell Management

ROI: CIS Outcomes

8/2/2019 505_NUR

50/60

50

ROI: CIS Outcomes

Quality Improvement

Decision Support

Improved compliance to standards

Nurse Recruitment and Retention

8/2/2019 505_NUR

51/60

51

CIS Security Requirements

HIPAA

HL7

User permission/access

CIS d R h

8/2/2019 505_NUR

52/60

52

CIS and Research

Vast amounts of clinical data available

Data Mining

Relational Databases

CIS K t S

8/2/2019 505_NUR

53/60

53

CIS Keys to Success

Workflow analysis and consideration

Super users

Staff education

Senior leadership support

Wh h d?

8/2/2019 505_NUR

54/60

54

What happened?

FY06 Competing priorities for Biomedical

Management Service Maintenance beingmanaged

Downtime Off tour support

Cannibalizing parts

Network initiative - V23 decision to implement

and standardize CIS

8/2/2019 505_NUR

55/60

55

Whats going on?

FY 07

MVAMC Multidisciplinary ImplementationTeam 4/07

V23 finalizing system requirements, combining

aspects of VISN 21s & VISN 12s projects. Scopeincludes all V23 facilities for CIS and AnesthesiaRecord Keeping

Contract to be awarded end FY07

CIS N t St

8/2/2019 505_NUR

56/60

56

CIS Next Steps

Implementation/Project plan

Timeline

Resources, especially staffing

Education

Change management

Communication Plan

8/2/2019 505_NUR

57/60

57

Other projects

Automated Vital Signs Capture w/ Welch-Allyn(local)

Electronic Scheduling Package (VasTech)

BCMAMotion Computing Tablet (handheld) APRN CPRS-based Peer Review Program GUI I&O Progress note templates (local) In-Bound Demographics: VasTech Interface

L L d

8/2/2019 505_NUR

58/60

58

Lessons Learned

Managing hurdles

Communication

Involvement of staff at point of care iscritical to success

Summary

8/2/2019 505_NUR

59/60

59

Summary

Strategy

ChangeManagementWorkflow

Leadership

8/2/2019 505_NUR

60/60

Questions?