At a time when clinicians are struggling to manage the countless tasks they face in their work every day, issues around mobile communications have come to the fore as never before. What’s not working are ad hoc non-systems involving pagers and devices disconnected from overall communication networks—even as by some estimates, pagers are still being used by an estimated 85 percent of hospital organizations.
But things have been changing rapidly at UW Medicine Valley Medical Center in Renton, Washington. Leaders at Valley Medical Center have been reworking their organization’s mobile communications infrastructure. Two-and-a-half years ago, they chose to partner with the Sarasota, Fla.-based Voalte Inc. That company has been working with the leaders at Valley Medical Center to implement a comprehensive set of communications solutions.
Recently, James Jones, R.N., the organization’s vice president of patient care services and nursing operations, and Vinita Singh, R.N., the nurse manager in its Renal Respiratory Unit, spoke with Editor-in-Chief, Mark Hagland, regarding their current initiative. Below are excerpts from that interview.
Please tell me about the origins of this communications initiative?
James Jones, R.N.: We started developing a relationship with Voalte about two years ago. We were challenged with improving our communications within our organization. We had several disparate communications devices, like pagers, we had a Cisco phone, we had other forms of devices to page and communicate. So what we’ve been trying to do is to figure out the best solution in the organization for a single HIPAA-compliant communications device.
James Jones, R.N.
What has the timeline been?
What happened in the organization was that our senior leadership team had met with our board, looking at the Quadruple Aim. We were looking at how to fulfill that. And the missing piece was how to reduce burnout among clinicians, and improve satisfaction, and make things as easy as possible for them. And as you know, with JCAHO, the number-one cause of sentinel events has been lack of good communication. And I worked closely with our IT department and senior leadership team, to come up with solutions.
When did those conversations begin?
Around about April of 2015.
And essentially, you decided you needed a unifying technology platform, correct?
Vinita Singh, R.N.: Yes. We wanted a technology that would be a great tool for the nurses, to work efficiently and safely. And Voalte offered a smartphone that would give us what we needed. We all want our nurses to have the best tools to be as successful as they can. And having good, reliable communications that can help you communicate with physicians in a timely manner to deliver quality care—that was the goal. And this tool allowed us to do that.
Jones: Vinita is spot-on. The other opportunity was to connect with the entire interdisciplinary team. And we realized that, working more collaboratively—we really needed to bring our rehab team, environmental services, dietary and pharmacy, into the process as a whole, as well.
When did you sign the contract with Voalte, and when did you begin to roll out the program?
Jones: We had the contract signed in January 2016. Our initial rollout on a pilot unit started in June and July 2016 on a medical/surgical unit—a 44-bed unit, the largest and biggest unit in the hospital.
Was it focused on getting rid of all the other devices, using smartphones?
Jones: We went with a pilot first, because Vinita had some really seasoned staff over there who could really give us some insight, and we felt that it would be more palatable to bring it to other units. We’ve piloted a number of other things on that unit as well.
What was the rollout like?
Singh: Well, it was definitely a change. And with any change, we needed buy-in from staff. And when I heard that our leadership had chosen our unit for the pilot, I was very flattered. I wanted to make sure this would be successful. And we worked hard with staff to make sure there was buy-in; we talked a lot with them about it. And we also shared with them what the wins would be. With any new system, you have challenges. And I think that staff buy-in was the biggest win. We talked about how this technology would benefit them and their patient care, and the patient experience, as well as the physician experience. It was a challenge to get buy-in, but it went well.
Vinita Singh, R.N.
How did you use the phone initially?
Singh: We went live on a Monday; we had already done some education for staff on the options and what it would look like, and had done some classes. And then we gave the smartphones to everybody and said, OK, this is where you’ll get the calls. And the IT department had done a staff directory, and everyone had a unique profile and phone number. And they started using the phones. The technology allows for texting. And we had a command center to help us. So as staff started using it, and they had questions, we gave them support. And we made sure the alarm system that connects through middleware, was set up as well. So we had a lot of planning in the background and education.
What changes took place in communications processes as a result?
Jones: Pager-based communications were replaced with direct calls and texting.
Singh: In the past, there would have been a pager involved that a nurse could have used to pick up and transfer a call. The problem always was that there was no way for a doctor to get hold of a nurse directly, without a lot of handoffs. Now with this, they could scroll down and see who was available, because once you log into the system, you’re live. And we had our staff on a status bar that would allow you to enter their assignments in terms of patient room numbers. So when the physicians logged in, they could see which nurse was around. The nurses are calling out to the doctors. The nurses didn’t have pagers. The doctors had been calling the nursing stations, and the nursing stations had been paging the nurses.
