Virtual 2021 Arch Collaborative Summit: Shared Ownership

EHR success denotes more than a great piece of software; it is a representation of great relationships. Organizations that use their EHR most effectively have tight relationships with not only their vendor but also each other. Shared ownership between IT leaders, clinical leaders, and operational leaders is a major key to success and is one of the three pillars of EHR satisfaction.

At our virtual 2021 Arch Collaborative Summit, we called upon Sarah Visker, Manager of Clinical Integration, to tell us about her journey to make Connecticut Children’s Medical Center a top-ranked organization in nursing-documentation satisfaction. The key? Shared ownership.

Documentation Overhaul

Connecticut Children’s Medical Center is the only pediatric hospital in the state. In 2019, the hospital received Magnet Recognition from the ANCC. But things didn’t start out that way.

In 2017, the nursing department was dealing with extensive customizations in documentation that inhibited integration between departments and took nurses away from the bedside. Sarah was hired to do a documentation overhaul.

A New Council

The first thing Sarah did was get leadership support. She met with the CNO of Connecticut Children’s. Sarah was very transparent about the fact that the project would require a complete documentation overhaul. She also established that the nurses would need to be in charge. The CNO gave her full backing for the project and directed her to meet with the hospital’s quality council.

Sarah spent several months meeting with the quality council and gathering the information required for the project. Eventually, the quality council determined that while a documentation overhaul was sorely needed, the members of the council were not the right people to make those decisions.

And so a new council was created composed of nurses, IT representatives, risk and regulatory experts, and Sarah herself as the informatics specialist. Together, the council made decisions about which practices should be kept, thrown away, or refined. The council also created a new process for adding customizations.

New Guidelines

In the past, many of the customizations were initiated by physicians who called upon the IT department to fulfill their requests without involvement from nurses. A new rule was established that all customization requests for nursing documentation should be approved by the nursing council before going to the IT department.

Another new guideline that was enforced was that all requests would need to be data driven in order to be implemented. The request would be evaluated in terms of how it would impact the organization and help them with their reporting goals.

And finally, a rule was set in place that all decisions should be based on clear evidence. That evidence may include peer reviewed journals, data on national standards, or verified information from The Joint Commission or other regulatory authorities.

A New Prioritization Tool

Because of the heavy number of customization requests, the nursing council implemented a prioritization assessment based on a tool developed by an outside doctor named Patricia Sengstack. The tool incorporates the information needed to make data-driven and evidence-based decisions. Below is a snapshot of that tool:

In order to submit customization requests, clinicians at Connecticut Children’s complete an assessment that ultimately calculates a score to determine prioritization order. Prioritizations are not just based on a quantitative analysis, however. The council evaluates each item on the prioritization list to make final decisions about what nurses and their patients most need.

Outcomes

There was no “easy hack” to reach success in this project, Sarah said. She and her colleague spent months analyzing spreadsheets. To anyone aspiring to accomplish such a feat, Sarah recommends patience, fresh air, and lots of snacks. She also spent many days shadowing nurses in the field and asking them questions about their processes and preferences.

Well, the outcomes were well worth the effort. Ultimately, Connecticut Children’s saw a 60% reduction in the required documentation for nursing admissions. They also saw improved interoperability. Sarah was most proud of the fact that nurses had 18 additional minutes to spend with patients.

Connecticut Children’s is continuing to enforce the rules of their project and to embark upon many other exciting projects, such as vital-sign integration and mobile documentation.

Final Advice

After Sarah’s presentation, Arch Collaborative Summit participants quizzed her on many of the fine points of the project. Sarah was happy to share many secrets to help other organizations reach similar successes.

The final summarizing question came from the discussion facilitator, Porter Hancock from KLAS, who asked, “What advice do you have for someone that might want to replicate this project?”

Sarah’s response was to include the day-to-day bedside nurses in the governance council, get operational leadership support, and to have a clear vision of the end result.

Image Credit: Adobe Stock, Monkey Business