The CNIO of Carolinas HealthCare System talks about the benefits of clinical documentation optimization, the challenges of change management, and the importance of leveraging technology to raise job satisfaction among RNs.
As someone who did the bulk of her Christmas shopping online this year, there have definitely been times when technology has made my life easier. But as much as I love avoiding frenzied crowds, technology can also make life overwhelming.
It seems like I'm constantly wading through a barrage of emails, texts, instant messages, and social media updates in search of that diamond of vital information from my children's daycare provider buried amid the coal of 20% off coupons.
Becky Fox, RN, CNIO |
I'm not alone in trying to keep my head above water in the sea of digital communication.
"Look at how much communication and information comes at us in our personal lives, whether that's social media, our personal phone, personal email, or personal texting," Becky Fox, RN, CNIO at Carolinas HealthCare System in Charlotte, NC, told me during a recent interview.
"There's a lot of information overload that's [coming to us] personally. And it's the same thing in our work lives." Fox and I talked about how to manage the growing volume of information so it may enhance both the nurse's role and patient care rather than detract from it. The transcript below has been lightly edited.
On Optimization:
"One of the big projects we're working on is what we're calling the clinical documentation optimization project. We've had our EMR in place for a number of years, and this is just an opportunity for us to go back and simplify, standardize, and optimize all of the things we had in place.
One big focus is to take the systems that already have great functionality and make them much more user-friendly and workflow-driven and just make things easier for the nurse.
We'll be turning on more functionality and bells and whistles but, at the same time, reorganizing the things that we have in place. It's kind of like if you walk into your pantry and things aren't organized in the best way and then you reorganize it and you can see all the labels, you can see exactly where the soup is, you can see the chips. It will make things easier when the nurse goes to document the daily assessment on the patient.
We're also trying to drive smart workflows as well as push information to the clinicians at right time. We're not going to alert them every day, we're just going to alert them at the appropriate time when there are key quality measures or aspects that need to put in place, whether that's a reminder to tell the nurse to flush the patient's central line, or to document something.
We're also going to be doing work around identification of patients with Clostridium difficile. For example, a patient may have a couple of symptoms, but if it's day four of their admission and I'm taking care of the patient for the first time, I might not have all the information in front of me.
In the computer system, we have a lot of that information. Instead of asking the nurse to go look that up, the system can do that through automation and alert the nurse that the patient is at risk for c. diff.
It's not that the nurses don't know how to recognize c. diff, it's just that the nurse has six or seven patients with various conditions. We can take these computer systems, make them smart, and make them do all the heavy lifting so that we're just pushing valuable information to the nurse."
On Change Management:
"Everyone recognizes that change is coming, but it's coming at people at such a fast pace that it's really hard for them to digest and to continuously make small, minute changes. We're leaning toward the stance that we need to pause and give the nurses a break to adjust to the changes and then make changes in bigger buckets and bigger sweeps, rather than stringing out different things.
For example, we have five different systems that we're going to either try to upgrade or put changes into this year, including the optimization project. Do we go live on something in March, April, May, June, and July?
That's five different times for education, five different supports at various levels, not to mention all the emails to all the nurses and all the paper that gets printed and posted on bulletin boards. Do you just couple that all in one? So that on Monday, this is how you did your work, which is how you've done it for the past year, but on Tuesday we're going to completely change how you do things, but we're going to give you good support at the elbow to make sure that you know exactly what you need to do.
We're leaning toward this approach because this is where our bedside nurses are—[they're saying], "Just give it to me at once."
It's still hard adjusting, I think, because everyone is somewhat overwhelmed in their personal lives with email and communication. Probably our biggest challenge is how to get the information to people without bombarding them with emails, notifications, and meetings."
On Staff Education:
"One of the other things we're trying to turn a little bit is how to we educate everyone. Historically, you would bring all of the nursing staff into the training room, which of course is offsite, and spend seven to eight hours training them. It was really hard.
People walked out and only remembered about 30% of what you told them. Then a week later it goes live, and now they really don't remember too much of anything or they're just challenged to remember it all in context.
We've recognized that when people get onboarded at an organization it's really overwhelming to take a new job. They're wondering, "Where do I park my car? What color do my scrubs need to be?" These are the kinds of questions people are consumed with when they're coming to orientation. They're trying to figure out the basic things so when we were injecting a lot of computer stuff at that stage, we'd find it wasn't sticking, and it didn't have context.
We're trying a new approach on our optimization project. We're going to do two hours of training on a web-based tutorial. Then we'll bring to them to a classroom, but the classroom is truly scenario-based. When someone walks in and says, "Hi, I'm an ICU nurse," we give them an ICU scenario packet and have them document a patient.
The scenarios they get are in the context of a workflow. Your patient is 67 years old with COPD, you've done a head-to-toe assessment, now let's go ahead and document a respiratory assessment. We walk them through the workflow of that. We're trying not to spend so much time on the front-end, but spend more time on the back-end. Then let's focus on the nuances of the unit and have some good reinforcement by their preceptors when they get to the unit."
On the CNIO role:
"As a CNIO, my job is to help make things better for the nursing staff and to have a positive impact on the patients we serve.
The nurses will feel better because they'll have a better user experience and will feel more confident in what they're documenting. We know nursing job satisfaction is a big issue. When you have happy nurses, it all makes a difference to patient care. We want to make sure that the nurses have a good work experience because we know that will ultimately impact our patients. And that's our goal."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.