After all the best practices, quality measures attainment, process re-engineering and other initiatives in healthcare organizations, workforce computer literacy will be a key market differentiator for organizations that want the biggest competitive edge. This belief, which I’ve held for 15 years, drives my approach to organizational leadership.
Historically, when information technology was a back office function during the batch processing era, there was little or no attention paid to workforce workflow and processes. In fact, during this period, outside of perhaps the finance department, there was no workforce awareness or concern whether systems were even up or down because there was no impact on operations outside of IT. In this idyllic world of yesteryear, things ran smoothly as long as there was appropriate paper stock and a sufficient filing and retrieval system.
In the good old days, the records department maintained a larger "Lost Paper" file. (I say it’s larger, because this file still exists today, since few organizations are totally paperless.) Important clinical information, from external as well as internal sources, that cannot be matched up with the proper medical record is found in this file. Hence, clinically significant information is missing for clinicians caring for these patients.
Of course, because this is the file of the Lost, clinicians and staff spend untold time and energy trying to find this information, which they know was collected or received. Finally, after accepting the information is no longer available, additional studies are ordered to supply the missing information rather than focus on a plan of treatment to speed the patient's outcome. Aside from the treatment delays that can cause harm to patients, this necessity also drives up healthcare costs.
We also forget the workflow required to create and maintain a sufficient filing and retrieval system. At just about every touchpoint, paper was processed in many ways. Remember NCR paper and multipart color-coded forms? Most administrative staff were located near fax and copying machines and, of course, file cabinets to store the faxed receipts and copied documents. Workflow included patient interaction, followed immediately by leaving the patient to process the paper.
As clinical software systems evolved, workflow changes had a cascading effect as the reality of "No department is an island" became a difficult reality. Ancillary systems are dependent on clinicians workflow accommodations to make the fullest return on investment.
Today, clinical software evolution is escalated by meaningful use criteria. Meaningful Use endorses interoperability and integration. Therefore, nearly every aspect of clinical workflow is supported by a core information system rather than a number of best-of-breed ancillary applications.
In the late 1980s, as clinical systems started rolling out to nursing departments, many nursing leaders allowed the use to be optional; they left it up to individual nurses to choose whether or not to use the new systems. After all, as nurse leaders often said then, "I want nurses, not people who know how to use a computer." I use nursing as an example because they are the largest workforce contingency in a health system. Surprisingly, this sentiment seems to continue, while it may not be as overt now as it was then.
Early in my first meaningful use implementation, leaders considered whether or not to make computer literacy a job requirement. My health system was expecting to spend about $20 million on this endeavor, and yet it was not clear whether computer literacy was to be used for making job placement decisions or to decide whether someone would maintain their current position.
As a result, many nursing leaders were still leading by an example that suggested that IT was the only department expected to be computer literate. These leaders' approach was, basically, "Let us continue to do what we do while IT and the vendor install the new software. After the new software is installed, then call us when you are ready for us to use the new computers."
Even today, there are unfortunate examples of the consequences of allowing clinicians to opt out of the implementation processes. As a result, the go-live and post-live events are predictable disasters that are blamed on IT or the vendor.
I recently interviewed an executive team from a market leading provider in their community. All were dissatisfied with IT and believed that, "they all [needed] to go." When I asked for specifics, the nursing leader was quick to respond that the Help Desk isn't helpful. I asked for more clarification and this was her response: "My nurses don't have time to attend training, and when they call the Help Desk for guidance, they don't get it." I asked if she had a nursing informatics director, and she said that she did, but it was not their job to provide this support.
There is a ying and yang between IT and the workforce that they support. Admittedly, IT likes being the smartest the kid in the room when it comes to computer literacy, and most customers like IT to relieve them of this burden.
I expected my IT staff to support their customers to the best of their abilities and do the work that only IT is in position to do. However, whenever IT staff step in to do something that a customer is qualified and in the best position to do, I counsel the IT staff not to do that.
I often asked my IT staff, "Who is doing your job while you are doing someone else's'?" It is my belief, generally, that when you do something for someone that they can do for themselves, you are both working at your lowest level.
Now more than ever, given the expense and energy devoted to evolving integrated clinical systems, I maintain my belief and commitment to supporting a computer literate workforce. I encourage organizational leadership to step up to clarify expectations and provide staff the necessary support to become confident with the computer skills now necessary to perform their job.
Edith Dees is President and CEO at CAPSYN, a Portland, Maine-based consultancy in healthcare that finds synergies between human and technical investments. Previously, she was vice president and CIO and Holy Spirit Health System.
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