nurse using the EHR

The Arch Collaborative: Successes at UCLA

At UCLA, we strongly believe in clinician satisfaction and in doing all we can to enable the EHR to be an effective, safe, and easy-to-use tool. We have been dedicated to this quest for years. Discovering how our customers and clinicians feel and being able to compare that information with valid data was a really appealing aspect of the Arch Collaborative.

We have always scored well on our own satisfaction surveys. Those results are great to see, but they don’t really tell us how we are doing compared to our peers. The Arch Collaborative has given us really valid data to compare ourselves to other hospitals, including academic medical centers and those using our same EHR.

Successes

UCLA is in the 99th percentile for nurse trust in IT. We have tried hard to build a strong culture in IT, focused on supporting efficient and safe patient care and on being mindful of what we ask the end users to do. We have a lot of clinicians who work in IT, and that helps us really understand the workflows and the users’ perspectives. But there are so many pieces, and we have to attack the issue of clinician satisfaction from many different angles to be successful.

For example, we also have very robust training and help desk teams. We have a strong clinical informatics team with nurse and physician informaticists and an active superuser program. Our rounding program is very active on both the inpatient and ambulatory sides. We do a lot of outreach and hold fairs to engage with our end users. We have a communication strategy regarding how we release updates and new features to the end users. In other words, we have a lot of engagement with the end users.

Last but definitely not least is our governance structure, which is extremely strong. It is much more than an organizational chart; it is something we work with on a daily basis. The clinicians very clearly understand that the system belongs to them. We do bring forth a lot of recommendations and suggestions, but the end users make all the decisions regarding the EHR.

What Sets Apart Our Ambulatory Rounding

Our ambulatory rounding program is very structured. We made a commitment to visit every clinic every quarter. Our senior leaders in IT have all committed to the investment of resources needed to make the program successful. That meant we were all going to participate—our desktop teams, our analysts, our training teams, and so on.

We have about 200 locations to visit. A lot of outreach had to be done to coordinate who was going to round on each day, to figure out parking, transportation, and so forth. But we don’t want to just walk into the clinic and announce our presence. We have a focus. We have a list of issues, often based on the data, that we think the staff might be struggling with. We do always defer to what is most important to the clinic staff, but we are very focused on what we go in there to achieve. We send out satisfaction surveys afterward to assess the effectiveness of the rounding program.

In the last couple of years, we have stepped up our ambulatory rounding program, and we are now discussing how to bring up the inpatient rounding program to those same high standards.

No Secret Sauce

The key is to slowly build programs around engagement. Our implementation happened from 2011 to the beginning of 2013. That was when we started building the foundation of our patient- and user-centered culture, and that was when we started creating our programs.

But we have optimized and changed throughout the years. We are always looking for what we can do better. While we have added certain things along the way, it has been nice to use the Arch Collaborative data to confirm what we have been doing. For example, we were able to really narrow down that our clinicians seemed satisfied with the new-hire training but that we had opportunities with ongoing training.

A lot of people go wrong by not developing clinician-led governance. Solid governance is a living, breathing thing. It is really hard to recover from events that upset the end users. Having solid governance is crucial and provides so much protection for IT that constantly pays off. Organizations can layer engagement programs on top of that. And if an organization is involved in the Arch Collaborative, they are already a step ahead because they know where their hot spots are and what they have to do to improve.

Developing Trust with Your Users

If you have a governance structure, use it. I would also recommend making it really clear that the system does not belong to IT; it's a clinical system. Protecting your brand and your image is extremely important, and that means that there shouldn't be surprises to the end users. Everything should be communicated in advance of a change. Being visible and accessible to end users is very important. 

Everyone makes mistakes; we have made mistakes. But when you have a trusting relationship with your end users, they are more forgiving. Any change that will impact end users should first be approved by clinicians—users of the system—and then communicated to the masses before they see that change in production.

When I present about clinician engagement, I always include a slide about what I consider to be the three elements of trust—competency, sincerity, and consistency. I really believe in those things. You have to be consistently good at what you do, and you need a team that builds things that won’t break. Users have to believe that you want the best for them, and the way you demonstrate that sincerity is through your outreach programs.

So through your communication and your engagement programs, the users have to feel that your team is dedicated to doing the right thing. Having a lot of clinicians on the team also helps to do that because they can relate very well to the users. Trust fits really well into and frames the conversation.

The Role of the CNIO

Finally, the CNIO should a member of the senior leadership team in IT. It is really important that the CNIO is given sufficient span of control to enact change and has a voice at the highest levels of the IT organization. Many organizations don't have a CNIO, and many CNIOs are not in a position to enact necessary changes. I feel very fortunate to be in my role and to have a voice in my organization and the ability to enact change.  




Photo cred: Shutterstock, Monkey Business Images