Understanding how technology can best be embraced by nursing staff is the key to harnessing its potential to improve service efficiency as well as patient outcomes
Digital transformation requires clinical workforce engagement
When Anne Cooper is asked why it is important for nurse leaders to see digital technology as part of their core work, she offers a question in response. “In 2018, in practically any other profession or as part of our lives, would we question the role of technology?” The answer’s clearly ‘no’. “So why,” asks the former chief nurse at NHS Digital, “should nursing be any different?”
Roisin Devlin started working in emergency care around 20 years ago, and says at that time there was very little use of computers. “You used computers to print out the clinical record, and to get hard copies of the X-rays, and if you wanted to send a referral you used to have to write a letter,” she remembers.
Nowadays, Ms Devlin and her emergency department (ED) colleagues at South Eastern Health and Social Care Trust can call up a patient’s electronic care record with ease, checking X-rays that have already been done in another area or seeing what medications the patient might be on. Such developments have served to transform communication between colleagues, she argues.
“I’m over three emergency departments – one large one and two smaller ones,” explains Ms Devlin, who is the trust’s lead nurse for ED. “So even to be able to communicate with the different departments within our one trust is really valuable. And all of that can be done through electronics.”
She argues the most successful digital transformations have one thing in common: they engage the clinical workforce right from the very start of the project. “If you’re going to have technology put in, it needs to be technology that’s actually going to help you to do your job better – and that’s not one that’s going to put an additional step in that will make your job more difficult.”
It is an argument with which Angela Reed strongly agrees. The senior professional officer at the Northern Ireland Practice and Education Council for Nursing and Midwfiery (NIPEC), Ms Reed studied nurse leadership digital capabilities as part of a 2017 Florence Nightingale scholarship. And she contends that directors of nursing are “uniquely positioned” to influence organisational decisions about digital systems and data capture.
“The executive nurse is one of the few at board level with a varied and expert understanding of clinical practice and patient services,” points out Ms Reed, who chairs a five-country professional digital leadership group, which advises the five chief nursing officers on digital practice.
“Future provision of healthcare will only serve to increase the level of technology and digital approaches,” contends Ms Reed. “It’s therefore vital that directors of nursing and other experienced nurse leaders engage confidently in leadership debate and decision making.”
She suggests that the appointment of chief digital nurses or chief nursing information officers, as well as the creation of wider teams of nurses who can represent nursing interests, will be important here.
At South Eastern Health and Social Care Trust, based in Belfast, Ms Devlin says the pending introduction of a new system will involve formal meetings with nursing representation. But she also speaks of the value of more informal conversations. She reports it was a relatively chance encounter with an IT colleague that triggered the successful introduction of a new communication system in ED, for instance.
“For me, there’s so much about those contacts and connections you can make. It was both of us saying: ‘How do we make this work?’ Even though my colleague is from IT, everything he does is about how he can make life easier for us to be able to care for patients. So I really think it’s about nursing and IT working really closely together.”
For Ms Cooper – who now serves as chief clinical officer at mHabitat, hosted by Leeds and York Partnership Foundation Trust and supporting digital innovation in health and social care – it is actually nurses’ responsibility to embrace technology. She says that needs nurse leadership at all levels, and stresses that it is not necessary to be an expert to lead.
“You just need to be focused on patients, services users and carers, ask searching questions, listen carefully, and make sure what is done is safe for everyone,” she concludes.
Hands-free communication improves care team collaboration and patient flow
David Cole, an ICT telecoms officer at South Eastern Health and Social Care Trust, had wandered down to the emergency department (ED) to discuss putting in a new telephone line. But by the end of his conversation with ED lead nurse Roisin Devlin, there was a much broader vision: a communications system that would connect all clinical staff in the ED.
Two years later and all ED nurses at the organisation have a special type of device pinned to their uniforms. The hands-free Vocera Badge allows them to talk instantly to clinical colleagues, be they fellow nurses, the consultant in charge, allied health professionals or pharmacists.
Ms Devlin says it’s made an enormous difference to day-to-day practice and patient flow. She points to the example of the daily multidisciplinary team safety brief. With an ED that is divided into five separate areas, traditionally people would be scattered everywhere and realise too late that they should be at the meeting.
“We now do a broadcast via Vocera around the department about three minutes before,” she explains. “And now we have, some mornings, 20-25 people at the safety brief. In the height of winter that was extremely useful, because it meant every specialty had an idea of what pressures the ED was under, and were able to offer support.”
Natalie Read tells a similar tale. A senior sister in paediatric intensive care at Birmingham Women’s and Children’s Foundation Trust, she says she primarily uses Vocera technology to communicate with the consultant and nurse manager to coordinate admissions and discharges.
“And if I want to have a face-to-face conversation with someone, I can use it to locate them – it tells me where they are, and I can go and find them to talk to, as opposed to wandering around trying to find them.”
But Ms Devlin emphasises that nurses must be closely involved in the roll-out of any such technology. She explains that she argued strongly that the Vocera device should just be used for communication in the first instance.
“And now it’s embedded, we can look at the next step, which is being able to set alarms to remind people what observations need to be done. I think if we had put too many steps in at first, people might have felt overwhelmed with it and not used it whereas, now, people panic if there are no badges left,” she reports.
Digital transformation requires empowered nurses
Rhonda Collins, chief nursing officer, Vocera
During a recent nursing conference at which I was a keynote speaker, I asked the audience: “How many of you are familiar with the term ‘digital transformation’?” Not one person raised his or her hand.
Digital transformation – the shift that occurs when we move to doing things using digital technologies in integrated ways – is disrupting all sorts of businesses. Think Uber, or Airbnb or Amazon.
It’s impacting on healthcare, too. But I think that many nurse leaders don’t immediately take an interest in it, because it perhaps doesn’t seem relevant to solving the tough challenges they face today. The reality is, it couldn’t be more relevant. By helping nurses communicate more easily than ever before, digital technology can allow them to practise at their very best – in turn improving job satisfaction, recruitment and retention.
But such solutions can only work if nurse leaders are actively involved in their implementation. For me, there are six questions to ask as you evaluate any technology solution:
1. Is a clinical expert at the table for every discussion about technology clinicians will use? Don’t allow others to make your decisions for you.
2. Have you begun with the end in mind? Always lead with the patient.
3. Are the solutions you’re considering user friendly? Make sure you’re setting up a workflow that makes it easier for nurses to get their jobs done.
4. Does the solution solve more than one problem? Make sure it doesn’t solve one problem while creating three more.
5. Is the solution sustainable? Make sure it will be able to grow and integrate throughout your organisation over time.
6. Have you incorporated the nurse perspective? Include frontline nurses in the decision-making process. Change is here, happening now and will only accelerate. Digital disruption and transformation in your hospital needs you, as a nurse leader, at the helm.