How Do You Teach IT?
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1. Standardize first
Like many large tertiary care facilities, William Beaumont Hospital in Royal Oak, Mich., had a communications problem between its telemetry techs and nurses. Some 264 patients in its cardiology and med-surg units were monitored by four techs stationed in a central monitoring room—a centralized set-up in place since the early 1990s. As volume grew, however, so did the number of outbound pages to nurses. “Pagers are not very efficient,” says Kim Bonzheim, director of noninvasive cardiology at the 1,061-licensed-bed facility, part of a two-hospital system. “The only way for the nurse to close the loop is to call back. We wanted nursing and telemetry to work together, but the pager drove them apart. The nurses got sick of being paged all the time.”
To address the problem, Beaumont turned to wireless “voice badges” from Vocera that enable immediate verbal communication among staff. With the wireless system, telemetry staff members say the patient’s room number, and the system connects the tech directly to the nurse on call in that room.
Before Beaumont deployed the badges, however, it formed a multidisciplinary team to create standardized paging protocols. “Our old telemetry process was not ideal,” Bonzheim says. “We created a response algorithm to clarify roles.” Once the paging protocols were complete, the hospital staged two training blitzes in which nurses underwent a required orientation to the new procedures. Some 2,000 nurses completed the training during a two-year period.
After the telemetry procedure became standardized, the hospital added the voice badges to the mix. “We wanted to make sure the underlying system was fixed first,” Bonzheim says. Training on the voice badges is quick—nurses need only about 45 minutes to learn how to use them, she adds. But unless nurses understood the paging protocol first, the voice badge technology would have contributed little.
2. Pick the right target
When Pinehurst (N.C.) Surgical Clinic adopted electronic medical record technology, Chief Information Officer Phyllis Schuck knew she had her hands full. The 37-physician multispecialty practice wanted the job done before its move last July to a new building. By hiring EMR “super-users,” Schuck took a common step among practices introducing new technology. The highly trained super-users would be the go-to staff for any question, large or small. Schuck hired four nurses to learn the system thoroughly.
However, after analyzing the workflow at the practice, Schuck figured most of her training effort should be directed at support staff and nurses, not physicians. “When you look at the office practice, most documentation for the patient visit is collected on forms by the nurse,” says Schuck. “Then the physician walks in, reviews tests, interacts with patient, makes a decision, walks out, reads all documentation and summarizes in a note. Nearly 75 percent of the clinical documentation is created by someone other than physicians. That told me my target was primary support staff.”
During the one-year roll out, which went surgical specialty by specialty, the super-user nurses shadowed the staff nurses, answering any questions immediately. In addition, two other trainers hovered nearby to help the physicians. But since Pinehurst had conducted rigorous practice drills with both nurses and physicians prior to the go-live, the clinical staff knew what to expect with the EMR, Schuck says. Each physician received 10 hours of one-on-one training prior to the go-live, primarily to learn electronic prescribing, lab results viewing and visit documentation. Schuck also recruited a physician super-user among the various specialties.
To expedite the training, Pinehurst preloaded historic clinical data into the EMR from Chicago-based Allscripts. “It is waste of training dollars unless there something in the software that approximates what the user sees [in the paper chart]. You need to help them draw analogies. When you click here, you will see test results. They can associate that with the tabs on the paper chart. People will not use it otherwise.”
3. Hire outside help
Children’s Medical Center Dallas has IT staff dedicated to staff training. Led by Mitzi Cardenas, director of advanced development, the department trains internal super-users and oversees annual upgrades to the center’s clinical information system from Cerner. But when
Children’s opted to deploy barcode medication administration and nursing documentation modules, Cardenas knew her small crew would be overwhelmed. “This was the first time a large number of clinical staff went through a significant process change at once,” she recalls. “We needed to evaluate our training approach.”
In February 2005, Children’s hired a nearby vendor to develop a curriculum and develop a training strategy for the new technology. It would impact many of the hospital’s 3,000 clinical IT users. The vendor devised a roles-based training curriculum, which carved up the new workflows into seven large categories of users, including nurses, physicians, lab techs and patient reps. For example, nurses went through a half dozen independent study training modules on a computer, each about 45 minutes long, says Cardenas. Once the computer-based training was complete, nurses would then attend classes for hands-on demonstrations of the barcode readers.
The blended approach to learning—mixing solo computer learning with group classroom instruction—was a departure for Children’s, according to Cardenas. In the past, the hospital relied extensively on classroom training. The blended approach paid off, she says. “Getting physicians or nurses to four-hour classes is difficult,” she says.
4. Use technology
Using computers as part of an independent study approach worked well for Children’s Hospital; the facility required clinical staff to complete certain computer-based modules before advancing to classroom instruction. The computer-based modules covered the basics, such as the value of using barcode technology, what functions the technology offered, and the patient safety factors that were driving the initiative. “It is the 30,000-foot perspective,” says Michael P. Morris, learning systems group manager.
Children’s has put technology to creative use in other ways in preparing clinicians to use information systems. Morris’ crew has developed animated computer tutorials that walk staff through new applications, such as an automated system that nursing and dietary staff now use to devise recipes for infant patients’ formulas. In the past, staff would type in ingredients, whereas the new system is driven by pull-down menus. To train clinicians on the system, the computer animation let users observe a screen being manipulated, then asked the observers to jump in and perform the same steps on their own. “It lets users practice in a safe environment before having to apply the knowledge on the job,” Morris says.
5. Don’t overfocus
IT training is a big deal at Iasis Healthcare—and for good reason. Iasis is plowing some $30 million into a new McKesson clinical information system that it is deploying across its 14 hospitals throughout the South. On top of that, Iasis has earmarked about $3 million for a training budget as it attempts to standardize its clinical workflows across widely dispersed hospitals. Iasis has already implemented a common financial information system, also from McKesson, across its member hospitals. By having standardized reporting tools, says President and Chief Operating Officer Sandra McRee, the hospital system can keep better tabs on its financial performance.
To pull off such a large deployment, Iasis is using a multidisciplinary standardization team with members from all 14 hospitals, says Pam Flentge, chief nursing officer at Southwest General Hospital. The 286-staffed-bed facility in San Antonio was among the first facilities to adopt the clinical information system. “The training modules were consistent from hospital to hospital,” she says.
Getting nurses and physicians plenty of instruction is critical to a successful transition, McRee adds, noting that each nurse received 16 hours of training. But Iasis has had to broaden the scope of training to include senior management at the local hospital level. “You think you have buy-in, so we figured we could train the administrative team without a lot of hands-on effort,” she says. “But we learned that senior management did not always have enough knowledge about the project to sit down with the nursing staff. So now we require senior hospital management to go through training as well.”
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
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