Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

• A Systems-Level Metod for Developing Nursing Informatics.pdf
• Project Management: Essential Skill of Nurse Informaticists.pdf

THE JOURNAL OF NURSING ADMINISTRATION Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

A Systems-Level Method for Developing Nursing Informatics Solutions

The Role of Executive Leadership

Sammie Mosier, DHA, MA, BSN, NE-BC, CMSRN, BC Wm. Dan Roberts, PhD, RN, ACNP Jane Englebright, PhD, RN, CENP, FAAN Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of their broad understanding and oversight of nursing care. We describe a systems-level method for creating nursing informatics solutions with clearly defined structure and leadership from nursing executives. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

Based on the guiding principles of clear lines of responsibility, respect for expertise, and commitment to project aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions. Data about nursing care have become a critical component of operational and patient care decisions. These data can potentially affect the productivity, efficiency, performance, effectiveness, cost, and value of nursing care when properly collected and used. The management and processing of data into knowledge for use in nursing practice have become an important specialty within the last decade. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

1 Nurse executives are dependent on data for effective decision making. The American Organization of Nurse Leaders has identified essential competencies in informatics that are necessary for effective leadership of this technology and data-informed environment.2 In the age of big data, nurse executives are responsible for creation of the framework that allows for nurses and other experts to apply their knowledge, Author Affiliations: Vice President and Assistant Chief Nurse Executive (Dr Mosier), Vice President of Care Delivery and Performance (Dr Roberts), and Senior Vice President and Chief Nurse Executive (Dr Englebright), HCA Healthcare, Nashville Tennessee.

The authors declare no conflicts of interest. Correspondence: Dr Englebright, HCA Healthcare, One Park Plaza, Nashville, TN 37203 (Jane.Englebright@hcahealthcare.com). DOI: 10.1097/NNA.0000000000000815 such as through the creation of a data culture, the development of data competencies, and the establishment of data infrastructure.3 Together, nurse executives and nurse informaticists are forging new solutions to improve nursing processes and patient care. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

The challenge is in determining how best to coordinate the efforts of subject matter experts from nursing, informatics, and information technology to design, develop, and deploy solutions to very complex problems. Nursing leadership is well poised to influence these processes by virtue of their broad understanding and oversight of nursing care. While not usually engaged in the development of nursing informatics solutions, we propose that executive leadership is necessary to this process. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

Here we discuss our development of a systems-level method, with clearly defined structure and leadership from nursing executives, to create nursing informatics solutions that enhance patient care. This article will describe the method and provide case examples of 2 successful applications. Nursing Improving Patient Outcomes & Patient Care Efficiencies Project Proposal

Methods This project was conducted within a large network of hospitals with affiliated facilities across the United States and United Kingdom. The goal was to develop a method for aligning leadership, clinical experts, informaticists, and information technology experts to design, develop, and deploy nursing informatics solutions. The chief nurse executive (CNE) developed the framework to harmonize the work efforts of disparate groups of clinical and informatics experts that were necessary to design, develop, and deploy nursing informatics solutions.

The framework was based on 3 guiding principles: clear lines of responsibility and JONA  Vol. 49, No. 11  November 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. 543 authority, respect for each type of expertise necessary to the project, and clear commitment to the aims of the project. Figure 1 depicts the structure. Clear lines of responsibility consisted of dedicated leadership for each component of the process, starting with executive sponsorship and guidance. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

A steering committee of nursing executives set the vision, objectives, scope, and guiding principles. The steering committee served as a resource for the other teams and an arbitrator of disputes between conflicting priorities. Teams of content experts and end-users were tasked with defining good practice and ideal workflow to generate technology requirements. Technical experts were charged with designing the technology solutions that could meet requirements, support the workflow, present content optimally, and incorporate decision support when possible. The clinical and technical teams work iteratively to develop and test aspects of the proposed solution. Subject matter experts provided critical input on regulatory requirements, answering questions and providing audit and review services.

Project management resources ensured the appropriate flow of decisions and work products among the teams in the appropriate sequence and ensured that any issues were escalated to the steering committee expeditiously. Respect for different types of expertise ensured that each of the above responsible parties was able to operate fully within their area of expertise. Technical experts deferred to clinicians on content and workflow. Clinical experts deferred to informatics experts on the best way to design input and output and the use of decision support. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

Regulatory experts deferred to clinical experts on content and workflow while providing guidance on regulatory requirements, including evaluation of the final product. Commitment to the vision and guiding principles established by the steering committee was a requirement for all colleagues participating in the project. A clearly articulated set of guiding principles was used in each work session to guide team members as they designed, developed, and deployed the new solution. Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal

Final success was measured on how well the solution adhered to these guiding principles. This framework was used to develop 2 distinct nursing informatics solutions within a large hospital system: Evidence-Based Clinical Documentation (EBCD) and the Nursing Data Portal (NDP). Nursing Improving Patient Outcomes Patient Care Efficiencies Project Proposal