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Implementing an Informatics System in a Perioperative Environment
JANUARY 1997, VOL 65, NO 1 Williams Sowell Smith
Implementing an Informatics System in a Perioperative Environment
T
oday’s trend toward managed care requires that staff members complete their daily assignments in addition to fulfilling other responsibilities (eg, committee work). Perioperative nursing personnel are accustomed to change; however, the acquisition and implementation of new technology, specifically a perioperative informatics system, presents a unique challenge for nursing staff members. An informatics system can provide a means for resource management and analysis of data generated in a surgical department. Nursing informatics is defined as managing and processing data, information, and knowledge of nursing.’ This article provides strategies for perioperative nurses to use in integrating informatics systems in their practice settings. An extensive review of the literature revealed a number of reports dealing with the importance of d o m a t i c s systems and their acquisition and use in
perioperative environments; however, a lack of a nursing involvement in the implementation process was evident. President Dwight D. Eisenhower said, “Plans are useless, planning is indispensable.”* In planning the implementation of a perioperative informatics system, it is necessary to educate and involve the end users to ensure acceptance and the ultimate success of the technologic implementation. To promote acceptance of the new system, it is essential that nursing staff members be actively involved in the system change. scRAT#;H: IMPLEMEMTATlON ELEMENTS
After the acquisition of an informatics system has been approved, planning for the implementation process is initiated. Implementation of new technology should include the follbwing strategic elements: a collaborative interdepartmental planning process, education and involvement of the staff members regardingA B S T R A C T the design of the system, This article identifies and describes strategies for successful development of a system implementation of an informatics system in a perioperative environimplementation timetable, ment. With the trend toward managed care, perioperative nurses selection of a professional must address the challenge of instituting advanced technology in perioperative nursing focus organizations with limited staffing and other resources. Plannlng group, and identification of staff memmethods of the past na longer are relevant in today‘s heatth care bers’ skill development resystems; therefore, innovative planning approaches are important. Five key elements in implementation of an informatics system are: a quirements. collaborative planning process, education and involvement of staff Planning process. The sucmembers regarding the system‘s design, development of a cess of any new system depends timetable, selection of a focus group, and assessment of staff mem- on how well the system change is bers’ training requirements. Methods are described for using a focus planned. Planning the integration group process, including recommendations for structuring the focus of an informatics system does not group and establishing responsibilities of core group members. end with the selection of a system-it is an ongoing process. AORN J 65 (Jan 1997) 94-97.
94 AORN JOURNAL
-
JANUARY 1997, VOL 65, NO 1 William Sowell- Smith 8
A focus group can work
Health care requires a business, time-management approach to accelerate implementation of new technology efficiently. Managed care constraints require that project planning be coordinated interdepartmentally to make efficient use of limited resources. Nurse managers can use assignment approaches that ensure staff members can and will attend planning meetings. Flexible scheduling options may include incorporating meetings with brown bag lunches or after-hour dinner meetings, rotating nurses assigned to attend meetings, and videotaping meetings for personnel who cannot attend. Nurses expect to have input into organizational changes because they no longer accept change solely on the position of a ~ t h o r i t yDuring .~ all phases of the implementation process, perioperative nurse managers depend on staff nurses to provide input that is timely and innovative. The first phase of a new project includes the selection of a project manager. The project manager must have extensive knowledge of the daily OR routine, be computer literate, and have excellent information systems networking abilities. The project manager acts as a liaison between perioperative staff members and the informatics system vendor and secures training and education services from the system vendor for all system implementation requirements. The project manager also creates and maintains an ongoing implementation process agenda. This agenda includes the system implementation timetable, the facilitation of a staff focus group, the evaluation of focus group outcomes, and the revision of the implementation plan based on the focus group recommendations. Focus group approach. The focus group is a core group of selected perioperative nurses who work interdepartmentally with the project manager to achieve results efficiently. The use of a focus group also provides an efficient mechanism to ensure that staff nurses who use the system have adequate input into its implementation. A core focus group of perioperative nursing staff members is identified and selected to represent all areas of the surgical services department. When the surgical services department is faced with difficult problems (eg, implementation of an informatics system), a focus group can provide a unique opportunity to work through the problems, arrive at solutions, and implement decisions aimed at improving the ~ y s t e mA . ~ focus group also provides a unique method of setting objectives, obtaining data, evaluating input, and making necessary revisions. Focus
through problems, arrive at
solutions, and implement decisionsfor improvement.
