Arch Collaborative Nursing Summit White Paper 2021

Identified Problem

Organization A wants nurses from the floors and at the bedside to become engaged with EHR changes. The nurses’ involvement would shape the EHR development and improve its usability, resulting in increased EHR satisfaction.

Proposed Solution

Organization A intends to better involve care-giving nurses in the governance process by developing an EHR-champion network comprising nurses from the floors. With better engagement and wider representation, the organization hopes that more nurses will become enthusiastic about the EHR and choose to participate in the champion network as part of their career path. Ideal candidates for the network ask questions like “How can I impact and shape the EHR?” and “How can I engage educators in their units’ workflows and EHR usability?” Nurse champions will need to gather feedback, often from personal interactions in hallways and emails. The organization wants to broaden those personal interactions by assigning a nursing representative to each floor. Feedback that is acted upon will improve functionality and help floor nurses feel heard.

Plan to Measure

Organization A will use smaller KLAS surveys to measure the effectiveness of their implementation. They will also better leverage data from Epic’s Nursing Efficiency Assessment Tool (NEAT). The organization wants end users to rate their engagement with the EHR-champion network to know what is and is not working.

Identified Problem

Organization B seeks to decrease burnout and the documentation burden among nurses. In the organization’s most recent KLAS survey, it was noted that nurses can spend up to 30–40 minutes completing the admission process.

Proposed Solution

To reduce burnout, Organization B will reduce redundant documentation. Each part of the documentation process will be examined to identify regulatory requirements and to determine whether the nurse is the right person to handle that documentation. The organization wants their system to retain information throughout the care continuum so if something is documented during one step of the process, it doesn’t have to be documented again during a later step. A governance process will be established to approve of new functionality and to determine whether older technology is still needed.

The organization also wants to look at Epic’s Thrive class for nurses and Epic’s Foundation System to see how their tools and practices compare to other organizations’. Because Organization B has been using Epic for a while, they are considering removing some tools and updating others that Epic has improved over the years.

Plan to Measure

Organization B wants to monitor nurses’ use and acceptance of Rover, which was recently rolled out. Additionally, they will continue to participate in the Arch Collaborative and use pre- and post-surveys to measure implemented tools. To understand the valuable time that could be added back into the nurses’ workdays, Organization B will track the time that nurses are currently spending in the charts.

Identified Problem

Organization C needs to improve their ongoing EHR training and education for nurses, who reported low satisfaction with their EHR education in their Arch Collaborative survey.

Proposed Solution

To address this problem, Organization C has identified several potential solutions, one of which is using Adobe Captivate or Microsoft Teams to record five-minute snippets of training content. The organization can currently access eLearning material, but using one of these programs would allow them to manage the material as well. The organization plans to save all learning materials in an accessible, but not editable, folder. This way, if a nurse has a question when trainers aren’t available, the relevant instructions or materials are readily available.

Organization C also plans to have a more targeted approach to their communication. To better distribute information, the organization wants to create a biweekly newsletter to share tips and tricks, write information on whiteboards, and place flyers in staff rooms. The organization will put dates on the flyers so they know when the flyers have become outdated and need to be replaced—an idea that was shared at KLAS’ workshop. These ideas will increase awareness of changes to the EHR. Because some changes only impact certain user groups, the organization intends to communicate changes to the appropriate people by outlining the top changes for each service line. This way, nurses won’t have to read through several pages of content to find the information they need.

Lastly, the organization will encourage two superusers from every service line to attend a monthly meeting. Ideally, at least one will be able to attend so that a superuser from each service line is present.

Plan to Measure

Organization C is considering doing a pre- and post-survey. At the time of the workshop, the organization had an EHR update scheduled for March, and they were considering doing another benchmark measurement about six weeks after the update went live.

Identified Problem

Organization D has several teams operating in various areas: clinical informatics, applied informatics, nursing professional development, nursing education, and application training. Team members’ roles need to be better defined so that everyone knows each other’s responsibilities.

Proposed Solution

Organization D wants to start a series of meetings to align and engage different team members. The organization had an integrative training work group in the past and believes reimplementing this work group on a monthly or quarterly basis would help improve nurse EHR education and satisfaction.

Additionally, Organization D is looking at cognitive learning platforms to design content and help provide a better EHR experience for nurses. A learning platform could help with ongoing education because the organization would be able to virtually publish micro-learnings using a very targeted approach. The platform would help Organization D avoid wasting time on unnecessary content and decrease the time nurses spend on education.

To assist educators in distributing content among the staff, Organization D wants to establish a stronger feedback loop. This would allow team members to work more closely with the educators to improve trainings.

Plan to Measure

Organization D intends to use their Epic NEAT data to increase transparency. Epic provides a dashboard that highlights nursing impact, and the organization could further build this out for managers. With COVID-19, the distribution of NEAT data to people who needed it was paused, but now the organization would like their trainers to have access to that data and to the feedback loop to increase transparency.

Identified Problem

Organization E wants to decrease the nursing documentation burden, specifically around best practice alerts (BPAs).

Proposed Solution

After examining their BPA usage, specifically during admission, Organization E determined they have an opportunity to remove some of the documentation they are doing. The organization will look at their data and use Slicer Dicer to better understand how BPAs are being used. This data will help identify solutions that are low-hanging fruit.

Plan to Measure

Organization E will use the data from their Arch Collaborative survey to inform them about their next steps and initiatives. They will also work with their KLAS representative to analyze measurements as they move further along their journey.

