Clinical communication technology:
considerations for nurse leaders

Clinical communication and collaboration (CC&C) technology coordinates care team activities, improving the efficiency of care delivery and enhancing the patient’s experience.

As the primary caregivers and hubs of care coordination, nurses make up the greatest percentage of patient-care technology users, so it’s imperative that nurse leaders are involved throughout the selection, implementation and sustained utilization of a CC&C solution.

Watch this webinar to learn strategies for incorporating nurse leaders into the implementation of a CC&C solution.

In this webinar, you’ll learn how to define the role of the nurse leader in the selection of a CC&C solution, avoid common pitfalls in selecting, implementing and maintaining CC&C technology, and boost end-user adoption and attain desired outcomes throughout this initiative.

Transcription

Carlene Anteau: “…and Collaboration Technology, Considerations for Nursing Leaders.” I’m Carlene Anteau, Vice President of Marketing for PerfectServe. I will be your moderator today. Thanks again for joining us.Before we get started, I want to take a moment to review today’s webinar platform with you. In the middle of your browser, you’ll see a box containing today’s slides. They will advance automatically throughout the presentation. If the slides are hard for you to view, please make sure that you expand your browser.

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Today, we’re excited to hear from two great speakers. Cory Werts, is the Chief Nursing Officer at Mercy Health Care, St. Rita’s Medical Center in Ohio, and Michelle McCleerey, is the Chief Nursing Officer here at PerfectServe. At this point, I’d like to introduce Michelle.

Michelle McCleerey: Thank you Carlene. A bit over three years ago, the Gartner Healthcare analysts identified a new market. They termed it clinical communication and collaboration, otherwise known as CC&C. Since that time the definition has been somewhat honed but basically, it is composed of mobile systems and services that have been designed to improve care team communication, and care coordination.While secure messaging is a salient feature of this technology. It actually has capabilities far greater than that, such as patient assignment functionality or schedule management capabilities and interoperability with the EHR and other healthcare IT.

Now before you, for those who may not be familiar, is the Gartner Healthcare Technology Hype Cycle. It actually traces the various phases of an introduction of a new technology or innovation to that of mainstream adoption. You can see the location of CC&C technology on that hype cycle.

It’s projected that CC&C solutions will reach mainstream adoption in two or more years. In fact, in the most recent publications by Gartner, they recommended that healthcare organizations adopt a CC&C solution as a critical patient care delivery initiative and technology program.

They recommended that this occurs in the next one to two years, as this needs, from their perspective, to be a higher priority on an organization’s road map. They see it as providing the foundation upon which more sophisticated patient experience and care team collaboration requirements can be built.

As more and more healthcare organizations purchase and deploy a CC&C solution, we thought it would be helpful to review those lessons learned by the earlier adopter healthcare organizations who have already gone through this process deploying such a solution, the considerations, best practices, and pitfalls to avoid.

To start the process, it’s necessary to have the appropriate framework. Simply, that is the recognition that communication in healthcare is broken. You are painfully aware that poor communication is a contributing factor if not a root cause of over 80 percent of all sentinel events that occur.

There are long-standing recalcitrant obstacles and challenges that have been well-documented to degrade care. One recent survey found that such obstacles include as a care team member, I don’t know who is the right person to contact for the particular situation at hand, and I spend an inordinate amount of patient care time searching, struggling, attempting, repeat calling, repeat paging trying to connect with the right person.

Unfortunately all too often, I contact the wrong person and I need to start that process again. All of which, did you know, delays patient care as well as patient transition and discharge.

We know that these problems become exaggerated when attempting to communicate outside the walls of the hospital and across the continuum. What’s really important to understand is that patient care and all patient care initiatives are dependent upon communication-driven workloads. If you launch an initiative, it will falter if not fail, if built upon this broken system.

Another best practice that we learned from the earlier adopters is that it is never too soon to establish governance. The sooner the better within this process, and that entails the formation of a multi-disciplinary, cross-functional steering committee.