groups allow decision makers to obtain a firsthand feel for consumer attitudes and reactions to products being ~ t u d i e d . ~ Historically, focus groups have been used in business organizations that must initiate specific plans within strict time constraints. A focus group approach also translates well to today’s health care environment and can be particularly effective in perioperative settings. Ideally, a focus group has six to eight members; however, this number can be determined by the department Size and the entities that make up the department. Nursing staff members selected for a focus group on informatics systems typically are chosen by their managers to represent computer-literate users who will be involved actively in the implementation process. The responsibilities of the focus group are to provide staff input, design a baseline computer fundamentals selfassessment tool, assist with formalized staff training, develop a policy and prbcedure manual, and set meeting agendas that coordinate with implementation timetables. Theoretically, focus groups should meet every two weeks for one to two hours. A running agenda format includes activities to be accomplished and methods for continuous evaluation. Focus group members are assigned responsibilities and given completion dates that align with the established timeline recommended by the informatics system vendor. Evaluation is ongoing and must be included in the agenda to ensure that revisions and modifications are reviewed and forwarded for vendor processing within the established rimeline. One member is assigned to take minutes at each 95
AORN JOURNAL
-
JANUARY 1997, VOL 65, NO 1 Williams Sowell Smith *
Table 1 BASIC COMPUTER KNOWLEDGE RECOMMENDATIONS
Anyone who will attend hands-on training should be able to identify the following hardware components and understand their functions. monitor, central processing unit (CPU), keyboard, printer be familiar with the standard keyboard layout and be able to idenMy the following keys and understond their functions: enter, escape, shift, control, alt, backspace, tab, caps lock, num lock, page up, page down, home, end, arrow keys
be able to perform the following computer functions: turn monitor on and off, tum CPU on and off, reboot computer, turn printer on and off, change printer paper, log in to and log out of the network be familiar with the following basic laser printer terms: on-line, form-feed be able to enter and exit system program and be familiar with the following basic features: the password screen, the main menu, hot keys to access menu options (Adapted wifh pemission fiom HBOC Sewing Sohvure Group, Minneapolis)
focus group meeting to provide consistent documentation of problems and staff input. Focus group minutes can be used to design a user-friendly, customized policy and procedure manual for postimplementation reference. These focus group minutes also can be disseminated in members’ work areas (eg, in a newsletter). Consistent use of this type of peer communication increases acceptance, thereby promoting staff buy-in of the project. Effective use of a focus group approach ensures that all end users have a voice in the design of their informatics system, and it facilitates a source for ongoing staff involvement. Education and skill development. Focus group planning for education and skill development begins with an assessment of staff members’ computer literacy. For staff members to be ready for formalized hands-on training, they must be familiar with computer fundamentals. Their baseline computer literacy can be determined by designing a computer fundamentals self-assessment tool. To decrease computer anxiety and promote staff members’ acceptance of the informatics system, the self-assessment tool should be user-friendly and nonthreatening. The goal of the self-assessment tool is to assess staff members’ understanding of the computer hardware components and keyboard functions that will be used most frequently in the informatics system. If necessary, additional instruction can be tailored to individual staff members’ needs. One way to reduce training costs is to have focus group members who have completed formalized training provide the training for their peers. Allowing time to provide additional