Identified Problem

Organization F desires to improve nursing efficiency. Within the organization, there is a tendency among nurses to fill all blank spaces when documenting. Organization F wants to change this mind-set.

Proposed Solution

Organization F discussed how to offer better EHR education for nurses, provide more real-time alerts, and help nurses have more of a voice when changes are needed in the system. The organization is moving toward a Cerner-supported model called clinical datasets and is completing an assessment through which nurses can report documentation challenges.

Previously, there was more feedback from bedside nurses, and the organization wants to encourage feedback by reimplementing a nursing informatics council within the next six months. This would allow bedside nurses to be involved in making changes and improvements to the system. For those staff members who have joined in the past year and a half, Organization F wants to distribute an assessment to evaluate the current training situation and improve both onboarding and ongoing EHR education. At the time of KLAS’ workshop, the organization wanted to achieve this within three months.

Plan to Measure

Organization F can use Cerner’s Advance data to see how long it takes nurses to do certain tasks in different areas. They will follow up on that data and use repeating surveys every three months to check their progress. Organization F wants to ensure that users aren’t overwhelmed and that all surveys and measurements are completed before moving on to future rounds of surveys and measurements.

Identified Problem

Organization G wants to invest in improving their EHR training program for nurses.

Proposed Solution

Organization G’s training team will prepare consumable content (i.e., able to be internalized in 15 minutes or less) and deliver it to leaders, who can then disseminate the content during staff meetings. Organization G will also launch a video series that provides tips and tricks for specific topics and explains how to maximize use of the EHR. The organization will determine whether this video series should be mandatory to watch and will widely advertise it so it is accessible to staff.

Plan to Measure

Organization G wants to invest in a training program based on the perceptions of both new and seasoned nurses. Organization G’s team needs to demonstrate to executive leaders that increased training is worth investing in. To do this, the organization will measure training efficacy by asking staff members the following questions: “Was the training worth my time?” “Do I feel prepared or competent?” “Did I learn anything that was intended to be taught?” Afterward, Organization G plans to observe whether trainees can do what they were trained to do. The organization will focus on a training’s success from both the instructors’ and the attendees’ perspectives. The organization wants to compare what content is taught with how the content is used by staff members once they complete a course. Organization G will also use KLAS, the Net EHR Experience Score, and Press Ganey results to continually measure staff perception, changes in attitude toward training, and KPI trends.

Identified Problem

Organization H has established an advanced training path for their providers but not their nurses. Ongoing education programs need to be defined and designed with a greater focus on user settings.

Proposed Solution

Organization H first wants to identify a pilot group, consisting of staff from either a specific service line or a specific facility. With a pilot group in place, the organization will examine which parts of the workflow can be personalized or modified for nurses. The resulting information will be presented to the organization’s CNO to create buy-in for the user-setting training. The plan is to roll out the changes to superusers first and then give superusers a list of nurses to teach. Organization H will also refocus on new nurses two to four weeks after they are hired to ensure they know how to navigate user settings.

Plan to Measure

Organization H will prove the value proposition, collect specific NEAT data, and use the Arch Collaborative to do a pre- and post-survey to look at the pilot group’s results. The organization will use the positive results as building blocks to build out their training path and offer more ongoing training for nurses.

Identified Problem

After taking the KLAS survey, Organization I discovered their ED nurses—who use their own system—don’t feel supported and need more ongoing education.

Proposed Solution

Organization I has several proposed solutions, several of which involve training nurses and creating specialists. In each service line, the organization employs clinical development nurses. Organization I would like each nurse in this role to become a certified trainer with Epic. The nurses in each service line would then have superusers and certified trainers to support them. Organization I also seeks to identify subject matter experts to represent each of the organization’s EDs and take advantage of Epic’s Thrive training.

To further expand their training, Organization I intends to have their principal trainers become more involved in change management to support ED nurses during changes. These trainers would be knowledgeable about the system and go-lives, and they would be responsible for creating reference sheets and videos for the nurses to quickly access.

Organization I also wants to better use data and tools to support their nurses. They plan to measure success and opportunities for improvement, adopt efficiency-enhancing tool sets such as an admissions navigator, and provide ongoing change management.

To tackle their current implementation process, Organization I has put together a clinically focused team that has experience working in departments and knows what pressures and concerns nurses face. The team will help the organization configure the system by being the nurses’ advocates. The organization seeks to be up front with nurses about how their work might slow down, simply because information won’t be documented on paper going forward. But the system will allow the organization’s staff to be more connected and better visualize data, ideally resulting in high initial adoption.

After the go-live, Organization I will host an optimization sprint in the ED and ask users what their five most significant worries are regarding the system. The organization will put together a team to establish a plan addressing those concerns while simultaneously optimizing the system.

Plan to Measure

Organization I wants to define multiple metrics to measure the work they do. They will define and establish baselines and build dashboards so managers can access data and take action.

Identified Problem

Organization J wants to promote user satisfaction and system efficiency by streamlining nurse education and introducing a personalization program.

Proposed Solution

Organization J seeks to optimize their current onboarding training and focus on user settings to facilitate ongoing efficiencies. The organization’s education team is already rewriting the inpatient onboarding training to make it more workflow based, which will decrease the total training time. Organization J also wants to check in with their round-back practice for new users to ensure these users see a bang for their buck when starting at the organization. Managers need additional training regarding efficiency, reporting, and personalization because they work in a different environment.

The organization would also like to create an advanced training program for their preceptors. The preceptors need to use the same approach across all locations so that everyone has the same expectations and level of preparation.

Plan to Measure

[Measurement plans were not completed during the workshop.]