HCA375: Continuous Quality Monitoring & Accreditation-Joint Commission Standards and Processes

F or many health care leaders, it’s considered a dream come true to build a new hospital from the ground up. This rare experience happened at Saint Clare’s Hospital in Weston, Wisconsin, part of the Ministry Health Care System. The construction and design process for Saint Clare’s took a team of health care leaders a number of years to conceptualize and implement, with the new facility opening in October 2005. “It was a once-in-a-lifetime experience,” notes Mary Krueger, R.N., M.S., president and chief operating officer of Saint Clare’s Hospital. “It’s rare to build a hospital from the ground up, not as a renovation.” Krueger was charged in 2003 with the mission of preparing the new facility and pulled together her “dream team” of leaders from around the country to help design and implement the hospital’s systems and processes. Many of these leaders are still part of the Saint Clare’s executive team, while others joined shortly after the facility opened. Probably one of the most innovative and forward-thinking planning elements was the decision that the hospital use a completely electronic system and avoid the paper medical (Continued on page 8) Hospital Built ‘All-Digital’ Training supports paperless system S POTLIGHT ON S UCCESS Page 1 Copyright 2009 Joint Commission on Accreditation of Health Care Organiza\ tionsThe Joint Commission: The Source, March 2009, Volume 7, Issue 3 record system. This decision required that Saint Clare’s not only consider its entire system and processes in relation to being paperless, but also provide robust and flexible training to ensure that staff members could efficiently and effectively use the system. This decision also integrated a very specific philosophy: that the new facility be patient centered. Because Saint Clare’s is part of a larger health system, planners tapped into the perspective and experiences of staff at their other hospitals and clinics.

“We would pull together key staff from other units and departments and ask them to help us envision and plan for the ‘ideal’ surgical unit or ICU, for example,” Krueger explains. All processes and systems were designed not only with the patient in mind, but also with a performance improvement focus. Planners began to map processes to see how well they were working and also to determine how to educate staff members. Planners also knew they’d have to look at ways to continually improve those processes, Krueger notes. Planners also knew that they’d need a team in place to deal with any issues that occurred after the facility opened. “Launching so many new sys- tems at once meant that we needed a responsive approach to what wasn’t working,” Krueger explains. From this was born the “SWOT team,” a group that met on a regular basis to do real- time problem solving. While most of the executive team began designing and implementing the new hospital with Krueger before it opened, other key leaders such as Colleen Hoerneman, M.B.A., vice president of Patient Care Services, joined shortly after the hospital opened. Hoerneman’s fresh perspective helped identify which processes worked well and which didn’t. She also spear- headed the SWOT team, which met every day for the first six months and then met weekly. “(The team) became a vehicle for us to release what needed quick fixes and helped cement our interdisciplinary collaboration,” she notes. Saint Clare’s also relied on a cross-discipline group that met month- ly about the broader agenda items that needed more focus and planning.

Saint Clare’s brought the majority of their new staff on board approxi- mately one month before the hospital opened. “We learned quickly that no one knew each other,” Krueger notes.

“So we knew it would take work to not only learn a new environment, but also to get to know each other.” To help staff members become more familiar with the facility itself and to build staff cohesion, the hospital conducted patient simulations as an orientation technique. This involved staff members playing the roles of patient and/or staff in a variety of sce- narios. Each simulation team recorded what occurred, tried to learn from what worked well and what didn’t, and then made adjustments to systems and processes. Information technology (IT) train- ing was crucial. Saint Clare’s initially used “super users,” which involved key staff being primary resources on each unit, but they became too busy to help other less trained staff use the electron- ic system. “We now use multiple approaches to how we educate staff so that we’re sure they are all competent and knowledgeable about the system, since there’s only one way that we work at the hospital and that’s electronically,” Hoerneman explains.

Computer experience is now listed as a requirement when hiring staff. In fact, the hospital takes computer expe- rience so seriously that, when collecting information from job applicants, it uses an online application system only.

“This helps us recruit staff that are comfortable and experienced in com- puters, those who will be open to an all-digital system,” Hoerneman adds. Once hired, staff members undergo a basic training program as part of an orientation and learn skill building with a preceptor. Additional advanced com- puter training also is provided. “We believe in sustaining an ongoing learning environment,” Hoerneman notes. She also has noticed an interesting develop- ment since the facility opened: younger and newer staff members are very com- fortable with the digital environment because they grew up with it. In addition, Saint Clare’s has added computer credentialing to its medical staff credentialing procedures to help ensure that its medical staff members are able and comfortable using the digital system. The facility also has a physician-oriented IT com- mittee that helps physicians learn the system and gain competency.

Spotlight on Success: Hospital Built ‘All-Digital:’ Training supports paperless system continued from page 1 At-a-Glance Facts Organization: Saint Clare’s Hospital Location: Weston, Wisconsin Details: Opening its doors in October 2005 with an all-digital, paperless environment was both innovative and challenging for the 110-bed hospital. Saint Clare’s relied on its patient-centeredness, focus on performance improvement, and flexible approach to orientation and training to ensure that its staff members could easily navigate and benefit from its electronic system.

It’s not an event,” Krueger notes. “This is particularly true in a digital world where things evolve and develop con- tinually. We have stressed from the opening that we may not be perfect, but we’re striving toward perfection.

Anything we do together should be toward that goal.” Saint Clare’s is without a doubt a hospital that takes pride in its patient- centeredness and openness to change and development. “Staff who are open to change and improvement thrive here,” Krueger notes. She adds that opening a new facility requires specific qualities, such as an entrepreneurial spirit, an ability to think outside the box, and embracing a bold vision.

With no past standards to build on, the organization has the opportunity and challenge to be flexible and make the necessary changes. An openness to change becomes the standard, not an option, for a new facility.

Krueger and Hoerneman offer some suggestions for health care orga- nizations that want to introduce an all- digital environment:

• Keep the avenues of communication and feedback open and as accessible as possible. Involve as many staff and perspectives as possible. You have to remain committed to learning from change and integrating improve- ments as needed.

• Remember it’s a process, not an end result. The changes that an organiza- tion may have to make may require a lot of consistent effort to help make it happen.

• Be willing to investigate and work on issues. Make sure you investigate all issues thoroughly and be willing to adapt. Expecting change makes you more flexible and adaptable to the change. S Wheel of EMR Success Data Integrity Ongoing Support Order Set Management Process Improvement Hardware Performance Network Performance Advanced User Training Practicum (on the job training) Training ( Classroom ) Quality Clinical Data & Pt Safety Data Integrity Ongoing Support Order Set Management Process Improvement Hardware Performance Network Performance Advanced User Training Practicum (on the job training) Training ( Classroom ) Quality Clinical Data & Pt Safety Saint Clare’s Hospital used this Electronic Medical Record Wheel to illustrate the multiple components of a successful electron ic medical record. They also used it as a guide to determine if they had considered all aspects or “spokes of the wheel” when they implemented an all-digital environment. Source:Saint Clare’s Hospital Page 9 Copyright 2009 Joint Commission on Accreditation of Health Care Organiza\ tionsThe Joint Commission: The Source, March 2009, Volume 7, Issue 3