basic computer skills training facilitates a timely implementation process. The computer fundamentals self-assessment tool can be developed by using focus group input and parameters recommended by the software vendor. This process provides a means for customizing staff members’ training in the use of the informatics system (Table 1). The assessment tool can be a simple, multiple-choice self-evaluation that reveals staff members’ knowledge of specific keyboard keys and functions, and it can be returned to the staff members for their future reference. Overall project evaluation. The last phase of the informatics implementation project is overall evaluation. To determine success of the project, an overall evaluation tool is used to measure outcomes. Specific areas to be evaluated are the vendor’s response to modifications, effectiveness of the staff education and skill development program, efficiency of the project manager, and the activities of the focus group. When the informatics implementation, formalized education of the professional staff, and project evaluation have been completed, the process described here will facilitate decision making regarding future technologic needs. CoNeuIsmN
Poor planning can lead to time delays that will result in increased costs, staff member frustration, lack of trust in the system, and minimal commitment 96
AORN JOURNAL
JANUARY 1997, VOL 65, NO 1 Williams Sowell Smith
to the new system. Even when implementation of an informatics system is well planned, some changes should be expected because not all problems can be anticipated before the system actually is implemented. One definition of implementation is “to give practical effect by positive action.”6 Clearly, positive action in today’s perioperative arena requires that perioperative nurses use strategies, such as those described here, t o ensure successful outcomes. Nursing and planning are a powerful combination that can affect the future of health care delivery and perioperative patient o ~ t c o m e sA .~
Pamela M. Sowell, RN, BSN, LCDR, US Navy Nurse Corps, is a graduate student at the Medical Universityof South Carolina, Charleston. The views expressed in this article are those of the authors and do not reflect the oficial policy or position of the Department of the Navy, the Department of Defense, or the US government.
Carol Smith, RN, DSN, CS, is an associate professor and director of graduate programs at the Medical University of South Carolina, Charleston.
Peggy W . Williams, RN, MSN, CNOR, LCDR, US Navy Nurse Corps, is a graduate student at the Medical University of South Carolina, Charleston. NOTES 1. J R Graves et al, “Description of a graduate program in clinical nursing informatics,”Computers in Nursing 13 (March/April1995) 60-70. 2. R Andrews, The Columbia Dictionary of Quotations (New York: Columbia University Press, 1993) 688. 3. M J Ball, K J Hannah,J D
Browne, Using Computers in Nursing (Reston, Va: Reston Publishing CO,1984) 193-194. 4. A R Davis, “Project management: New approaches,” Nursing Management 23 (September 1992) 62-65. 5. M B DesRosier, K C Zellers, “Focus groups: A program planning technique,” Journal of Nursing
Administration 19 (March 1989) 2025. 6. The New BritannicaIWebster Dictionary and Reference Guide, sv “implementation.” 7. D L Davis, K M Salmen, “Nursing, planning, and marketing: From theory to practice,” Nursing Administration Quarterly 15 (Spring 1991) 66-71.
AORN’s Continuing Education Approval Committee in American Nurses Credentialing Center’s Commission on Accreditation guidelines. The CEAC has 12 members who are divided into two reviewing teams, with the two CEAC cochairs acting as team leaders. Each application is reviewed by two team members and a team leader. Last year, the Committee as a whole reviewed 715 applications. The term for CEAC membership is two years. The Committee is not a standing AORN committee; therefore, there is a separate willingness-to-serve form, which is available from the AORN approval unit staff and at the CEAC booth at Congress. Membership on the Committee not only helps sharpen individuals’ evaluation skills, but it also broadens their views of education programs and topics being offered nationwide.
