HIMSS14: Nurses' role in innovative care delivery

ORLANDO--Nurses can play a meaningful role as leaders and innovators in designing and implementing new care delivery models, said Laura Wood, DNP, MS, RN, senior vice president, patient care services and chief nursing officer,  Boston Children’s Hospital (BCH), at the Nursing Informatics Symposium at the Health Information and Management Systems Society’s annual meeting.

“We need to elevate our nurses,” said Wood, who oversees 3,000 nurses at BCH. But to be successful leaders, nurses must be willing to work with staff beyond their departments and exist in the context of an interprofessional team.

“To move beyond department goals, you move leadership to places where you may get bruised and may not get the door opened for you,” she said. “But it’s an important part of leadership if we are going to influence and change practices around us.”

Improving patient engagement is a unifying effort at BCH, she said. “It is rare for a hospital or ambulatory setting to be designed around the needs of the patient and family, rather than providers. This is such an important area of focus for us.”

Wood cited two cases where nurses played a role in implementing new practices, and some challenges in making these changes stick—which she referred to as “crossing the O-gap,” or the tricky terrain when a system operationalizes a pilot.

About two years ago, through its innovation office, BCH launched a pilot that involved handing out iPads to patients and families. These iPads included apps like MyWay, which helps patients and families navigate BCH’s 150,000 rooms and MyPasspost, which helps patients and family members access lab results, identify and contact team members, and obtain a care plan.

“The patients loved it,” she said. However, implementation fell to the nurses—who were charged with managing security of devices, keeping track of them and helping patients and their families find multilingual support, among other tasks. The pilot allotted one nurse per unit to answer iPad questions, which was incredibly short of what was needed. “It was really hard to sustain,” Wood said.

With pressure to expand the pilot to an additional unit, Wood said she met with the chief innovation officer, the chief informatics officer and frontline nurses to help all stakeholders better manage expectations.

Full implementation remains a work in progress. “It’s hard to close the O-gap. Even in an organization with talent and resources, we struggled.”

Wood also shared experiences of a rapid cycle improvement initiative, in which an interprofessional team of more than 30 participants worked to solve the problem of missing medical equipment—in this case, infusion pumps—in a 100-day timeframe. Their goal was the ability to access any pump, and all of its parts, within five minutes of a request.

The team developed a tracking tool in just six days and then launched a pilot in which wireless scanners and tap-and-go technologies were utilized to track technologies. Also, workflow was changed with protocol defining how nurses and staff would retrieve devices and request more if needed.

The results were positive, with some challenges in the cleaning of equipment.

Now BCH is evaluating the test results, as well as looking into whether RFID technology, which is more costly, would be a better way to manage equipment inventory. The pilot allowed the RFID evalation to take place in a more informed environment. "Looking at a rapid improvement structure helped us a great deal," she said.