By Suzi Birz, principal, HiQ Analytics
What happens when all new computer systems and processes arrive at a hospital on the same day? What does it take to prepare and succeed? This month's Technology Report examines the important role of nurses in Project Genesis, Trinity Health's innovative effort to coordinate the computers in its multihospital system.
In May 2003, Novi, Michigan-based Trinity Health activated Project Genesis, a $285 million project to implement common computer systems and best-practices throughout its 23-hospital system, for the first time at Mercy Hospital in Port Huron, Michigan. The systems include state-of-the-art clinical and revenue cycle systems with supply chain management systems to follow. Today, a total of six hospitals have launched these systems and 17 more are planned by 2008. In all, approximately 44,000 employees and medical staff members will be trained on the new clinical and revenue cycle systems.
Mary Trimmer, senior vice president of Project Genesis operations at Trinity Health described the “big bang” approach being employed at each hospital in the system: “When we flip to go live on the new systems, employees have access to pharmacy, physician order entry, electronic health records including nursing clinical documentation and revenue systems all at once,” Trimmer said.
To succeed, clinical leadership is mandatory. As senior vice president of patient care services at Trinity Health, Joy Gorzeman, RN, BSN, MBA, sets the example for clinicians to take lead roles in the project. Gorzeman learned this lesson first hand. Before joining Trinity, Gorzeman, while serving as COO/CNO at a hospital implementing a new clinical system, was offered the opportunity to take a leadership role and she took it. Gorzeman’s philosophy is that a “strong clinical person is required at every meeting.”
Scope of Project Genesis
With a focus on patient safety and quality of care while improving financial performance, Trinity is placing an emphasis on evidence-based and best practices as processes are changed and the system implemented.
Trinity Health’s member hospitals are varied. The geography is diverse and crosses time zones. Hospital size ranges from 100 to 500 beds. Some member organizations are multi-hospital sites. Some are paper-based and some have more advanced computer systems.
The goal remains to create integrated processes that cross functional boundaries. For instance, patient orders include order entry, review and fill by pharmacy, cart stock, administration and charging. While the current state at each site may be unique, Trimmer explained that “common technology plus common procedures equal best practice embedded in all member organizations.”
Gorzeman noted that there may be some variation as required at that site, but more importantly, she said, “the team is able to use the lessons learned from one site at the next.” What emerges is “evidence-based and best practices,” she added.
Impact on Nurses
The first thing that nurses notice is that they spend less time looking for things—charts, labs and pieces of scrap paper tucked into pockets. With a generous deployment of computers and mobile devices, nurses are using the computer system to access information about their patients, enter nursing documentation and make referrals to other departments, such as social services and occupational therapy. The patient information is as close as the nearest device.
The primary process change for nursing is the change to real-time charting using structured documentation. Nurses are encouraged to take the computer into the patient room to do charting. In the beginning, documentation takes longer. Trinity Health recognizes this and staffs up on the units with additional nurses as well as “SuperUsers,” nurses that have had special training on the system. Some nurses still jot patient data on small pieces of paper, but Trinity is finding that the nurses see the potential and are eager to use the system.
As the nurses become more accustomed to the system, they are able to take advantage of the time saved to spend more face time with patients. Patient education information is available on the computers and nurses have the opportunity to teach the patients about “what is going on with them,” Gorzeman explained.
Benefits of the system include decreased time spent telephoning ancillary departments, decreased time looking for information, chart legibility and an opportunity for physician/nurse collaboration.
“All of these are positive changes,” added Gorzeman. An informal poll of nurses using the new systems indicated that while there are improvements they would recommend, they do not want to go back to paper.
Travel Nurses Provide Value from Site to Site
Knowing that additional staffing is required to implement Project Genesis, and that there would not be enough internal resources to meet the need, Trinity has established relationships with staffing agencies. As additional sites have “gone live,” it has been discovered that the staffing need is predictable, both in quantity and timing. From this experience, Trinity is working on a plan to train a pool of travel nurses that would be available from site-to-site, leveraging this training during the implementation period.
Opportunities for Nurses
Getting ready for the implementation involves quite a bit of work: 18 to 24 months of preparation. During this time, Trimmer noted, “a big emphasis is placed on the transformation process change enabled by the technology.”
Trimmer and Gorzeman explained that nurses have been instrumental in the transformation:
Nurses have played key roles in the design of the clinical documentation and the design of the screens. Nurses have served on procedure groups and councils. Nurses with a keen interest in the system have become analysts and gotten directly involved in building the system.
“Nurses can be as involved as they want to in the local planning efforts,” Trimmer noted.
The opportunities will increase with time as the data becomes available for quality and patient safety analyses.
What advice do the Trinity experts have for nurses working at organizations that are implementing new systems?
“Nurses should seek every opportunity to be involved in the preparation, take advantage of every bit of training and practice opportunities, ask questions, share ideas and support each other,” Trimmer said.
Gorzeman advised that nurses and nurse managers be willing to think out of the box and try to really look at changing processes, rather than doing things the same way as the paper world.
“Acknowledge the transition, recognizing that it is going to be different and uncomfortable at first, and be patient with yourself and with the system,” she added. “As your comfort level increases, it will get easier.”
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