After reviewing statistics and feedback, AORN’s Continuing Education Approval Committee (CEAC) members recently changed the approval process for CEAC applications. The application matrix is now divided into sponsor categories according to size, number of contact hours, and application timeliness, and the fee schedule has been revised to reflect the increase in communications costs (eg, mail, fax, telephone). The largest fee increases have been assigned to applications received within 10 days or less from the presentation date. Chapter program chairs need to ensure that their applications are current. Chapter presidents will have copies of the updated application forms in their chapter resource manuals. In addition, CEAC members have made minor changes to the application form to streamline the process while remaining with97
AORN JOURNAL
Implementing an Informatics System in a Perioperative Environment
T
oday’s trend toward managed care requires that staff members complete their daily assignments in addition to fulfilling other responsibilities (eg, committee work). Perioperative nursing personnel are accustomed to change; however, the acquisition and implementation of new technology, specifically a perioperative informatics system, presents a unique challenge for nursing staff members. An informatics system can provide a means for resource management and analysis of data generated in a surgical department. Nursing informatics is defined as managing and processing data, information, and knowledge of nursing.’ This article provides strategies for perioperative nurses to use in integrating informatics systems in their practice settings. An extensive review of the literature revealed a number of reports dealing with the importance of d o m a t i c s systems and their acquisition and use in
perioperative environments; however, a lack of a nursing involvement in the implementation process was evident. President Dwight D. Eisenhower said, “Plans are useless, planning is indispensable.”* In planning the implementation of a perioperative informatics system, it is necessary to educate and involve the end users to ensure acceptance and the ultimate success of the technologic implementation. To promote acceptance of the new system, it is essential that nursing staff members be actively involved in the system change. scRAT#;H: IMPLEMEMTATlON ELEMENTS
After the acquisition of an informatics system has been approved, planning for the implementation process is initiated. Implementation of new technology should include the follbwing strategic elements: a collaborative interdepartmental planning process, education and involvement of the staff members regardingA B S T R A C T the design of the system, This article identifies and describes strategies for successful development of a system implementation of an informatics system in a perioperative environimplementation timetable, ment. With the trend toward managed care, perioperative nurses selection of a professional must address the challenge of instituting advanced technology in perioperative nursing focus organizations with limited staffing and other resources. Plannlng group, and identification of staff memmethods of the past na longer are relevant in today‘s heatth care bers’ skill development resystems; therefore, innovative planning approaches are important. Five key elements in implementation of an informatics system are: a quirements. collaborative planning process, education and involvement of staff Planning process. The sucmembers regarding the system‘s design, development of a cess of any new system depends timetable, selection of a focus group, and assessment of staff mem- on how well the system change is bers’ training requirements. Methods are described for using a focus planned. Planning the integration group process, including recommendations for structuring the focus of an informatics system does not group and establishing responsibilities of core group members. end with the selection of a system-it is an ongoing process. AORN J 65 (Jan 1997) 94-97.
94 AORN JOURNAL
-
JANUARY 1997, VOL 65, NO 1 William Sowell- Smith 8
A focus group can work
Health care requires a business, time-management approach to accelerate implementation of new technology efficiently. Managed care constraints require that project planning be coordinated interdepartmentally to make efficient use of limited resources. Nurse managers can use assignment approaches that ensure staff members can and will attend planning meetings. Flexible scheduling options may include incorporating meetings with brown bag lunches or after-hour dinner meetings, rotating nurses assigned to attend meetings, and videotaping meetings for personnel who cannot attend. Nurses expect to have input into organizational changes because they no longer accept change solely on the position of a ~ t h o r i t yDuring .~ all phases of the implementation process, perioperative nurse managers depend on staff nurses to provide input that is timely and innovative. The first phase of a new project includes the selection of a project manager. The project manager must have extensive knowledge of the daily OR routine, be computer literate, and have excellent information systems networking abilities. The project manager acts as a liaison between perioperative staff members and the informatics system vendor and secures training and education services from the system vendor for all system implementation requirements. The project manager also creates and maintains an ongoing implementation process agenda. This agenda includes the system implementation timetable, the facilitation of a staff focus group, the evaluation of focus group outcomes, and the revision of the implementation plan based on the focus group recommendations. Focus group approach. The focus group is a core group of selected perioperative nurses who work interdepartmentally with the project manager to achieve results efficiently. The use of a focus group also provides an efficient mechanism to ensure that staff nurses who use the system have adequate input into its implementation. A core focus group of perioperative nursing staff members is identified and selected to represent all areas of the surgical services department. When the surgical services department is faced with difficult problems (eg, implementation of an informatics system), a focus group can provide a unique opportunity to work through the problems, arrive at solutions, and implement decisions aimed at improving the ~ y s t e mA . ~ focus group also provides a unique method of setting objectives, obtaining data, evaluating input, and making necessary revisions. Focus
through problems, arrive at
solutions, and implement decisionsfor improvement.
