How to Successfully Implement New Technology
From bedside blood testing and physician call routing to barcode medication systems and electronic medical records, technology is changing health care delivery--and it will continue to do so as providers and hospitals strive to improve quality and safety. But how can health care facilities ensure that all staff members use these high-tech devices and systems properly?
Successful implementation of new technology requires overcoming people’s natural resistance to change.
“With any change of practice, who leads the charge is very important, and the change needs to be managed,” said Dana Lewis, RN, MSN, NE-BC, ONC, nursing informatics manager at South Nassau Communities Hospital in Oceanside, N.Y., which recently implemented a barcode medication administration system. “Staff needs to understand why in terms of how it relates to the job and their patients and how it will make things better. If you explain that in a way that gets their buy-in, the change becomes easier. It gives them more incentive to make it successful.”
Louise Urban, RN, MHSA, vice president and chief nursing officer at Jefferson Regional Medical Center in Pittsburgh, Penn., which recently introduced the PerfectServe physician call routing system, added, “Successfully navigating change requires good up-front planning, getting people on board, making sure you have covered all variations in the process and educating all of the people involved.”
PerfectServe lets a nurse enter one number for a physician, and the system finds that doctor, whether he is at the office or at home, or the physician covering for him. Jefferson Regional involved physician champions and nurses in planning meetings. They created flow charts and walked through various scenarios.
Involve nurses early on
“Get nurses involved in the beginning, from the time you start looking for a system,” advised Marlene Sides, RN, MHSA, director of information services at MCGHealth in Augusta, Georgia. “Then they own it. They helped pick the system and acclimate better to the product.”
MCGHealth began implementing electronic medical records (EMR) eight years ago, gradually adding more functions. It invited nurses to serve on all of the implementation committees. Nurses soon asked for their documentation to go electronic earlier in the process and then convinced physicians of the benefits of computerized records.
“What made us successful is we involved bedside nurses from the very beginning,” said Melissa Popkin, RN, BSN, clinical informatics specialist at Children’s Healthcare of Atlanta, which recently implemented a customized EMR system.
Children’s Healthcare brought nurses from each of its facilities together monthly at first to show them the system and phases for the project, seek their recommendations, and then let them test doing different things on the system before it went live.
Robb White, RN, director of emergency services at Tomball Regional Medical Center in Tomball, Texas, agreed that involving nurses from day one is essential when converting to a paperless world, such as his facility did with the MEDHOST emergency department information system.
“There are no secrets, everybody knows what is coming, and there is a lot of positive energy,” White said. “We delivered it in a positive manner and got them energized about it.”
Lior Blik, CIO of Hoboken University Medical Center in New Jersey and CEO of nIThealth in New York, recommended creating a committee, comprised of about 10 physician and hospital leaders, including the chief nursing and information officers, to research and select the product to use.
When an attending physician at Miami Children’s Hospital in Florida suggested bedside laboratory testing using the handheld i-STAT System, nurses initially were concerned about taking on additional work normally performed by laboratory department staff, and what would happen to those workers’ jobs. So the hospital held a team meeting to discuss the new technology.
“We gave them the rationale of why we wanted to go to it,” said Mary Ernst, ARNP, MSN, nursing director for the cardiac care center at Miami Children’s. Hospital leaders were so convinced the product would prove beneficial to patient care, they agreed to stop using it if nurses found it was not helpful.
“Once they do it and see how easy it is, the resistance [dissipates],” said Ernst, adding that nurses appreciated having the results within two minutes, and the device sold itself. Nurses convinced skeptical peers about the benefits.
White, at Tomball Regional, said the electronic MEDHOST system offered an opportunity to revamp processes. Those changes, along with the electronic system, have allowed the emergency department to decrease turnaround time from an average of 220 minutes to 140 minutes.
Blik recommended establishing interdisciplinary, clinical subcommittees to observe and verify current processes, and then meet with the software vendor and determine where the system can be modified and where the clinicians need to change their established workflow.
South Nassau’s implementation team watched nurses administer medications and learned they checked the medication in the med room and verified it was the right patient at the bedside. The planned barcode system required them to check both in the patient rooms. Before going live, nurses began verifying both at the bedside.
“It’s best to implement [the new process] before you implement the technology,” Lewis said. That way “the process is comfortable before you add the technology.”
Train and educate
Lewis recommends assessing nurses’ computer skills and bringing their competencies, such as keyboard skills, up to standard before starting them on job-required electronic devices. Once nurses feel comfortable with a computer, she said, it is easier to introduce new technology.
Children’s Healthcare conducted scenario-based training, leading nurses through the workflow of how they would document an assessment or administer a medication.
Banner Gateway Medical Center in Gilbert, Ariz., moved into a new, all-electronic facility a couple of years ago. Nurses trained on the software. Then leadership took about 20 percent of the nurses to the new hospital and let them practice on the new system during mock drills. Some local Boy Scouts played the roles of patients to create a more realistic simulation.
“It allowed them to get comfortable with the electronic tool, and it helped us identify any issues we had to fix before we opened,” said Sheri Dahlstrom, RN, MSN, chief nursing officer at Banner Gateway.
Employ super users
Banner Gateway trained super users who did not have a patient load during and for about two weeks after the “go live” to help nurses navigate the system.
Children’s Healthcare of Atlanta also prepared nurse super users. They attended additional educational sessions, listened to their peers’ questions and were ready to assist fellow nurses when the system went live. The super users wore special T-shirts, which helped identify their temporary role, and were not given a patient assignment so they had time to spend assisting fellow nurses.
“It was worth the investment,” Popkin said. “Cost is always a consideration, especially when you think about nurses not having patients, but it gave them an opportunity to help their co-workers get off to a successful start and use the tools in the right way.”
Blik suggests training file clerks and other people who will lose their jobs when an electronic medical record is implemented as software experts who can help clinicians use the system.
Popkin and most of her peers on the Children’s Healthcare informatics team have extensive clinical experience, as nurses, respiratory therapists or in other roles.
“That has helped us to be successful,” Popkins said. “We have experiences personally about how the real-world hospital works.”
At Banner Gateway, everyone from the CEO on down supports its paperless initiative. There are no paper handouts at meetings. People bring their laptops.
“We sent the message that this is our new environment,” Dahlstrom said. “It’s not optional.”
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