Arch Collaborative Nursing Guidebook 2022

Authored by: Jacob Jeppson, 08/23/2022 | Read Time: 10 minutes

As the Arch Collaborative has grown, so has the voice of nurses. While past editions of the Arch Collaborative Guidebook primarily represented providers, this is the first to focus exclusively on nursing professionals. Insights come from 35 organizations who (1) surveyed nurses about their EHR experience (a total of 15,993 respondents across a breadth of organization types) and (2) completed as a leadership team the nursing section of the executive survey, sharing details about various organizational EHR practices and processes.

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<div class="row" style="margin-top: 40px; background:#2b333a; padding: 15px;"><img src="/images/report-images/2022/arch_collaborative_nursing_guidebook-organization_types_represented_in_this_report.svg" alt="organization types represented in this report" style="max-width: 1440px; max-height: 383px; width: 100%;" class="fr-fil fr-dib" /></div><div class="row" style="background:#c18654; padding: 15px;"><h3 style="color:#ffffff;"><strong>What Is the Arch Collaborative Nursing Guidebook?</strong></h3><p style="color:#ffffff;">The Arch Collaborative Nursing Guidebook is the result of thousands of hours of combined effort. With the survey taking roughly 10 minutes to complete, the almost 16,000 nurses represented in this guidebook have dedicated a total of 2,500+ hours to sharing their feedback and insights. This incredible effort has allowed the Arch Collaborative to identify universal best practices that any health system—regardless of their EHR vendor—can use to improve their nurses’ EHR satisfaction. These best practices are shared here to help healthcare leaders find their organization’s own path to EHR success. It should be noted that improving the EHR experience is rarely, if ever, about a single factor. So while each area can drive some improvement, healthcare organizations should glean insights from all sections and apply them to their own needs.</p></div><div class="row" style="margin-top: 20px;"><p><strong>Below is a breakdown of the insights found in the following pages:</strong></p><p>High-Level Findings to Consider</p><ul><li>Change Is Urgently Needed</li><li>Recommendations for Deploying Best Practices</li></ul><p style="margin-top: 20px;">Best Practices for Nursing EHR Success</p><ul><li>Communication and Engagement Strategy (nursing representation in IT, use of superusers, governance and EHR changes, etc.)</li><li>Onboarding/Initial EHR Education (training time, content, trainer quality, training methods, etc.)</li><li>Ongoing EHR Education (frequency, IT rounding, use of virtual training, etc.)</li></ul></div><div class="row" style="margin-top: 20px;"><p>Since the last edition of the guidebook, the Arch Collaborative has also updated our highest-level findings on what is required for EHR success. The original three pillars—strong user mastery, an organization-wide sense of shared ownership, and EHR technology that meets users’ unique needs (personalization)—now rest on a foundation of strong EHR system reliability and response time. This reflects growing evidence that organizations and EHR vendors need to invest more in maintaining proper EHR infrastructure. Because this addition is a recent change, this guidebook remains focused on strengthening the three pillars of EHR success. (Insights surrounding the fourth foundational principle can be found <a data-id="423" data-itemtypeid="7" href="/report/2007-best-in-klas-awards-software-professional-services-and-medical-equipment/423"><u style="color:#4c8bc9;">here</u></a>.)</p></div><div class="row" style="margin-top: 40px; background:#c18654; padding: 15px;"><h3 style="color:#ffffff;"><strong>High-Level Findings to Consider</strong></h3></div><div class="row" style="margin-top: 20px;"><div class="col-md-4"><h3 style="color:#c18654;"><strong>Change Is Urgently Needed</strong></h3><p>The best practices shared in this report are vital for organizations that want to achieve EHR success. User mastery has seen a stark decline since the beginning of the pandemic. It is imperative that organizations have great programs for building user mastery. Many would benefit from reevaluating how their training and education programs prepare nurses for their day-to-day EHR use while also weathering inevitable EHR and related environmental changes.