groups allow decision makers to obtain a firsthand feel for consumer attitudes and reactions to products being ~ t u d i e d . ~ Historically, focus groups have been used in business organizations that must initiate specific plans within strict time constraints. A focus group approach also translates well to today’s health care environment and can be particularly effective in perioperative settings. Ideally, a focus group has six to eight members; however, this number can be determined by the department Size and the entities that make up the department. Nursing staff members selected for a focus group on informatics systems typically are chosen by their managers to represent computer-literate users who will be involved actively in the implementation process. The responsibilities of the focus group are to provide staff input, design a baseline computer fundamentals selfassessment tool, assist with formalized staff training, develop a policy and prbcedure manual, and set meeting agendas that coordinate with implementation timetables. Theoretically, focus groups should meet every two weeks for one to two hours. A running agenda format includes activities to be accomplished and methods for continuous evaluation. Focus group members are assigned responsibilities and given completion dates that align with the established timeline recommended by the informatics system vendor. Evaluation is ongoing and must be included in the agenda to ensure that revisions and modifications are reviewed and forwarded for vendor processing within the established rimeline. One member is assigned to take minutes at each 95
AORN JOURNAL
-
JANUARY 1997, VOL 65, NO 1 Williams Sowell Smith *
Table 1 BASIC COMPUTER KNOWLEDGE RECOMMENDATIONS
Anyone who will attend hands-on training should be able to identify the following hardware components and understand their functions. monitor, central processing unit (CPU), keyboard, printer be familiar with the standard keyboard layout and be able to idenMy the following keys and understond their functions: enter, escape, shift, control, alt, backspace, tab, caps lock, num lock, page up, page down, home, end, arrow keys
be able to perform the following computer functions: turn monitor on and off, tum CPU on and off, reboot computer, turn printer on and off, change printer paper, log in to and log out of the network be familiar with the following basic laser printer terms: on-line, form-feed be able to enter and exit system program and be familiar with the following basic features: the password screen, the main menu, hot keys to access menu options (Adapted wifh pemission fiom HBOC Sewing Sohvure Group, Minneapolis)
focus group meeting to provide consistent documentation of problems and staff input. Focus group minutes can be used to design a user-friendly, customized policy and procedure manual for postimplementation reference. These focus group minutes also can be disseminated in members’ work areas (eg, in a newsletter). Consistent use of this type of peer communication increases acceptance, thereby promoting staff buy-in of the project. Effective use of a focus group approach ensures that all end users have a voice in the design of their informatics system, and it facilitates a source for ongoing staff involvement. Education and skill development. Focus group planning for education and skill development begins with an assessment of staff members’ computer literacy. For staff members to be ready for formalized hands-on training, they must be familiar with computer fundamentals. Their baseline computer literacy can be determined by designing a computer fundamentals self-assessment tool. To decrease computer anxiety and promote staff members’ acceptance of the informatics system, the self-assessment tool should be user-friendly and nonthreatening. The goal of the self-assessment tool is to assess staff members’ understanding of the computer hardware components and keyboard functions that will be used most frequently in the informatics system. If necessary, additional instruction can be tailored to individual staff members’ needs. One way to reduce training costs is to have focus group members who have completed formalized training provide the training for their peers. Allowing time to provide additional