It’s important to have representation across the entire organization’s ecosystem to prevent that pitfall from focusing on the needs of one stakeholder group to the exclusion or detriment of another. For example, focusing on a nursing mobile communications solution and choosing one that may not support physician or other care team members’ workflow.

It is the responsibility of this steering committee to develop a comprehensive CC&C strategy that needs to be inclusive of all those stakeholders’ needs. This will present the pitfall from simply choosing a fragmented point solution such as an alerts and alarms management product which isn’t supporting the broader communication and collaboration goals of the entire organization.

Importantly, not only should the strategy be inclusive of the immediate needs of the organization, but also the future direction and projected growth of that organization as we seek here transition outside the walls of the hospital.

From that comprehensive strategy, the steering committee will be able to identify core capabilities. Those are the foundational, fundamental capabilities that are going to target those known obstacles and challenges that I just discussed.

In that way, you are ensuring that you are going to build your initiative and future feature-functionality upon a solid foundation. For example, one core capability is dynamic intelligent routing. That is the automatic identification and immediate connection to the right care team member for that particular situation at hand.

To do this, all of the workgroup workflow rules as well as the multiple call schedules across multiple facilities, and the personal contact preferences are gathered from each practice as well as each workgroup, and then incorporated into an intelligent routing algorithm for each.

At the time of communication, all of the variables of that situation are analyzed in real time in order to direct that communication to the right person. This eliminates that need to search and struggle to find out, who is the person to contact, and how do I contact that person. As well as it eliminates that opportunity for error of contacting the wrong person.

With this capability — and this is key — it can reduce communication cycle time, the time that it takes for a communication to be initiated to the receiver to respond to the same. In this example that you see before you, the average communication cycle time was reduced by almost 70 percent, from an average of 46 minutes down to 14 minutes.

Importantly, it also dramatically reduced the number of times of repeat calls, because if a person is immediately responding, then I don’t need to call, call again, leave more messages or pages, as we’ve already connected.

Another core capability for consideration is cloud-based architecture. This allows dynamic intelligent routing as well as other capabilities to easily be extended across the entire ecosystem of that organization, that ability to automatically identify, and immediately connect with the right person regardless of their care setting.

With that, it reduces the support and maintenance that is required of your traditional client-server architecture. On top of that, it is designed for no down time and it maintains all users, all care settings on the most recent version of software.

Once you’ve established this firm foundation that directly resolve those communication obstacles that exist today, then that allows you to build deeper feature functionality that may target specific stakeholder needs, as well as initiatives in your own time frame, based upon your own needs, and your own budget.

With that I will ask Cory to share her personal experiences as an early adopter of the CC&C solution.

Cory Werts: Thank you Michelle. As Michelle alluded to, my name is Cory Werts. I am currently serving as the Chief Nursing Officer at Mercy Health, St. Rita’s Medical Centre in Lima, Ohio. I have been with this organization for 17 years. I absolutely, truly believe in the mission, vision, and values that we have here, which is the reason I stay.In addition, in my tenure here I have held many positions. I started as a new grad in the ICU one night back in 2001, I worked on the Telemetry floor, I held a position in IV team, I have held many different manager jobs, supervisor jobs, spent a couple of years focusing on patient experience, and most recently, within the last eight months, I’ve had the opportunity to serve as the Chief Nursing Officer.

I tell you my journey and my story, because I think it’s powerful from the standpoint that I’ve had the opportunity to experience PerfectServe as both the frontline nurse, with direct patient contact, but also as an opportunity to interact with PerfectServe, and use it from the nurse leader stand point. Offering you both of those perspectives gives you a well-rounded view of what PerfectServe has to offer.

As I alluded to before, I started in the ICU as a new grad back in 2001. At that time my nursing education did a fantastic job of preparing me to take care of the patient at the bedside. What it may have done was offered me that opportunity to learn how to function in a hospital.

As we know nurses can function in lots of many different roles and many different places, and our nursing schools teach us how to take care of patients, but oftentimes there’s the gap in learning how to function in a hospital. Some of those functionalities that that nurse does at the bedside, is a clear communication hub that that nurse puts together, from all different aspects of the care that’s provided to the patient.

