Hospitals are struggling with the workflow and security challenges posed by the widespread use of mobile devices in clinical settings. The combination of new technology, process changes and the expectations of altered behavior can be difficult for nurses to assimilate. But with the right approach, the implementation of mobile technology can be a smoother, more successful process.
Unsecured texting is rampant in many hospitals, used by physicians and nurses alike. Texting is not something that hospital leaders can control—they can’t see it happening, but they just know it’s happening, and they feel vulnerable to HIPAA violations and the threat of exposing confidential patient information.
To many leaders, the acquisition of a secure texting app appears to be the solution to this problem. But if they make this decision in isolation, they have left out other key pieces of hospital communications and data security, including verbal communications and the security issues involved in allowing medical device or EHR data to be sent to smartphones. They become so preoccupied with texting that they may lose the context that must be considered in building a scalable and secure communication platform.
A texting solution is a tactical approach, not a strategy. To create a strategy and a solid foundation on which to build, hospital and nursing leaders must look at the broader scope.
The broader view originates from the practical goals of information technology in the clinical environment: to solve a problem, to improve a work process or to improve patient care. If a hospital builds something that is too complex or adopts an isolated solution that does not improve communication among all care providers, it does not support their goals.
The adoption of mobile communication technology in a clinical setting involves far more than getting people to embrace change. Mobile strategy doesn’t just affect the way clinicians communicate; it also changes the way they practice. This is why nursing leaders have to understand and meet users’ expectations and support the practical use of new technologies.
To be purposeful about their strategy, chief nursing officers should create a clinical communication strategy that includes three areas of input into decision-making:
- The patient-care ecosystem context
- How people expect technology to perform
- How nurses use technology
Understand the patient-care ecosystem context
The National Center for Biotechnology Information has identified moderating and mediating factors that hospital leaders need to understand and address in the earliest stages of identifying and procuring technology. These factors are organizational (policies, resources, culture, training programs and the like), social (characteristics of nurses and patients), physical (relating to the physical environment), and technological (reliability, validity, compatibility and more).
It is essential to understand all of these factors and the specific use cases for which the technology is intended before purchasing and implementing it. Examples of such use cases include direct and indirect nursing care delivery, protecting patients and nurses from harm, and patient assessment, monitoring and surveillance. Nursing leaders should also set forth the initial and long-term outcomes they seek in introducing the technology.
Before designing workflows using a new communications technology, an implementation team should carefully assess what the nurses are doing now. For example, the team might ask the nurses, “How do you communicate today?” If the most frequent answer is “by land lines”—as it was in a survey my company did in 2016—the team should dig further to find out why nurses use land lines.
According to the results of the survey, most nurses have mobile devices and are comfortable using them. They use land lines at work because they lack the information they need to use the mobile technology in a healthcare context. They still have to go back to their desks to find a number; to find out who’s on call; to determine whom do I call right now, today?
The software or the foundation of their existing communication system doesn’t give them all the information they need when they are mobile, including contact information for on-call resources. So if they’re carrying a mobile phone and trying to find the cardiologist on call because a patient is having some issues, they either have to look at the list of numbers in their pocket, which changes with every shift, or go back to their desks to find out whom to call.
The nurse is mobile, but the information is not, and in this case, the mobile phone does not solve the problem. After the nurse is back at the desk, it’s just easier to pick up the land line and call.
In evaluating a hospital’s culture, nursing demographics must always be considered. Because the workforce is aging, many nurses will require additional education and training on new technology. Using mobile technology might not be as intuitive for them as for younger people. They might use a mobile phone in their personal lives, but only to call people without understanding all of its other functions. They might not even know what will happen when they tap on a banner at the top of their screens.
Understanding the patient population is also very important in building a mobile communications strategy. For example, if a solution is designed to push information to patients, nursing leaders should find out how much access different subgroups of patients have to mobile devices or desktop computers.
The physical environment is another critical consideration. For instance, the hospital should have Wi-Fi coverage everywhere so the technology will work throughout the facility. If it doesn’t work everywhere, the perceived usefulness of the solution will drop, and the users will stop using it.
Understand how people expect technology to perform
Technology adoption will succeed only if the solution meets end user expectations: If nurses are told that a technology is supposed to work in a certain way, they expect it to work like that. Everyone in the hospital, from the people who will use the technology to those who have agreed to purchase it, expect that it’s going to work. And if it does not work for the end users, they won’t use it.
This set of expectations about how a solution will work has been described as performance expectancy. The elements of performance expectancy include:
- Job fit and relevance: The technology must be matched to the job. A healthcare communication technology, for example, must support patient and caregiver interactions.
- Perceived usefulness: Users value the potential for a system to meet their work needs and improve efficiency, but they lack confidence in how the system will perform. They worry that the system will be slow and inaccurate and that it will distract their focus from the patient.
- Relative advantage: the degree to which an innovation is perceived as being better than its predecessor. In a healthcare setting, this advantage depends on whether the new technology adds efficiency, enhances safety or quality, and/or raises patient or caregiver satisfaction.
Nursing leaders must understand the state of performance expectancy as they prepare to introduce new technology. If they have not addressed all of these factors, they should not put the technology in the hands of their nursing staffs.
Understand how nurses will use technology
In assessing the initial and long-term outcomes of a solution for clinical communication and workflow, the prime considerations are the usefulness of the data and the devices that will be used to access it.
Clinical and operational systems generate an overwhelming amount of data. But unless the data solves a practical problem, allows a clinician to make a more informed decision, or is information that a nurse would use regularly, it’s not useful.
To offer this kind of value, a communications solution must be able to sift through the huge pile of data to help users find the pieces that are relevant. To make the best use of mobile technologies, nursing leaders must ensure that the solution they choose cuts through the cacophony of data generated by activities in the patient room and elsewhere in the hospital.
Besides being useful, the data also has to be accessible to end users. The selection of the right device is crucial in enabling that access.
A nurse cannot be completely mobile, and he or she cannot use a single device for all tasks. There are some tasks for which nurses need to go back to their workstations. They use the desktop computer because it has a larger screen than mobile devices do. Trying to sort through complexity on a small device like a smartphone is not safe for the patient or for the nurse, and it can also be time consuming.
Nurses may work on a unified platform or software environment, but the ability to choose among devices remains critical to their workflows. For a communication platform to be effective, users must have the option of selecting the device best suited for them and for the task at hand.
The aim of an effective communications strategy is to standardize behavior. To achieve that goal, the software must be standardized, and end users should be allowed to use the devices that make sense for them in their environments. As research continues to learn about user adoption of mobile technology in the clinical environment, the industry will better understand how the workflow dictates the device, and the need to know particular types of information dictates the flow of data to that device.
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