The Arch Collaborative and the Power of Nursing

As I sat by myself in the back of the room, I looked ahead at the empty chairs and wondered whether I would need to scoot up to a row closer to the front. But like churchgoers arriving just in time to fill the pews, attendants soon filed in, and the room was nearly full of listeners.

These attendees of the Arch Collaborative Summit were eager, as I was, to participate in a panel focused on how to help nurses succeed with the EHR. The panelists included Ryan Zulkoski from Children’s Hospital and Medical Center, Teresa Niblett from Peninsula Regional Medical Center, Ellen Pollack from UCLA Health, and Samantha Richards from WVU Medicine.

Users as Part of Success

Ryan Zulkoski was the first to present his organization’s successes. “We ensure that our end users feel heard and valued,” he said. His users were tired of being told no and didn’t feel that their opinions mattered. They didn’t feel that anyone was listening to them.

“I don’t want to have that kind of culture,” Ryan said. “You need to show people that you are doing something for them rather than to them.” Ryan’s advice was to make people aware and increase their desire to improve and make a difference.

Teresa Niblett also attributed some of her organization’s success to the relationships with their analysts and frontline staff. “We let users in different areas raise issues, and we try to make sure there is bandwidth dedicated to the needs of those users.”

Ellen Pollack felt that governance isn’t just about designing but also about the discipline of using the EHR. She said that decisions should be made by those as close to the people using the system as possible—if not by the actual users themselves.

“Know what the operations people are trying to achieve,” she advised. “Make things visible. People have so much pride in their work, so we try hard to have checks and balances and to find the best and most innovative way to do things.”

Ellen said that UCLA Health ensures that what they do actually helps the clinicians on the floor. “Focus on safety and efficiency by adding value, and then you can’t go wrong.” 

Governance and Councils

Obviously, simply trying to “involve” the users isn’t enough. There needs to be a tangible plan and a structure put in place to achieve that involvement. This train of logic naturally leads to governance, which was a consistent theme not only in the nursing breakout but throughout the entire summit.

“I would recommend our structure,” said Ryan. “We have an informatics nurse over our med/surg areas who works one shift per week in each unit; that person can be in the know.”

The panel discussed the challenges of being removed from what happens on the floor and by the bedside each day. Having someone who can do the hands-on homework is key. “As soon as we step away from the floor, there is a disconnect,” Ryan said. He recommended assigning a 0.6 FTE to problem areas.

But not every model is going to work for every organization or structure. Some health systems and facilities are still going through growing pains and can’t think about optimization, and not all entities are big enough to have a CMIO. 

“I think our success goes back to our governance,” said Teresa. Peninsula Regional is in the 89th percentile for net EHR experience and 87th for nurse satisfaction with ongoing training. “With the evolution of the EHR, there has been interdependency on things we design. The EHR has been a helpful, centralized place to review and influence initiatives.” 

Samantha Richards described WVU Medicine as being in a state of rapid Epic onboarding. They have grown from a single hospital in 2007 to eight hospitals in 2019 using the Epic platform and have had to adapt to a fast pace.

WVU Medicine has utilized an interprofessional user council to standardize their workflows and leverage their workforces. The council meets every month and has a representative from each of their hospitals. The council reviews ticket requests, and if there is stalemate, a CEO affinity group can make final decision. 

Ellen admitted that in the past, when things got “meaty” and were impacting a lot of users, arguments would sometimes erupt in front of the users. “Going to the governance groups first has helped us iron things out beforehand.” 

“Sometimes people want to add clicks, and we want to reduce clicks,” added Samantha, “so we need to find a balance of what is best for the patients.” 

“Some of our lower-level councils absolutely influence decisions,” said Teresa. “But they don’t influence the executive level very much.” That clout depends on how good the councils’ relationships are with the executives. “Our director of physical medicine has influenced a lot of things,” she added.

Nurse Appreciation

“Our nurses do amazing things,” said a man in the audience. “If I could only get my providers to do a tenth of that work! I want to learn from you all and be a better CMIO. The revelation for me is to get my physician informatics group on the floor. I am seeing a paradigm shift in how we care for patients. We are starting to be more collaborative and to use families. We are taking some baby steps in that direction.”

As the session came to a close, the consensus in the room seemed to be that equal representation needs to be brought to the table.

I am certainly no healthcare expert, but I could sense the passion and concern that permeated through the people in that room. Nurses want to be at the table of decision-making and want to work with hospital leaders. Many people feel that despite nurses knowing everything that physicians do, the reverse is often not true.

KLAS’ Taylor Davis summarized the room’s feelings with this apt and simple statement: “The power of nursing is incredible.”

     Photo Cred: Shutterstock, Manop_Phimsit