adopting a collaborative approach to the deployment of it solutions

Prepared for the American College of Healthcare Executives Congress on Healthcare Leadership

March 2009

Adopting a Collaborative Approach to the Deployment of IT

Solutions

Presented by: John Antes, President, Progress West Healthcare Center

Bob Zollars, CEO, Vocera Communications

American College of Healthcare Executives

Learning Objectives

• At the end of this session, you will have learned: Best practices in implementing new technologies

among clinicians The respective roles of the healthcare executive, nurses,

and IT department technicians in deploying IT solutions How technology providers can help you achieve a

successful deployment How to compare your organization to leading hospitals

in collaboratively approaching the adoption of new technologies

Agenda

• Case study from Progress West Healthcare• Deployment approach• Best practices for collaboration• Questions and discussion

Collaboration for Success

• Technology in healthcare needs to help with one of the following imperatives: Improve careReduce cost Improve access

• If it can help with more than one —even better.

Collaboration For Success

• Technology should not be designed or deployed simply for the “cool” factor.

• Manufacturers are working in partnership with healthcare to create technology that:

Improves clinical workflow Supports effective decision-making Positively impacts patient outcomes

• Key to successful IT deployment in healthcare begins with cross-functional participation from concept and continues through deployment and post-deployment.

Collaboration For Success


Technology companies deliver better solutions through collaboration with hospitals:

• Customer advisory boards• User forums• Focus groups• Webcasts and webinars• Community sites and blogs• Customer satisfaction surveys


• Ongoing dialogue with customers helps technology companies establish product criteria and feature priorities

• Annual Customer Satisfaction Survey Dialogue with 468 users via an online survey Followed up by phone with 15 percent Recast development priorities based on feedback

About Progress West Healthcare Center• Based in the St. Louis suburb of O’Fallon, Mo.

Opened February 2007 State-of-the-art facility

• High tech and high touch• Patient/family empowerment• Outcomes focused

72 private patient rooms• Eight LDRPs• Six ICU

12-bay emergency department Four operating suites Comprehensive imaging department

Progress West Healthcare Center

• The hospital evaluates its success based on a patient-centric approach that measures the quality of the patient experience and safety

• The primary consideration for each decision made at Progress West is the impact on patients

• Decisions are made using four key service priorities: safety, courtesy, expertise, efficiency


American College of Healthcare Executives 11

Information TechnologyBroad-based Infrastructure

• Base IT budget for PWHC is $7M for approximately40 applications, including: Basic hospital operations: scheduling, registration, billing, medical

records, transcription, and OR management Emergency department electronic charting and CPOE Ancillary support systems, including pharmacy, laboratory, radiology,

and PACS A full state-of-the-art data/voice wireless network Emerging technologies, such as reduced sign on (RSO), patient

touch, RFID, lobby kiosks


Progress West – Our Philosophy on Patient Care

• Patient-focused environment: create an ideal setting for patient care

• Emphasis on patient safety and staff efficiency

• Patient convenience is incorporated into the hospital design (way finding, parking, entries, destinations, etc.) and patient rooms

• Inviting and friendly: provides a welcoming environment for patients, families, and visitors

• Embrace the application of technology where it enables superior clinical quality, patient empowerment, and physician and staff productivity

• Provide for the physicians needs to enable top-quality care, easy access, and convenience

Our vision for the new hospital is to transform how we deliver the patient and family experience.

How will we accomplish this?

PWHCPWHC

Transforming the Patient Experience


Patient Experience Traditional Future State

Technology Supporting Future

State

Outpatient Testing

- Linear services

- Redundant data gathering

- Lack of coordination

- Poor communication

- Patients ”lost” in system

- Enhanced workflow management- Leverage existing data

- Improved communication

- Patient location/wait times available real-time

- Patient touch technology

- RFID

- Vocera

Emergency Department

- Long waits

- Sporadic communication

- Rigid

- Not family friendly

- Minimized waiting

- Frequent communication

- Flexible

- Family friendly

- Electronic documentation

- RFID

- Vocera

Inpatient – Med/Surgery Unit

- Lack of control

- Not a partnership

- Limited visiting hours

- Centralized work areas

- Patient-offered choices

- Care partner is key

- Flexible (patient driven)

