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Big Data Means Big Potential, Challenges for Nurse Execs

Analysis  |  By Jennifer Thew RN  
   April 19, 2016

To ensure big data is used to influence outcomes that are meaningful to the nursing profession, nurse executives need to act as data visionaries and architects.

Have you ever found yourself poring over stacks of data, feeling more like a statistician than a nurse? If you have, welcome to the world of big data.

"You have all of these different data sources coming at you on a weekly, monthly, quarterly basis. The CFO has a stack of data for you, your productivity-management engineer people have a stack of data for you, HR has a stack of data for you, and then your quality director, your clinical folks, have a stack of data for you," says Jane Englebright, RN, PhD, CEBP, FAAN, chief nursing executive and senior vice president at Nashville, Tennessee-based HCA.

"And your job is to sort through all that data and synthesize it in some way and come up with brilliant conclusions about how to run the organization."

Big data "typically refers to a large complex data set that yields substantially more information when analyzed as a fully integrated data set as compared to the outputs achieved with smaller sets of the same data that are not integrated," according to the Online Journal of Nursing Informatics.

Dealing with big data can understandably be challenging for chief nurse executives.

During a session titled, "The CNE Role in the Big Data Revolution," at the American Organization of Nurse Executives last month in Fort Worth, TX, Englebright and healthcare management consultant Barbara Caspers, RN, MS, PHN, discussed importance of shared strategies to help CNEs ready their organizations for the "big data revolution."

Drowning in Data

When a CNE is analyzing and synthesizing data, it's typically done manually and is a very time- and labor- intensive process, in part, because technology systems have traditionally been built in silos. "Often they don't even call the units the same thing. They don't name them the same thing. They don't necessarily define them the same way," Englebright says.

For example, the definition of a day may vary from system to system and the way a month is calculated in the finance systems may differ from how it is calculated in the payroll system.  

Trying to "figure out how to keep up with your agency hours and what the cost of your agency is in the finance system versus the scheduling system," Englebright says, is "just a nightmare, trying to make all of these different things sync."

The lack of data standardization can also make it challenging for a CNE to assess how the organization or a particular unit is performing and to make well-informed decisions about what to change. Having good data is key to making effective changes.

"For those of us who grew-up studying the biological sciences, we understand that we have taken a very linear, Newtonian-approach to data over something that's really much more like a biological system," she explains. "When you perturb one part of our system… it has ripple effects throughout the entire organization."

Failure to recognize how this data interacts throughout the system has been a limitation in the types of data analytics that have been put forth.

"The frustration that we often have as nurse leaders in looking at this data, is [that] some of the variables we care about the most, aren't even in the data," Englebright says. "We don't have something that measures nursing competence, for example. We don't have something that measures how committed the nurses are. We don't have something that measures if the patient really [is] going to do the stuff we just invested all this time in teaching them to do."

Because of this, CNEs end up having to advocate for the things they care about in a person-on-person debate, than being able to make a persuasive business case based on data, she says.

The Big Data Checklist

For all its current stumbling blocks, big data holds the potential to change healthcare delivery for the better. But for that to happen, nurse executives need to act as data visionaries and architects, Caspers says.

To support CNEs in doing this, Englebright, Caspers, and a workgroup that grew out of the University of Minnesota's annual Nursing Knowledge: Big Data Science Conference in 2014, developed the CNE Big Data Checklist.  It outlines three main areas where nurse executives should become leaders in driving the use of big data:

  1. To create a culture that thrives on data
  2. To develop big data competencies for the organization
  3. To create an operation infrastructure to support big data use

"The promise with big data is that we will quickly be able to move towards prescriptive analytics where we will be able to provide information that will give us knowledge and suggest interventions, or the capability to do something about a predicted upcoming event," Caspers says.

Using big data in this way will be a boon to population health, in that it will help inform decisions about how to manage risk and disease states across the care continuum.

"Big data will help us manage the upcoming transformation into value-based care," Caspers says.

It will also support CNEs in being more nimble when it comes to making decisions. Rather than waiting for the end of the year or end of the month to get various reports, they will have access to near real-time data.

Englelbright says that by breaking down data silos, big data will also facilitate a balanced approach to assessing organizational and nursing performance.

"I'm not over here worrying about my volumes, and I'm not over here worrying about my quality and over here worrying about my cost," Englebright says. "I'm able to think about all of these things in relation to each other and success is when they all get better… and I'm able to move forward in all of these dimensions at once."

The future of big data could be very bright, but chief nurses must get involved to ensure nurses gets the full benefit.

"The big data revolution is here," Englebright says. "We are much further along this path than we think we are and it is time for the chief nurse executive community to jump in the middle of this and to claim our part in it, to guide it and direct so we end up with the tools we need for practice and for our work."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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