As a new grad in the ICU, that was probably one of the most anxiety-provoking things for me to experience. Not only did I have to manage two very critically ill patients for 12 hours, but to learn how to navigate a call schedule, physician call schedule, paper call schedule, at 2:00 in the morning.

Oftentimes I found myself, clearly as Michelle alluded to before, increasing that cycle time for communication by simply trying to fumble through the paper call schedules, and find out who is on call first when I had a critically ill value or a critically ill patient, and a critical value to share with that physician.

At that time, I would frequently finding myself also maybe calling the wrong physician at 2:00 o’clock in the morning. As we all probably have experienced before, those calls aren’t fun to get on the receiving end [laughs] to learn that unfortunately you’ve paged the wrong physician.

In 2004, our organization entered into a relationship with PerfectServe. At that time I still had direct patient contact, and had the opportunity to be an early adopter and to learn to use PerfectServe from the front-line. It was a God sent. The technology that was available that was available to us from PerfectServe allowed us to take that paper call schedule and eventually eliminated it at the time.

The nurse at the bedside, in my experience at that time, allowed me to pick up the phone, know that I was caring for Dr. Smith’s patient, and be able to dial one number to either get a hold of Dr. Smith, if I needed him and PerfectServe took that burden off of me to have to navigate that paper call schedule. I was able to just dial Dr. Smith and PerfectServe would route me directly to either Dr. Smith, or whoever was on call for him at that time.

As PerfectServe grew and we grew, we both grew together. As their capabilities got better so did ours. We were able to move from having one single number assigned for a physician, to being able to pick up the phone and say, Dr. Smith. At that time then PerfectServe would route us to either Dr. Smith, or the physician who is on call for him.

To most recently, within the last five years, we’ve had the capability of a Web-based platform. I could type in a message, via PerfectServe, and that message would automatically be sent to Dr. Smith or whoever was on call for Dr. Smith for a return phone call.

Most recently, in the past year, we’ve had the opportunity, I believe it was in May of 2017, to interact using bidirectional texting. PerfectServe offers us that capability, which has increased immensely that ability to immediately communicate with physicians and other providers who are on the care team taking care of the patient.

That’s really been my journey as the nurse at the bedside, and now fast forward to 2017, where I’ve taken on the role of chief nursing officer. In the last eight months, I’ve had the opportunity to experience PerfectServe and to work with them, advocating for that nurse at the bedside. I’ve learned a few things about the nurse leader role in this capacity.

As I alluded to at the beginning, absolutely, nurses are the hub for clinical communication and collaboration.

We are, obviously, the glue that holds the team together, and our ability to be able to quickly tie that communication together for the patient, to advocate for the patient, to ensure that the patient gets everything that they need, and to do it quickly, is essential in our job.

As the leader of the team and as nurse leaders, we have that responsibility and critical role for setting the stage and processes that facilitate that communication, and really advocating for that nurse at the bedside. Our job, and I take it most seriously, is to make their jobs easier. I truly believe that in my heart of hearts.

In leveraging technology, as we move forward, is absolutely key to creating an ease of use for the nurse, to be able to coordinate and collaborate with the healthcare team.

If you are a nurse leader and you’re in the nurse leader role, you are probably no stranger to unfortunate outcomes that at times happen for our patients. When you peel back those layers of the onion, most frequently what I find is that it is communication breakdown.

At the heart of it all, it is our responsibility to make that communication easy for the bedside, and leveraging technology is absolutely the way to do it.

Our responsibilities are, obviously, that creation of policies and processes surrounding that clinical communication and use of the technology to protect the nurse, to protect the patient, and to protect the provider.

PerfectServe has absolutely served as a key role in this area in ensuring that we are creating those policies and processes to support the nurse and the provider in those communication interactions.

If you’re considering entering into a relationship or advancing your clinical collaboration technology, here are some considerations that I would offer you from having gone first on both sides of the fence, as a staff nurse and as a nurse leader.

