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
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. 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. 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. 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. 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
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
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. 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. 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. 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. 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
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. 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. 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. 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. • 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. 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