So now a physician can call or text a nurse directly?
Yes, that’s correct.
What makes this new process easier for everyone, and how has it all worked out?
Singh: It’s cut down the number of middle-people to reach people. When you were getting a message from a doctor in the pager system, or leaving a message for a doctor—if you’re paging a doctor, you don’t know whether they’re getting the message. Now, we’re texting them.
Does the nurse then get a notification like an email receipt, that the physician has seen the text?
Singh: It shows up as red in the system when you text and it’s received.
Do you have any quantitative or qualitative data on any results yet?
Jones: We do have qualitative data. We know that in the past, it would take a half-hour or longer to reach people. In the past, nurses would page a doctor. Now, they can text them and get a message back, saying, well, I’m in CTU, I’ll be back there in 30 minutes. So it’s a two-way process: tell the family member I’ll be there in 30 minutes to meet with the patient. Now, it’s a more certain process. In the past, they would finish what they were doing before they could get to a phone. So it’s decreased the uncertainty around communications. So now I know the doctor has read my message, and I know he’s prioritizing tasks.
And generally, then, you’re texting rather than phoning?
Singh: Yes, we prioritize texting over phoning, because it involves fewer interruptions.
Jones: Yes, we’re seeing a 60-percent rate text-messaging now. Most organizations with Voalte reach about 70-percent levels of text-messaging, and we want to get to that. And some of the key events we looked at early on were skin integrity events, pressure ulcers, medication errors, and slip-and-fall events. And what we realized was that we still have some work to do. We started out like gangbusters. And we were trending really well.
We did go to the 99th percentile in terms of our HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] scores that first month, because the unit got remarkably quieter, and the communication improved dramatically. And we saw the medication errors drop dramatically. But our onboarding of the floating nurses was a challenge to our success. So we realized that was an area of opportunity for improved. We had tried to keep it localized on 3 North, and the floating nurses weren’t becoming proficient in the use of the phones.
What have been the biggest learnings so far among your team and in your organization, around this?
Jones: I would say the biggest learning, at a higher level, for me, being an executive sponsor for this project, the biggest learning has been that you need as many stakeholders as possible to participate as early on as possible. I would have had the physicians and nurses involved even earlier on. I had the opportunity to be hands-on with the technology, and we had a few physicians doing so. I realized that that was really important. You really have to over-communicate to be successful.
And we’re looking at our policy now—and we created a mobile strategy technology and operations committee, and that will help us move forward. We have key stakeholders from each area; I’m on that committee; our CIO is on there; Vinita is on that committee; our CMIO is on it as well. And IT analysts own the project on a daily basis, and clinicians from each area of the hospital, and informatics. And the last thing I would add is, know your workflow organizationally and really understand it. 3 North was a great unit to pilot on. But when you start looking at critical care or perioperative services, the use is different.
Singh: I believe that the Voalte device is a great technology, and it’s a great tool in a toolbox. But it’s only as great as the user. And our staff deserves the best technology to do quality work. And it takes good people and good leadership to achieve good results. When your leadership is there and provides the best technology, it’s up to us to make the best use of it. With any technology, it’s only as good as the end-users.
Jones: One thing that Vinita and other colleagues have done is to look at [this initiative in the context of] the organization’s mission and vision statement. And that alignment is really important in order to get adoption. We really focus on putting the patient at the center of everything. And that relates to the Quadruple Aim and being technologically savvy. It’s also a great recruitment tool—we have providers [physicians] coming in and asking what technology we have and what’s in place.
Is there anything that you’d like the CIOs or CMIOs of other patient care organizations nationwide to know?
Jones: I would say that CIOs and CMIOs should go back and look at their mission and vision, and also go to your staff for input and participation—not just clinicians, but also departments like environmental services, pharmacy, all the areas. Most organizations look at nurses and physicians. But if you want that streamlined care and that collaborative, interdisciplinary team, you have to bring the key stakeholders into the process early on for good communication and collaboration. And one thing we did really well, and I know not all Voalte organizations did this—we did training sessions where our IT and informatics teams were able to go through different scenarios and work through them, before they rolled this out.
Singh: Education and support beforehand are so important in all of this work, absolutely.