basic computer skills training facilitates a timely implementation process. The computer fundamentals self-assessment tool can be developed by using focus group input and parameters recommended by the software vendor. This process provides a means for customizing staff members’ training in the use of the informatics system (Table 1). The assessment tool can be a simple, multiple-choice self-evaluation that reveals staff members’ knowledge of specific keyboard keys and functions, and it can be returned to the staff members for their future reference. Overall project evaluation. The last phase of the informatics implementation project is overall evaluation. To determine success of the project, an overall evaluation tool is used to measure outcomes. Specific areas to be evaluated are the vendor’s response to modifications, effectiveness of the staff education and skill development program, efficiency of the project manager, and the activities of the focus group. When the informatics implementation, formalized education of the professional staff, and project evaluation have been completed, the process described here will facilitate decision making regarding future technologic needs. CoNeuIsmN
Poor planning can lead to time delays that will result in increased costs, staff member frustration, lack of trust in the system, and minimal commitment 96
AORN JOURNAL
JANUARY 1997, VOL 65, NO 1 Williams Sowell Smith
to the new system. Even when implementation of an informatics system is well planned, some changes should be expected because not all problems can be anticipated before the system actually is implemented. One definition of implementation is “to give practical effect by positive action.”6 Clearly, positive action in today’s perioperative arena requires that perioperative nurses use strategies, such as those described here, t o ensure successful outcomes. Nursing and planning are a powerful combination that can affect the future of health care delivery and perioperative patient o ~ t c o m e sA .~
Pamela M. Sowell, RN, BSN, LCDR, US Navy Nurse Corps, is a graduate student at the Medical Universityof South Carolina, Charleston. The views expressed in this article are those of the authors and do not reflect the oficial policy or position of the Department of the Navy, the Department of Defense, or the US government.
Carol Smith, RN, DSN, CS, is an associate professor and director of graduate programs at the Medical University of South Carolina, Charleston.
Peggy W . Williams, RN, MSN, CNOR, LCDR, US Navy Nurse Corps, is a graduate student at the Medical University of South Carolina, Charleston. NOTES 1. J R Graves et al, “Description of a graduate program in clinical nursing informatics,”Computers in Nursing 13 (March/April1995) 60-70. 2. R Andrews, The Columbia Dictionary of Quotations (New York: Columbia University Press, 1993) 688. 3. M J Ball, K J Hannah,J D
Browne, Using Computers in Nursing (Reston, Va: Reston Publishing CO,1984) 193-194. 4. A R Davis, “Project management: New approaches,” Nursing Management 23 (September 1992) 62-65. 5. M B DesRosier, K C Zellers, “Focus groups: A program planning technique,” Journal of Nursing
Administration 19 (March 1989) 2025. 6. The New BritannicaIWebster Dictionary and Reference Guide, sv “implementation.” 7. D L Davis, K M Salmen, “Nursing, planning, and marketing: From theory to practice,” Nursing Administration Quarterly 15 (Spring 1991) 66-71.
AORN’s Continuing Education Approval Committee in American Nurses Credentialing Center’s Commission on Accreditation guidelines. The CEAC has 12 members who are divided into two reviewing teams, with the two CEAC cochairs acting as team leaders. Each application is reviewed by two team members and a team leader. Last year, the Committee as a whole reviewed 715 applications. The term for CEAC membership is two years. The Committee is not a standing AORN committee; therefore, there is a separate willingness-to-serve form, which is available from the AORN approval unit staff and at the CEAC booth at Congress. Membership on the Committee not only helps sharpen individuals’ evaluation skills, but it also broadens their views of education programs and topics being offered nationwide.
After reviewing statistics and feedback, AORN’s Continuing Education Approval Committee (CEAC) members recently changed the approval process for CEAC applications. The application matrix is now divided into sponsor categories according to size, number of contact hours, and application timeliness, and the fee schedule has been revised to reflect the increase in communications costs (eg, mail, fax, telephone). The largest fee increases have been assigned to applications received within 10 days or less from the presentation date. Chapter program chairs need to ensure that their applications are current. Chapter presidents will have copies of the updated application forms in their chapter resource manuals. In addition, CEAC members have made minor changes to the application form to streamline the process while remaining with97
AORN JOURNAL