- Chart, meds, computer in patient room

- Bedside medication admin/charting- Patient touch technology

- RFID

- Vocera

Patient-Centric Approach

• More time spent at the bedside; less time seeking information or looking for assistance Technologies based on this approach that have been

implemented include applications that maximize patient safety, and others that are primarily concerned with patient satisfaction and comfort

Patient-Centric Approach

• Cutting-edge technology is key to effectively meeting patients’ needs more fully and efficiently Facility built without nurses' stations to mirror nurses’ workflow Adopting applications that function at the patient bedside Utilizing wireless-on-wheels workstations equipped with computers

in patients’ rooms Computerized charting

Technology Implementation and Experience

• 40 healthcare applications running across numerous technology systems and devices to provide clinical staff with maximum mobility and flexibility Wireless and hands-free communication at the point of care Clinical electronic documentation Bedside bar-coding RFID and fingerprint identification for computer log-in Touch-screen technology in patient’s rooms

• Videos address broad health topics, yet are personalized to relate to patients treatment and care

• Makes patients feel more at home in the hospital and contributes to a betterpatient experience

What is it Like to be a Nurse at PWHC?


• WOWs with electronic documentation in each room Electronic documentation Medications — mini Pyxis with administration supplies

• Supplies — “Nurse Server”

• Medical records in the room

• Hands free wireless Vocera communication devices Wireless call lights answered in person Alarms communication devices

• Pharmacist on the floor — medication reconciliation duty

• Physiological monitoring on each WOW

• Shift report at bedside

• Patient progress rounds

• “Withdrawing” from the unit secretary


• Reduce travel distance Decentralized supplies/meds Decentralized nursing

• Increase direct care time with patient Bedside charting

• Enhance staff health and safety Ergonomics

• Reduce stress and fatigue Same-handed rooms

PWHC

Staff Efficiency and Satisfaction

Technology Implementation and Experience

Challenges• Common pitfalls of IT implementation

Deploying technology for technology’s sake Departments frequently understand their needs, but not the needs of

other departments or functions. Failure to engage key constituents in the review, deployment and

adoption process Staff does not understand the responsibilities or workflow of other

departments

Opportunity• To assess how the technology will impact hospital processes,

and then … improve facility-wide performance, workflow, and decision-making

Technology to Improve Care Processes


Old Approach New Approach Technology

Registration in Lobby Registration at Point-of-Service

Registration WOWs

Centralized Nurses Station

Care Team AreasWOWs/Charts in the

Room

Multiple Sign-Ons Reduced Sign-On RFID and Biometrics

Decentralized Pharmacy

Pharmacy at the Bedside

Applications at Point-of-Care

Technology to Improve Communication


Old Approach New Approach Technology

Patient Educational Brochures

Computer-Based Education

Bedside Flat Screen Monitors

Paper Requisitions Sent to Lab

Electronic Orders and Results

Portable/Wireless Phlebotomy Device

Phones/Pagers/ Overhead Pages

Hands Free Communication

Wearable Voice Communication

Device

Interdepartmental Collaboration Approach

• Collaboration is key — no silos• All stakeholders take part in the discussion• Effective interdepartmental communication

expected


Create a Culture of Accessibility

• Identify and engage hospital administrators, clinical, and IT/telecom leaders

• Promote strong interdepartmental partnerships to vet the pros and cons of new technologies from each department’s unique perspectives

• Establish formal forum of communication• Practice teamwork in discussing and problem-solving

in advance of technology deployments

Why Collaboration is Critical

• To develop an action plan and an understanding of the expected outcome for the deployment

• Vet key concerns before decision-making • Develop a deeper understanding of the scope of

deployment and time table• Set expectations among various departments• Establish ongoing responsibilities• Create ownership for success

Defining Roles Within the Organization

Hospital AdministratorGoals: Provide strategic technology to:•Optimize patient care, safety, patients’ experience•Streamline hospital processes — not create more work for organization and staff•Create a culture of accessibility and respectability to any input•Ensure leadership involvement and buy-in to provide consistent direction to staff

