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Part 1 of a 3-part series in conjunction with our nurse leadership webinar series.
Six years ago, the National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), recommended that nurses lead inter-professional collaboration and healthcare delivery improvement and redesign. They noted that nurses are uniquely positioned to do this since, given the care setting, they are quite often the primary patient caregiver. As such, they serve as the virtual linchpin of care—connecting the various care providing professions while coordinating patient care across the entire care team. Toward that end, nurses are responsible for over 90% of physician communications while directing over 80% of their own communications to the broader care team.
While some inroads have been made in regard to this IOM recommendation, there are formidable challenges impeding significant progress. As the industry transitions to value-based-care, nurses are being held increasingly more accountable for patient outcomes and experience. Paradoxically, they are concurrently being asked to perform more indirect and non-patient-care tasks which reduce the amount of time at the patient bedside—one of the strongest predictors of positive patient outcomes and experience.
One such activity is care team communication.
Specifically, nurses have reported that difficulty communicating with the care team has decreased direct patient care time. One survey study found that 75% of nurse respondents reported wasting valuable care time just attempting to communicate with physicians and other care team members. In part, as 50% of the respondents acknowledged, this is because they are unaware of the right care team member to contact for the clinical situation at hand. The latter explains why the majority of physicians reported being frequently erroneously contacted when not the right physician for the situation.
These recalcitrant obstacles to care team communication and collaboration have served to delay patient care and prolong patient wait times. No one is more acutely aware of this than the nurse.
Nurses quite often find themselves waiting for physicians to return phone calls/pages while their patient needlessly suffers. As the nurse struggles to coordinate care, no one is more cognizant of the impact of missed care or delayed transitions on the patient and the patient’s family. Moreover, no one is more handicapped by the limits of fragmented communication technologies that have not successfully overcome these challenges because they only address a small component of the overall problem. And no one is in more need, than the nurse, for innovative technology that is able to immediately connect the right care team members to facilitate timely collaboration.
The good news is that this technology is now available. However, when evaluating the various care team collaboration platforms, it is important to avoid common pitfalls. Here are a few guiding principles to keep in mind:
- While secure messaging is a salient feature of the platform, it is not wholly sufficient to address these communication obstacles since it is dependent upon two flawed assumptions.
- The recipient, such as the physician, must desire to be contacted at all times for all situations every day of the week.
- The sender, for example, the nurse, knows who to contact in every single situation.
- All of the care team must be on the same platform. As the IOM noted, “True inter-professional collaboration can be accomplished only in concert with other health professionals, not within the nursing profession alone.” This holds true for any other profession.
- Most importantly, the technology must be purposefully designed to overcome the known referenced obstacles. To do this, it must be able to automatically identify and provide immediate connection to the right care team member for that particular clinical situation. This type of complex logic requires that for every single communication by every care team member, the contextual variables of the particular message must be analyzed in real time to ensure the communication is routed to the correct individual.
- The care team collaboration platform capabilities must transcend the walls of any one facility. Nurses, as well as physicians and other care team members, quite frequently need to contact team members who work in and across other facilities and locations. The platform must be able to support this communication and the intelligent routing capabilities must extend to provide immediate identification and connection to these care team members when needed.
- Ultimately, the care team collaboration platform must have proven functionality to reduce communication cycle times. Reducing the time to connect and close the communication loop translates into care team efficiency and increased patient care time. As every nurse knows, this means speed to treatment, improved patient experience and improved patient outcomes.
Nurses are indeed perfectly positioned to lead inter-professional collaboration and healthcare delivery improvement. However, it is critical that they are provided with the technology that will allow them to overcome all the challenges this entails.
Let us not repeat the mistakes of the past—providing nurses with inadequate technology in response to which, they must find a work around—increasing their effort and workload in the endeavor. Quite sincerely, healthcare improvement and reform depends on it.