Why Nurse Executives Should Gather and Use Data to Guide Strategies

Robust data and analysis provide speed, reliability, and rapid information-sharing, Tampa General's new CNO says.  

Effectively gathering and using data allows nurse leaders to achieve outcomes more quickly and more reliably, says Annmarie Chavarria, DNP, MSN, RN, NEA-BC, who brings her data-driven leadership style to Tampa General Hospital as its new senior vice president and chief nursing officer.

Chavarria developed a data-driven leadership style to solve problems faster for patients, she says.

"We can move forward so quickly and we don't have to wait long periods of time to realize that we need to pivot," says Chavarria, who brings more than 15 years of nursing leadership experience to Tampa General, a 1,007-bed nonprofit academic medical center.

She embraced data "once I realized that we didn't have to spend months on something, but we could spend a couple weeks. [When I noticed] that something wasn't making an impact, but we could pivot and do cycles of improvement on it and actually make changes much faster because our changes are affecting people's lives," she says. "It's affecting patients; it's affecting their outcome; it's affecting quality of care that we provide."

Gathering usable data

The process for gathering data depends on the problem that needs to be solved, and it may mean asking "why" more than once, she says.

"When we're looking at a problem, we ask a bunch of 'whys,'" she says. "We might ask 'why' six or seven times to get to the bottom line of what is causing the problem or what it is that we are trying to measure."

"A lot of times we'll look do a gap analysis [to see] all the pieces and what we're missing. Then we sort of build out things so we can get the pieces of information that we're missing," she says. "It's similar to an apparent cause analysis. Once we identify what that [cause] is, we call it a key process measure. We use those believing that those processes are going to affect our outcome because they're key in that outcome."

Sometimes they're wrong and must make adjustments to start all over again, Chavarria says.

"If we're doing the process well but the outcome doesn't change, we have to circle back and do a cycle of improvement and dig down again and ask those "whys" five more times or more until we get to another process that might be affecting that outcome," she says.

Managing cognitive bias with data

Relying more on data is advantageous in reducing cognitive bias in clinical care, Chavarria says.

"Historically in nursing, we did a lot of things by what we thought anecdotally, and then when we actually get to see data, sometimes it forces us to change our mindset because whatever we thought was happening may not be what the data shows," she says. "Sometimes it does show the same thing, which is usually validating and helpful because then we know we were focusing on the right thing."

The risk related to data and cognitive bias is in measuring only what is thought to be the problem, which, in itself, is cognitive bias, she says.

"Your thinking needs to broaden and a lot of times you need to have outside people who are not in your world every day," she says.

Outside people might include data experts, information technology professionals, or consultants who can bring a fresh, new perspective to a problem, she says.

"It helps us if we are truly measuring the right thing, but if we picked only what we thought the problem was," she says, "then we might be letting cognitive bias affect us in a negative way."

Data and decision-making

For data to be quality enough to be used in decision-making, it must be consistent, plentiful, and trended, Chavarria says.

"We have to have it for a long enough period that you can make a decisions based off of that," she says. "A couple of data points does not make a trend, so you wouldn't make big decisions off of just a couple of points."

Data input also has to be known to be coming from an accurate place.

"Electronic medical records are challenging so sometimes things are documented in a couple of different places and not everybody documents in the same way," she says. "Usually having people at the point of care participate in these identifications of data and results of data and asking them, 'does that match what we do every day?' and 'does that feel right?' will help."

Make the data investment

Technology makes data collection and analysis much easier and more effective, Chavarria says.

"I have been very fortunate to work in organizations that have data centers or have processes or software set up with data like Qlik Sense [a data analytics platform]," she says. "If you don't have that, it's actually much harder to work with data."

Her advice to fellow nurse executives? "The best money you can spend is on technology that gives you this data that helps you make decisions accurately and quickly, and then helps improve your processes," she says. "It really is an investment you have to make."

Becoming a data-driven leader requires bringing staff along, as well, and building communication and an education strategy around it, Chavarria says.

"You also have to do a lot of training with people to help them understand data," she says. "You have to share it accurately. You have to push data to people; you can't expect that they would pull it out anywhere. You have to educate to it. You have to communicate it. You have to make sure that people are on the same page with why you're measuring things."

 "With data, you can publish it, you can share it professionally, and you can put it out there and everyone can benefit," she says. "So, doing things faster, doing things more reliably, and being able to share things quicker is why I have adopted it."