Leveraging Technology

Leveraging Technology

Annabaker GarberJennifer LassondeGeorge Reardon

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

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Success

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Success happens

here

Success Requires Adoption

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Adoption =Perceived

benefit“Peer” pressur

ePain+

Increasing Benefit

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Fits with strategic goals and plans

Fits with the users’workflowFills a need

Enhances safety, quality, satisfaction

Has desired outcome; easy to

use

Cool facto

r

Increasing Peer Pressure

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Strong leadership, expectations, and

communication

Processes to monitor, provide feedback, hardwire

behavior

Regulatory and policy requirements

Fits in the cultureReward and recognition

Decreasing Pain

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Strong communication and working relationships between users, implementers

and leadershipStreamlined processes to

use and support the technologyAbility to

evolve and improve

Good value

Lessons Learned from our Communication Technology Journey

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• 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

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

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Goals

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• 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

Technology Change: Focus on the Process

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4 Day Event Follow- UpPre-work

Aug-Dec 2010 March 9 - 13 Project Kick-Off

Stakeholder Interviews Observation Data Collection & Analysis

Process Mapping

Focus of the Event

Jan 11-14 Brainstorm Ideas Select Ideas to Test Develop Test Plans Test Ideas Implement Solutions Plan for Communication & MonitoringViable Solutions, Communication & Monitoring Plans

Jan 17- Feb 14 Validate the New Process

Tweak Final Changes Monitor Progress & Impact

Local Ownership of Ongoing Monitoring

Kaizen Workshop 2011Pr

oces

s Im

prov

emen

t

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• 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

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• 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

technology15

The

Impa

ct

•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

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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

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6 week trial of each device on

2 inpatient units


Patient Feedback

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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.


Staff Feedback: Voalté

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Searching for Better Technology Decision: Voalté

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• 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

Technology ImplementationVoalté at MGH

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• 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

Technology ImplementationVoalté at MGH

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• 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

MGH

St

ats

Technology Impact

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•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!

Technology Change:What’s Next?

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•Complete implementation

•Work with vendor on system development: oTesting, utilities,

feature/function etc.•Most importantly, re-focus on Process Improvement:oIn the midst of off-

priority initiative to ensure consistent use of best demonstrated communication processes

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

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Health & Medicine

Leveraging Technology