The Role of Information Systems and Clinical StaffGoals: Aligned with hospital administration•Discuss variety of technology tools, applications, and their benefits•Evaluate needs for continuous improvements•Clinicians identify obstacles to patient care and hospital processes and communicate directly to IS department for solution


IT and Clinical Partnership for Deployment Success

• Advanced and thorough planning Progress West elects a nursing representative to work with IT on

the plan• In creating the plan, the nurse will approach implementation from the clinical

perspective, while the IT technicians will focus on the technical aspects• The nursing representative specifically addresses nurse’s concerns,

determines the expert training needed to use the technology, and advocates the benefits of the technology solution

All clinicians, IT staff, and administrators are involved in identifying issues and supporting a particular solution

Implementation Plan Components

• Identification of stakeholders and their needed resources• Communication plan – who to notify, when, and how• Listing of tasks by all parties (including vendor, employees, IS)• Training schedule• Implementation• Go-live and post go-live support plan• Project closure



• Design ongoing support processes• Define and communicate escalation process• Engage and empower “Super Users”• Address coverage or system issues immediately• Build in regular IT visits with end-users• Educate help desk staff• Clinicians establish and maintain relationship with

technical support


Deployment stages• Benefactors of IT solution divided into pods

• Each pod has Super Users — nurses who are experts and can determine how the solution will improve processes

• Super Users train other nurses communicating the benefits of the technology and best practices Minimizes rejection of technology

Ongoing upgrades/new applications for continuous improvement• IS work with best-in-class healthcare IT vendors

• Networks at industry conferences, meetings, hospitals for most current information


Integration is Paramount• Integration is paramount to improved processes

and patient safety• Integrated technologies

Reduces the number of individual applications needed to learn, manage, and monitor in pursuit of patient safety

Wireless voice system integrates with nurse call system and heart monitors• Nurse wireless devices receive alerts directly for

instant communication• With integration of heart monitors and wireless

communication system, a text message and voice mail are sent to the nurse caring for a patient

• Messages provide date — patient room number, time, and patient status

• Integration results in efficiencies that deliver optimal patient care and safety


Measuring Outcomes• Conduct pre- and post-implementation studies

to evaluate technology impact and ROI Patient satisfaction: “Top Box” by PRC

• 2007 = 77.7• 2008 = 83• Top national for PRC

Employee engagement: Towers Perrin• 2007 = 89%• 2008 = 91%

• IHI National Comparison Survey Nurses that spend their time at the patient’s bedside National mean = 40% PWH = 55%


Patient Satisfaction — Performance compared to TargetService Quality — YTD (1/08 – 9/08)

YTDSept 08

2008Target

65.4 65.6

61.4 64.3

79.7 77.3

69.6 68.4

55.5 59.4

70.8 68.2

61.2 63.8

65.8 65.7

72.3 69.4

83.8 69.7

57.3 60.4

56.5 57.0

53.0 59.1

84.1 83.8

68.2 68.2

62.1 58.5BJCBH

BJCHC

BJCMG*

CCH

MBS

PHC

PWHC

BJWC

BJSP

AMH

BHC

CH

MBMC

SLCH

BJH

BJC Overall

Threshold Target Maximum

*YTD through July 08

Performance vs. Service Quality Target

33

BJC Overall - % Top Box Advocacy Percentile Ranking

0

50

100

2006 rank 2007 rank 2008 6-month rolling rank

Per

cent

ile R

anki

ng

90

75

Based on current percentile normative standards

PHC

Patient Satisfaction Time TrendsHospital Performance Compared to Current Norms

CHN

MBS

CCH

AMH

PWHSLCH

BJWC

BHC

MBMC

BJSP

BJH

Favorable Scores

Service Excellence

Employee Engagement

Integrity and Patient Safety

Diversity

Teamwork/Working Relationships

Operating Efficiency

Immediate Manager

Leadership

Work/Life Balance

Development and Training

Total Rewards

2008 Towers Perrin Employee Engagement SurveyPROGRESS WEST HEALTHCARE CENTER (279)

CATEGORY SCORES

93

91

89

88

87

85

83

82

81

80

71

0 25 50 75 100

Categories Ranked By Difference Favorable Scores

Leadership

Work/Life Balance

Employee Engagement

Integrity and Patient Safety

Total Rewards

Diversity

Service Excellence

Operating Efficiency

Development and Training

Teamwork/Working Relationships

Immediate Manager

Red / Green Difference Bars are statistically significant

Differences From Benchmark

2008 Towers Perrin Employee SurveyPROGRESS WEST HEALTHCARE CENTER (279)

vs. BJC OVERALL (19363)

