Digital transformation is happening faster than ever, but new technologies can often feel more like hurdles than tools, particularly in healthcare. In recent years though, the Nursing Informatics Council (NIC) at Berkshire Health Systems has flipped that script. By focusing on optimizing nursing workflows to seamlessly integrate necessary documentation, we have improved nursing engagement and — most importantly — patient outcomes.
Our goal is to “center the voice” of the bedside nurse — to capture all of their care and wisdom and weave it into our systems and records. To that end, we’ve made sure nurses are leading the way as we make changes. That’s what the NIC is; what began as a nursing documentation committee working on the shift away from paper forms morphed into a collaborative effort focused on optimizing our EHR. In recent years, we’ve picked up steam, and it has become clear that what we’re doing is more than just managing the EHR.
Translating Nursing Insights into Meaningful Change
The NIC is composed of nurses from a wide range of areas and backgrounds; it’s a cross section of our entire organization, including all three of our hospital sites. We have representatives from med/surg, substance abuse, critical care, ED, oncology, case management, nurse education, and more. We also have an operations analyst and a clinical analyst from IT.
Most of the council’s members are direct-care nurses — they’re connected to their peers and deeply trusted, they receive feedback from frontline nurses, and they’re known as “gurus” on the floor. We’re able to use all of this expertise to pinpoint the issues that matter most and address them promptly and directly. That leads to tangible wins that let everyone know that the system is flexible and changing, which means it can always be molded to better represent the way we actually work.
Natural workflows are our guide
With that in mind, we are guided by a couple of important principles. First is that everything starts with natural workflows. A good example of this is the success we’ve had with care plans. During the early part of the pandemic, care plans were often on the back burner. Our clinical analyst suggested embedding care plan problems into assessments, system by system. It’s no longer another intervention to go into — it comes up organically in the regular nursing workflow.
Through this integration, we’ve seen an unbelievable uptick in care plan initiation and follow-through — an impact that was validated in our most recent Joint Commission Survey, which didn’t have a single finding about care plans.
It’s exciting to note that the NIC has improved our organization’s ability to prepare for Joint Commission visits, but this line of thinking has served us well in ways that lead directly to better care, too. For example, we took a similar approach in embedding patient teaching into the workflow — after all, nurses teach as they work, as they document interventions, administer medications, etc. Now, all of that teaching displays in the record, and it includes patient responses. That ensures that we’re working with a more complete and accurate patient record, which helps us deliver high-quality care.
Nursing education and peer-driven change
When it comes to educating nurses and pushing out beneficial changes, the most important thing is designing changes that make sense. We try to make sure we “balance the budget,” so to speak. That means if we’re adding a piece of documentation, we try to look for redundancies and opportunities to take things away. When we had to add documentation around social determinants of health, we made sure to go through and find all the other places where we were collecting similar information and remove it. Reducing the overall documentation load for nurses really softened the landing of that new process.
When we make changes, we want to make sure that we’re making the right thing to do the easy thing to do. Ultimately, no matter how smart and efficient a change is, the delivery of it matters. Changes from peers are more readily accepted. The NIC’s visibility helps in this regard — we’re able to reach out to groups, be a part of work retreats, and more. Nurses throughout the system know us, which helps them trust that the changes we put forward are peer-built and peer-driven.
Staff submit suggestions, screenshots, and other feedback, and because we appreciate the need for rationale, we make sure that when we decide not to implement a suggestion, we explain why — whether the reason is a technical barrier or a downstream effect. We certainly do not always have consensus, but this process means we always maintain trust and mutual respect.
Looking towards the future
Up until now, in order to maintain stability and consistency, we’ve prioritized standardization across the system. Especially after our recent EHR update, we wanted nurses to use the system for a while before we proceeded with any template changes. Looking ahead though, we’re beginning to explore ways of “democratizing” this: for example, by allowing for the customization of widgets by area.
We are also very excited to be at the beginning of our journey towards Magnet status. Part of that journey is that we’re working on connecting informatics metrics directly to patient outcomes. We’re also continuing to iterate on the EHR. More recently, we have had a great deal of success using rules to decrease instances of double-charting and also removing unnecessary questions from workflows.
In making all of these changes, big and small, we’re not just tinkering with our EHR. We’re using nursing expertise to give time back to our nurses, and that time ends up being spent in the best possible way: with our patients.
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