Leveraging Technology

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  • Staff’s first priority was communication flow from patient request to staff to fulfillment of need
    Scope- no new Resources or Technology
  • Leveraging Technology

    1. 1. Leveraging Technology Annabaker Garber Jennifer Lassonde George Reardon 
    2. 2. Innovation • Innovation is the hallmark of a high achieving organization • Must have systems in place to encourage and adopt innovation • Requires systems for research, adoption, and sustaining • Works in the context of understanding culture, workflow and practices, technology 2
    3. 3. Success Su c ce ss h ap pe ns h er e 3
    4. 4. Success Requires Adoption Adoption = Perceived benefit + “Peer” pressure Pain 4
    5. 5. Increasing Benefit Cool factor Has desired outcome; easy to use Fits with strategic goals and plans Fits with the users’workflow Fills a need Enhances safety, quality, satisfaction 5
    6. 6. Increasing Peer Pressure Fits in the culture Reward and recognition Regulatory and policy requirements Processes to monitor, provide feedback, hardwire behavior Strong leadership, expectations, and communication 6
    7. 7. Decreasing Pain Strong communication and working relationships between users, implementers and leadership Streamlined processes to use and support the technology Ability to evolve and improve Good value 7
    8. 8. Lessons Learned from our Communication Technology Journey • New technology is necessary but not sufficient. Constant focus on the process and improving it is the key driver. • Partnership between IS & Department Leadership from the start is essential • Implementation plans change due to both technical challenges and evolving operational needs. Open communication, trust and flexibility between Department Leadership and IS or other Depts is critical • Sharing impact and feedback from front-end users with the IS or other Dept team members who made it possible is valuable • Change isn’t easy, but if we collectively hit the mark on these things, likelihood of meaningful success is much greater 8
    9. 9. Identifying the Need for New Technology • High volume of messages sent from Unit Clerks to Nurses and there is also a growing need for direct communication between Nurses • Cell phones then pagers were implemented; neither worked well • Recognized the need to find a communication tool to support intra-unit communication • Lacked focus on the process • Money & technology alone didn’t resolve issues • Decided to step back and focus on Process Improvement before moving forward with technology 9
    10. 10. Goals • Improve patient satisfaction: HCAHPS Scores for Responsiveness & Quiet • Increase staff satisfaction & efficiency • Plan ahead for communication challenges with opening of larger patient care units in our new inpatient building 10
    11. 11. Technology Change: Focus on the Process 11
    12. 12. Kaizen Workshop 2011 Process Improvement Pre-work Aug-Dec 2010 Project Kick-Off Stakeholder Interviews Observation Data Collection & Analysis Process Mapping Focus of the Event 4 Day Event Jan March 911-14 13 Brainstorm Ideas Select Ideas to Test Develop Test Plans Test Ideas Implement Solutions Plan for Communication & Monitoring Viable Solutions, Communication & Monitoring Plans 12 Follow- Up Jan 17- Feb 14 Validate the New Process Tweak Final Changes Monitor Progress & Impact Local Ownership of Ongoing Monitoring
    13. 13. 13
    14. 14. Technology Change: Focus on the Process • Staff identified specific interventions to improve communication & responsiveness • Improvement opportunities using existing technology & staffing  Examples:  Educate patients on how to better communicate their needs  Utilize scripting to ensure all staff obtain a high level of detail when answering the phone and/or nurse call  Send specific messages via text pagers to RNs & PCAs to indicate details of patient requests or phone calls  Positive impact noticed almost immediately 14
    15. 15. Technology Change: Focus on the Process The Impact • 90% of the text pages were clear/specific within weeks • A noticeably quieter environment • Less overhead paging • Staff reported less repeat calls from patients, noting patients felt more confident that staff is in the process of fulfilling their request • Sense of greater efficiency • Clinicians clear that lack of a feedback loop is limiting • Challenge to maintain the above with out better technology 15
    16. 16. Searching for Better Technology • Goal • To assess different products ability to support and enhance the new communication process • MGH Patient Care Services Product Trial Principles • End users are asked to trial only products that can be technically and operationally supported • No product is ever perfect for end users or IS • Explore up front but trial only when funding is in place. • Users decide 16
    17. 17. Searching for Better Technology • MGH Patient Care Services & Partners IS partnership  Joint search for technology  Decided to trial Vocera, the market leader and Voalté an emerging option (Voalté identified by IS)  Partners IS worked with the vendors to set-up the infrastructure required for trials  Patient Care Services worked with vendors and end users to ensure trial matched up with process improvement principles 17 6 week trial of each device on 2 inpatient units
    18. 18. Searching for Better Technology Patient Feedback Oncology Patient/Family Advisory Group • All patients want the full attention of their nurse. • Knowing that nurses do need to attend to other patients they would like this disruption to be as minimally intrusive as possible • Voalté • Texting identified as preferred method of communication: secure, private, and quiet. • Thought iPhone had more potential for future use • Vocera • About 2/3 of the patients reacted negatively to voice interruption while nurse caring for patient. • Did not want to hear about other patients; not comfortable with other patients hearing about their needs. 18
    19. 19. Searching for Better Technology Staff Feedback: Voalté 19
    20. 20. Searching for Better Technology Decision: Voalté • It was clear that Voalté better met our communication process • Staff selected Voalté because it delivered the most in terms of quiet and responsiveness and easy to use. • It was also clear that it was not a perfect fit: • Voalté functionality met maybe 70% of feature/function needs; has some drawbacks • IT infrastructure challenges • MGH Infrastructure concerns; small company with a relatively new engineering team 20
    21. 21. Technology Implementation Voalté at MGH • In use by staff on 37 Inpatient Units: • Nurses, Nursing Assistants, Unit Secretaries, Unit Leadership • PC Only: Social Work, Case Management, Chaplaincy, Dietary • Selected generic roles set-up for Physicians • Physical Therapy, Occupational Therapy, Respiratory Therapy, Speech Language Pathology • Support • PCS Project Specialist • IS Voalté Analyst hired December 2012 21
    22. 22. MGH Stats Technology Implementation Voalté at MGH • • • • 1041 phones in use 4400 users Average of 750 concurrent users 505,000 total voice and text messages in June • 95% of which were text messages 22
    23. 23. Technology Impact • Improved ease of communication • Faster triage of message than with paging/cell phone calls • A noticeably quieter environment with less overhead paging • Increased responsiveness to patients • Staff love it! 23
    24. 24. • Complete implementation • Work with vendor on system development: Technology Change: What’s Next? o Testing, utilities, feature/function etc. • Most importantly, refocus on Process Improvement: 24 o In the midst of offpriority initiative to ensure consistent use of best demonstrated communication processes
    25. 25. Lessons Learned from our Communication Tool Technology Journey • New technology is necessary but not sufficient. Constant focus on the process and improving it is the key driver. • Partnership between IS & Department Leadership from the start is essential • Implementation plans change due to both technical challenges and evolving operational needs. Open communication, trust, and flexibility between Department Leadership and IS or other Depts is critical • Sharing impact and feedback from front-end users with the IS or other Dept team members who made it possible is valuable • Change isn’t easy, but if we collectively hit the mark on these things, likelihood of meaningful success is much greater 25
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