82

81

91

89

71

88

93

85

80

87

83

16

12

11

11

11

9

8

8

8

7

7

-20 -10 0 10 200 25 50 75 100

* indicates a statistically significant difference

PROGRESS WEST HEALTHCARE CENTER (279)

2008 Towers Perrin Employee SurveyKey Drivers of Employee Engagement

vs. PROGRESS WEST HEALTHCARE CENTER 2007 (250)

Variance Explained: 76%

Favorable

Score

Difference

From Benchmark

Favorable

Score

Difference

From Benchmark

Key Drivers

Employee Engagement

91 1

82 Leadership-1 1

80 Development and Training2 2

93 Service Excellence1 3

Key Lessons Learned

• Collaboration begins with the initial idea and continues through post-deployment

• Collaborative culture• Cohesive teamwork and support• Training is a must

Initial, follow-up, and ongoing training

• Give nurses the tools to spend more time with patients and less time locating people and resources

Adopting a Collaborative Approach to the Deployment of IT Solutions

• Collaboration begins with the initial need identification and continues through deployment, training, and post-deployment. Administrative Clinical Facilities Finance IT Operation Patient and family needs

• Manufacturers and technology partners should be strategic partners throughoutthe process.


Questions?

BibliographyProfessional Research Consultants, Inc. (PRC) for Patient Satisfaction Survey

http://www.prconline.com

Institute for Healthcare Improvement - Transforming Care at the Bedside (TCAB) Study

http://www.ihi.org/IHI/Programs/StrategicInitiatives/TransformingCareAtTheBedside.htm

Towers Perrin International Survey Research for Employee Engagement Survey

http://www.isrinsight.com/Solutions/engagement.aspx


http://www.prconline.com/



http://www.isrinsight.com/Solutions/engagement.aspx

Contact UsBob Zollars

[email protected]

Chief Executive Officer

Vocera Communications

525 Race St

San Jose, CA 95126

(408) 882-5100


John Antes

[email protected]

President

Progress West HealthCare Center

2 Progress Point Pkwy

O’Fallon, MO 63368

(636) 344-1113

mailto:[email protected]

mailto:[email protected]

Biography – Bob ZollarsRobert Zollars is the Chairman and CEO of Vocera, which provides a hands-free, 802.11 b/g wireless solution enabling instant voice communication among mobile workers to over 550 hospitals. Prior to Vocera, Zollars served as President and CEO of Wound Care Solutions, leading operator of outsourced chronic wound care centers. Previously, he was Chairman and CEO of Neoforma, Inc., a provider of supply chain services, and Executive Vice President for Cardinal Health, where he was responsible for five wholly owned subsidiaries. He has an M.B.A. in Finance from John F. Kennedy University and a B.S. in Marketing from Arizona State University.

Zollars serves as the Chairman of the Board of Advisors for the Center for Services Leadership at Arizona State University. He is also a director of VWR International, Reliant Technologies, and Diamond Foods.


Biography – John AntesJohn Antes is president of Progress West HealthCare Center, the first new hospital built in the St. Louis region in more than 20 years. Before joining BJC Healthcare in 2005, Antes served as president and chief executive officer of MedCath Inc.’s Heart Hospital of Milwaukee. Previously, Antes was vice president of MedCath's Harlingen Medical Center in Texas and executive director of its Heart Clinic in McAllen, Texas.

Antes holds a master's degree in health administration from Washington University and a bachelor's degree in business administration from Memphis State University.


adopting a collaborative approach to the deployment of it solutions

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