</p></div><div class="col-md-8"><img src="/images/report-images/2022/arch_collaborative_nursing_guidebook-initial_and_ongoing_training_satisfaction_2018_to_2022.svg" alt="initial and ongoing training satisfaction 2018 to 2022" style="max-width: 960px; max-height: 539px; width: 100%; margin-top: 10px;" class="fr-fic fr-dii" /></div></div><div class="row" style="margin-top: 40px;"><h3 style="color:#c18654;"><strong>Recommendations for Deploying Best Practices: Focus on Weak Spots, Use Pilot Programs</strong></h3><div class="col-md-8" style="background:#f2f3f4; padding: 15px;"><p>Areas in which your organization has low scores are great opportunities for deploying the best practices in this guidebook. For those who struggle to identify what areas need help, one option is to focus on the most consistently low-performing areas across the Collaborative. In particular, many nurses in radiology, PICU/NICU, procedural, or behavioral health environments struggle with the EHR and tend to disagree their EHR has the functionality they need; nurses in these areas would particularly benefit from improved onboarding, ongoing training, inclusion in governance, and improved communication efforts. A <a data-id="341" data-itemtypeid="15" href="/archcollaborative/casestudy/optimizing-ehr-workflows/341"><u style="color:#4c8bc9;">case study</u></a> from Sutter Health on improving the experience of perioperative nurses could be a helpful resource for organizations that want to tailor their improvement efforts to the nurses who struggle with the EHR the most.</p><img src="/images/report-images/2022/arch_collaborative_nursing_guidebook-agreement_that_ehr_has_needed_functionality_by_nursing_focus_area.svg" alt="agreement that ehr has needed functionality by nursing focus area" style="max-width: 960px; max-height: 666px; width: 100%; margin-top: 20px;" class="fr-fic fr-dii" /></div><div class="col-md-4" style="background:#2b333a; padding: 15px;"><p style="color:#ffffff;">Pilot programs are an effective, low-risk way to launch improvement efforts. In <a data-id="401" data-itemtypeid="7" href="/report/speech-recognition-2007/401"><u style="color:#4c8bc9;">past research</u></a> on EHR satisfaction in ambulatory settings, the Arch Collaborative has shared recommendations for implementing a successful EHR optimization sprint.</p><ol style="color:#ffffff;"><li>Identify an area that has poor performance but strong leadership for a pilot program.</li><li>Design the program using staff members who are interested in the change and have a deep knowledge of nursing workflows. If the budget is a limiting factor, ask to borrow staff from other areas rather than trying to hire net new FTEs.</li><li>Measure nurses’ EHR sentiments and skills before the program is implemented.</li><li>Measure nurses’ EHR sentiments and skills after the program is implemented and after nurses have had a chance to go back to work.</li><li>Based on the changes you see, iterate to improve on program weaknesses and move on to implementing the program with additional nursing groups.</li></ol></div></div><div class="row" style="margin-top: 40px; background:#c18654; padding: 15px;"><h3 style="color:#ffffff;"><strong>Best Practices for Nursing EHR Success</strong></h3><p style="color:#ffffff;">To learn more about the best practices below, including case studies and supporting data, download the full report.</p></div><div class="row" style="margin-top: 20px;"><h3 style="color:#c18654;"><strong>Communication and Engagement Strategy</strong></h3><ul><li>Nurses should be included in EHR governance and decision-making</li><li>To better build relationships with nurses, ensure you have at least 1 nurse employed by IT/informatics (full or part time) per 100 nurses</li><li>Allow frontline nurses to make requests regarding the EHR</li><li>Successful organizations have a fast track for quick, obvious EHR changes, and most have a maximum of four committees reviewing any changes</li><li>Develop superuser programs that reach each department in your health system</li><li>Don’t rely on simply spending money to drive EHR success; money spent on IT is not a great predictor of EHR or communication success</li><li>Organizations should holistically audit the full spectrum of technology used by nurses, including but not limited to the EHR</li></ul><h3 style="color:#c18654;"><strong>Onboarding/Initial EHR Education</strong></h3><ul><li>Nurses should receive at least 10 hours of onboarding education within the first three months of employment</li><li>Onboarding education should be simulation based</li><li>Onboarding training is more successful when most of it occurs in the classroom</li><li>EHR education can be provided by either peer clinicians or a qualified non-clinician</li></ul><h3 style="color:#c18654;"><strong>Ongoing EHR Education</strong></h3><ul><li>Consistent rounding works—every nurse should be visited at least every 6 months</li><li>Nurses should spend 3–5 hours each year refreshing their EHR knowledge</li><li>Classroom training is a popular, effective education modality</li><li>Online training is most effective when it is used broadly and the available content is robust</li><li>Mandating training does not improve the ongoing training experience</li></ul></div>

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.

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