Number one, if you’re considering any change or project, support from the highest level of leadership is an absolute must. On a previous slide, what I had alluded to is back in 2004, our relationship with PerfectServe began and that effort was led heavy handedly by our CMO and our CNO at the time.

It took a team. It still takes a team today to ensure that those policies, processes, accountability starts at the absolute highest level. We’re ensuring that we include all the stakeholders, much as to what Michelle alluded to, in that process to ensure that communication happens.

Bullet point number two and number three really go hand-in-hand, creating a steering team that’s really focused on outcome. If you’re considering propelling and moving forward, ensuring that you have a team, a multidisciplinary team, with key stakeholders at the table, that’s focused on results.

Results such as reducing that cycle time for clinical communication for the nurse at the bedside and for the provider. Then surrounding and putting some teeth in and some accountability around ensuring those results happen is an absolute must have from the team.

Number four, you must be culturally ready for change. If you are a healthcare leader of any sort in the healthcare world of today, change is no longer a four-letter word.

We absolutely embrace it and move forward, and you must ensure that the organization and the people that you have are ready for that change, and ensuring that you can incorporate those key stakeholders, they understand the process, not only with their head but also with their heart.

They have to believe that they’re going to make a difference by using this product and improving that communication throughout the use of PerfectServe.

Number five, I think, is absolutely extremely important. That’s ease of use and support of the product. Many times in the nurse leader role, I find myself looking at opportunities to improve either patient care, nursing care, provider care, and the number one question I always ask myself is, “Is it easy to use?”

Because I believe we can all agree that if it’s not easy, they’re not going to use it. We are absolutely here to facilitate their role and not hinder it, not to put up another barrier. Our experience with PerfectServe is that it is an absolute easy product to use and easily adaptable on both the provider and the nursing side.

Support of the product, if somebody’s having a problem, and it’s 2:00 o’clock in the morning, that there’s going to be somebody to help that clinician who needs something to take care of their patient and who’s going to support them.

I can tell you from experiences, both a bedside nurse and a nursing supervisor, that every time that I have 24/7, reached out to PerfectServe for that support, they’ve been there to facilitate that conversation with the provider. We’ve had absolute support of that product.

Finally, cybersecurity is an absolute consideration. Here at Mercy Health, St. Rita’s, we’re part of the Mercy Health System across the state of Ohio and Kentucky.

We have a very stringent cybersecurity policy. Any interaction from IT perspective that involves patient information goes under a stringent review process. I’m here to tell you that if PerfectServe can pass our cybersecurity test, they can pass about anybody’s.

I think it’s an extremely important consideration. Not only for the fact that we need to protect our patients but also we need to protect our clinicians when it comes to interacting in that communication capacity.

What I did not allude to here is something else to consider is that after you’ve made the selection and decided to proceed forward with…Perhaps propelling your clinical communication technology forward is absolute a necessity that you stay focused on continued and sustained value.

Some of those things that might help, and that we do here currently, are regular meetings with both myself and our current CMO and PerfectServe.

We meet on a quarterly basis. We stay focused on cycle times. We stay focused on what providers and what nurses are using in on a regular basis, the number of times that they’re responding, how long it takes to respond, and other metrics to keep us focused, that we are staying on track with easing that communication between the provider and the nurse.

In addition, the use of PerfectServe and this technology has just become who we are. I think staying focused on processes, on surrounding onboarding in nursing orientation, it is absolutely an expectation.

You will use this as well as physician communication. If you are coming on as a provider here at Mercy Health St. Rita’s Medical Center, there are no questions asked. We sign you up, this is how you will be communicated with, and how we will manage your call schedules.

What I find as we move forward is that providers and nurses are both thankful that we have taken that route with the clinical collaboration technology, because it allows that collaboration to take place, and it’s easy to do. They both want it to be easy to do.

Michelle, I believe I’ll turn it over to you to talk to us a little bit about vendor-provider strategic partnership.

