A panel convened to discuss the increasing role of technology in healthcare and how it can benefit, and be accepted by, staff and patients alike
As Rhonda Collins emptied her pockets to go through US airport security, the Transportation Security Administration agent surveyed her with a knowing grin. “Oh, you must work in healthcare,” said the officer. Puzzled, she asked what had given her away. “Pager,” replied the security officer in a matter-of-fact fashion. “Nobody but healthcare still has pagers.”
Ms Collins – chief nursing officer at clinical communication firm Vocera – offered the tale during the latest Nursing Times roundtable. And it’s a neat summary of how healthcare has often been the last bastion of gadgets considered out of date in any other setting.
“We have millennials coming into hospitals and when they come to work we’re asking them to use technologies or methodologies that were really obsolete before they were born,” continued Ms Collins.
“When you talk about landline phones, and you talk about fax machines and all of those things, that was technology that was starting to fade 20 years ago. Yet in healthcare, we still use them.”
So the natural question: why? Why are nurses often still having to use outdated technologies? And how could more modern devices and software help them deliver better care – not to mention develop an even stronger leadership role in the clinical community?
The roundtable – co-hosted by Ms Collins and deputy chief nurse at Public Health England Joanne Bosanquet, and chaired by Nursing Times editor Steve Ford – brought together a small expert panel to try to answer those complex questions.
For Jan Stevens, chief nursing officer at The Wellington Hospital, healthcare’s status as a refuge for old technology is definitively not a reflection of outdated attitudes from staff. When the first waves of digitisation hit the NHS – before home computers were common – perhaps wariness was an issue. Today we live in an age in which, courtesy of smartphones, the overwhelming majority of people
have a computer in their pocket. But, Ms Stevens suggested, the issue is that discussions about how best to support nurses in using technology have not moved on in the same way.
“Actually the conversation isn’t now how do you engage with people – people accept technology exists, so it’s more about how do you use it and how do you work with it. There’ll always be a few laggards, but if you always put your effort into the laggards you will just waste your energy and drain it. So for me now, the conversation is ‘it’s here, so how do we use it – and well?’.”
That shift is also one that Simon Noel has witnessed. The chief nurse informatics officer at Oxford University Hospitals Foundation Trust has been involved in healthcare digitisation for the past 18 years. One of his most recent projects is introducing digital documentation at the trust, and he revealed that nurses are far from resistant to the development – quite the contrary, in fact.
“It’s been noticeable, particularly over the last few months, that whereas previously we would be saying: ‘Here, here’s your electronic notes, please use them,’ and creating templates and doing all sorts of things [to encourage uptake], we’re getting to a situation, particularly with nursing documentation, where they’re pulling [us], they want to do it, they want to document electronically.”
Kathryn Halford – chief nurse at Barking, Havering and Redbridge University Hospitals Trust – suggested the key issue was clinicians being able to understand the benefit of any technology. If they are to engage, they need to understand what’s in it for them and their patients. With a chuckle, she pointed out that nurses never seem to have a problem in using e-rostering.
“They can do that without any trouble at all, because they’re interested in it. So I think there is something about what is the motivation for it, and how do you sell that.”
But as well as ensuring there’s a clear benefit, selling technology will involve making sure it is intuitive for nurse users. As Karen Bonner, a divisional director of nursing at Chelsea and Westminster Hospital Foundation Trust, put it: “Is it going to work for me, and how do I use it and interact with the patient at the same time?”
For, while a nurse flicking through a set of paper records is deemed completely acceptable, there are worries about whether the same can be said of a nurse swiping through charts on an iPad. Paula Anderson, EHRS clinical lead at University College London Hospitals Foundation Trust, reported that her organisation introduced an electronic prescribing medication administration system four years ago. Nurses interact with it through mobile devices but, she says, some have felt that serves to distance them from their patients.
“Nobody questions you as you flick through a set of paper records. But actually, if you’re doing that on an iPad, are you watching the TV?”
Jackie Bird, chief nurse and executive director of quality at The Christie Foundation Trust, agreed there were challenges to overcome here. “It is about how nurses learn to work in a different way, and actually have conversations with the patients [about the technology being used]. There are ways of doing it, but it is a different mindset.”
Could making it much clearer visually that a device is being used to deliver care help address this issue? Anna Awoliyi, clinical transformation programme manager (clinical) at Kettering General Hospital Foundation Trust, thought so. “If you’ve got technology – hardware or software – is it customisable [with the trust logo]? It is something patients can look at and understand from the outset that it is being used for their benefit?”
The answer at Frimley Health Foundation Trust is a definite yes. Kevin Percival, chief nursing information officer, reported that the trust’s logo appears on its technology. “And I was up in Leicester yesterday, and they’ve actually got a label on the back of their mobile devices. It says: ‘I’m using this device to provide care.’ I think that’s really important.”
It does seem likely that, as time goes on, more and more nurses will be using devices that could do with one of those stickers. Electronic observations are becoming increasingly commonplace and software developers have also created means of completing Malnutrition Universal Screening Tool (MUST) assessments digitally, along with assessments for falls, and for pressure ulcers.
But – setting aside issues of technology – should nurses really be consistently doing all these assessments in the first place? It was a question posed by Ms Stevens, and one that generated significant debate around the table.
“I think one of the professional challenges is really around how do you simplify the requirement for all these things that we’ve professionalised over the last 20 years,” she argued.
“Look at MUST, bed-rails assessments… you take the 12 assessments that nurses are expected to do, often on paper at the moment, and actually challenge some of the norms around that. Firstly you’ll find that 60% of the data requirements are the same; therefore a [digital] system could easily feed that.
“But also there is a bit of a challenge in that most of the patients coming into hospital are vulnerable, they’re likely to fall, they’re likely to get pressure ulcers, they’re likely to be nutritionally compromised. We could probably save a fortune in less complexity if we just had a professional conversation.”
It was a point built on by Deb Small, chief nurse at Cleveland Clinic London – the UK branch of the renowned US healthcare provider is due to open in 2021. “I think the thing we have to keep in mind is the patients at the centre of all of this,” she argued.
“So everything we’re doing, in as far as documentation and implementing technology and changing tech, the patient has to be at the centre, and the outcome of all the data that we’re implementing and documenting is really for the patients.”
Or, as Andrew McGovern – senior nurse quality improvement and development, Barts Health Trust – put it: “It isn’t about nursing care being more technological. It’s about improving nursing care through the use of technology.” Although it is probably time to kiss the pagers goodbye, regardless.
This event took place Tuesday 30 October 2018
Paula Anderson, EHRS clinical lead, University College London Hospitals Foundation Trust
Anna Awoliyi, transformation programme manager (clinical), Kettering General Hospital Foundation Trust
Jackie Bird, chief nurse and executive director of quality, The Christie Foundation Trust
Karen Bonner, divisional director of nursing, Chelsea and Westminster Hospital Foundation Trust
Joanne Bosanquet, deputy chief nurse, Public Health England
Rhonda Collins, chief nursing officer, Vocera Communications
Steve Ford, editor, Nursing Times
Kathryn Halford, chief nurse, Barking, Havering and Redbridge University Hospitals Trust
Andrew McGovern, senior nurse quality improvement and development, Barts Health Trust
Simon Noel, chief nurse informatics officer, Oxford University Hospitals Foundation Trust
Kevin Percival, chief nursing information officer, Frimley Health Foundation Trust
Deb Small, chief nurse, Cleveland Clinic London
Jan Stevens, chief nursing officer, The Wellington Hospital