Michelle: Thanks, Cory. Just briefly in closing, if you are considering the purchase and deployment of a CC&C Solution, know that you are not on that journey alone.Select a vendor who can serve as your strategic partner. A continuous collaboration throughout the entire process, from the point of selection to — as Cory had referenced — sustained, continued, and added value.

Where there’s shared expertise in resources and competencies for mutual benefit. Together you can map out what technology can support your new and emerging needs.

As care changes and transitions, you can help the vendor understand what are the new challenges that you face, and that will help direct our development to ensure that we continue to deliver a product that will best meet your needs, plus offer the potential for great innovation together.

Carlene, I will turn it over to you for questions.

Carlene: Thank you, Michelle and Cory. That’s awesome. Let’s take a moment to answer a few questions from our audience.As a reminder, there is a Q&A box to the right of the slides that you may use to submit a question.

Our first question is, “What did you do to foster nurse and physician adoption and continued utilization of the technology?” That’s for you, Cory.

Cory: Sure. I will rewind 14 years ago to where we began the using of the technology. What I remember the most about that time was number one, literally, the paper calls schedules disappeared.We did our education. We ensured that we had champions for both nursing and provider, who were readily available when we went live with the use of PerfectServe.

At that time, it was absolutely a must-have that our old paper call schedules disappeared. For lack of a better term, we ripped off the Band-Aid [laughs] and just held people accountable to ensuring we were using the product.

At the same time, we also supported them by having champions available and readily available around the clock. If somebody got stuck, we were there to help them.

Carlene: Awesome. Our next question is, “Could you please provide an example of the policies and processes that best support and protect the nurse?”

Cory: Sure. So I think what comes to mind the most is within the last about three years we’ve developed the Physician Safety Advisory Council. This is a physician led group. We were having some issues at that time with call backs and the length of time it would take for a physician to call a nurse back.With the help of PerfectServe, we were able to identify that length of time and an average length of time, took it to the Physician Safety Advisory Council, who could see the data — the very telling data. The group advised that…As a medical staff we believe that if it’s important enough that a nurse reaches out to us, we must respond within 10 minutes.

That’s just an example of a process that we have set up here that PerfectServe helped us implement and ensure that we were able to hold people accountable to.

Carlene: Nice. OK. Our next question is what has been your greatest challenges in the deployment of a CC&C Solution?

Cory: The one is probably the most recent would be our bidirectional texting which we went live with about a year ago. It was great technology and both the nursing staff and the physicians were very excited about it. However, quickly we learned and what we knew prior to deploying it was the inability to text orders.

Carlene: [laughs]

Cory: Yes. [laughs] And, so what we had to learn…From the nursing standpoint was when do I text and when do I call? And, some of those decisions still need to be made. There are just things that you shouldn’t text because obviously you’re expecting an order. And so it was, for lack of a better term, don’t bait the physician because the physician can’t send you back an order.It was more this one is reserved for a phone call and this one is appropriate for a text. We’ve been using it about a year now. We’ve gotten better at it.

We’re certainly not perfect at it and occasionally we’ll run across an angry physician that says, “Well, don’t text it to me if you can’t take the order by text. Pick it up and call me.” We are still learning how to navigate through that.

Carlene: Yeah, that makes sense though. OK. The last question I see so far is, “What do you wish you would have known then that you know now?”

Cory: Probably hands down would be including a group of physicians on our steering team. I alluded to you a couple questions ago about our Physician Safety Advisory Council. That has actually only been adopted within the last three years or so. We’ve had a relationship with PerfectServe since 2004.I would probably suggest that you have some sort of physician council or physician driven steering team that absolutely is with you from the beginning of the journey. It was championed by our CMO. He was very involved but much like nursing, you must involve that front line also.

Carlene: All right. Well I think we’ve reached the end of our questions. I don’t see anything else in the queue. This concludes today’s webinar. Thank you for spending your very valuable time with us today.We hope that you will take a moment to complete our short survey and tell us how we did. You should see a survey icon at the bottom of your screen which you can launch manually if the survey doesn’t automatically launch for you right now. Again, thank you for your time and I hope you have a…