A Summary of the October 2009 Forum on the Future of Nursing: Acute Care

Home Health Columnist / Guide · May 16, 2010

from dr. marilyn chow, vice president of national patient care services at kaiser permanente in oakland, ca.

core concepts for imagining the future of nursing

chow focused on five core concepts, described below, for imagining
the future of nursing in acute care.
core concept 1: leverage the power of the electronic health record
the ehr could be the connective tissue of the health care system.
an ehr not bound to one site or caregiver could enable improved care
coordination and transitions, provide complete information connectivity,
and transform the manner in which care is delivered and received, chow
said.
kaiser permanente has learned many lessons from the electronic system
it has developed and implemented. last year the system had 6 million
electronic visits—“imagine the personal time savings for the patient,
having an e-visit, versus coming into a clinic or an emergency department,”
chow said. the ehr has enabled the invention of new patientcentered
roles for nurses. for example, a pilot program in a southern
california kaiser permanente emergency department called the “virtual
charge nurse” tracks patients from the time they arrive at a hospital until
a decision is made to discharge or admit them. the ehr shows what has
or has not happened to a patient, allowing tests and procedures to be
moved online and providing patients with a “virtual advocate.” in another
program, ehrs have been used to standardize the documentation
and management of pressure ulcers. in kaiser’s experience, the
implementation of ehrs has reduced documentation loads and increased
nurses’ time in patient rooms. “the ehr is a tool that will raise the bar
for care delivery across all settings, including acute care,” said chow. “it
must be seamlessly integrated with other technologies and devices so that
nurses are not the human interface for technology that does not work together.”
core concept 2: achieve a balance among technologies, disruptive
business models, and human needs
incredible technological developments are on the horizon. for example,
chow highlighted miniaturization and wireless technologies that are
being used to create body sensor networks that will monitor everything
from heartbeats to brainwaves to temperature to blood glucose levels
from anywhere in the hospital or even remotely from home.
the convergence of molecular biology, computer, and medical science
with electrical, mechanical, genetic, and biomedical engineering
could have profound effects on practice models. in a revolutionized future,
technologies could assist nurses with much of their work and help
consumers in diagnosing and treating themselves with self-help tools and
personalized designer drugs. an example is the website developed by
microsoft and emory university (h1n1 flu (swine flu) response center -
microsoft) that allows users to determine if they likely have the flu, whether or not to be seen by a health care provider, and what their overall risk is as a flu patient. “imagine smart systems to guide patients and clinicians through available health information,” chow said. such technologies produce what she called a “wow factor.”
so-called disruptive innovations and business models,1 such as retail
health care clinics, nurse navigators, health coaches, and patient advocates, could be another prominent feature of a future health care system.
these disruptive business models could have a major impact on nursing
practice. furthermore, these innovations can be combined with or en-
abled by technology. in the future, technology will come to people rather
than people going to the technology. “remember when you had to send
your printing requests to a central duplication center?” chow asked.
“now you can print at your own desk.” in 2002, for example, general
electric sold a conventional ultrasound machine for $100,000 and up to
sophisticated hospital imaging centers. in 2007, ge sold a portable
ultrasound machine for emerging markets in developing countries at a price
of $15,000, giving remote areas access to high technology.
disruptive innovations aimed directly at human needs have been far
less plentiful. “what would we [need to] do to actually be human centered?
what are the core human needs? is it that i hate to travel to the
doctor’s office or the emergency department, but that i still want someone
to look me in the eye, to listen to me, to touch my hand, and to advocate
for me? how might we design for human needs and more efficiency,
while using innovative business-to-business and technology tools?” the
goal is to find a balance among technology, disruptive innovations, and
human needs
core concepts 3 and 4: implement rapid translation teams and
interdisciplinary teams of designers
nurses cannot design a patient-centered system by themselves.
technologies are arriving faster than they can be integrated into the
health care system, and people are not able to make sense of much of the
information already available. chow suggested that one possible solution
to this deluge of new technology and information is the creation of rapid
translation teams. they would assist in the implementation of patient
centered systems that were developed by interdisciplinary teams of designers.
these rapid translation teams could scan, understand, and integrate
the technological environment and make connections among technology,
research, science, and acute care. teams could include nurses and other
experts such as engineers, geneticists, academic researchers, architects,
ethnographers, designers, technologists, change specialists, and frontline
clinicians. rapid translation teams could in turn interact with
interdisciplinary teams of designers, including behavioral scientists,
marketers, engineers, clinicians, and patients. the result would be a
system for designing the future of acute care, with human needs consciously
incorporated into the design process. “change in acute care
will happen,” chow said. “it is a question of how we design it.”
core concept 5: create an infrastructure for rapid network exchange
of successful system design innovations
a system to design successful innovations will need to be agile.
technological changes occur too quickly to plan, prototype, and test
innovations over the course of several years. “we need to create a simple,
easy venue for the quick exchange of what’s working and not working,”
chow explained.
successful system design innovations also demand leadership and
coordination. for example, a national institute for human-centered,
empathy-based care with regional nodes could help spread the work of
the rapid translation teams and interdisciplinary design teams. such an
institute might focus on economic measures of the value of nursing. it
could emphasize an approach to nursing comparable to how one would
care for a parent or sibling. “we nurses want to help patients and family
members the way we do as the nurses for our families,” said chow.
health innovation design forums could also help disseminate the work of
rapid translation and interdisciplinary teams. nurses could help prototype
and pilot new processes, systems, and multidisciplinary practice models.
several institutions have demonstrated the value of these approaches.
for example, the university of pittsburgh medical center has piloted
equipment in 22 rooms designed to improve patient safety, increase
customer satisfaction, and help nurses and other health care professionals
to deliver the right care at the right time, every time. ascension health is
planning to have three innovation units, and kaiser permanente has
established a 37,000-square-foot facility to explore the intersection
of technology, space, and workflow.

Home Health Columnist / Guide · May 16, 2010

copied selected testimony from several at back of report i found interesting:

cathy rick, chief nursing officer, department of veterans affairs

acute care has become a fast-paced, episodic set of intensive events
that requires system redesign to support the work of nursing. this system
design needs not only to transform care at the bedside, but across the
continuum of care, rick said. acute care nursing requires a cadre of
nurses who are well prepared to provide focused attention to clinical surveillance and targeted, proven interventions that are coordinated with
interdisciplinary care partners. she noted elements in moving toward not
just a patient-centered, but also a patient-driven, model of care that includes the role of the clinical nurse leader (cnl), data-driven staffing
methodologies, registered nurse residencies, and structured language for
nursing documentation.
the cnl is an essential component of the patient care delivery
model of the future, rick said. cnls are master clinicians who advance
nursing practice at the point of care through application and dissemination
of evidence-based nursing practice and system redesign. the cnl is
prepared at a master’s degree level as a generalist who is an expert in
managing care challenges from a clinical perspective. rick indicated that
the veterans administration has fully endorsed this new nursing role and
has a comprehensive plan to implement the role across all settings by the
year 2016. early findings demonstrate a positive impact on financial indicators, quality of care, and patient satisfaction.
rick highlighted three areas to consider about the future of nursing:
1. staffing methodologies, including workload and outcome indicators,
need to be embedded in ehrs.
2. funded and mandated registered nurse residencies are very important
to consider.
3. to advance the understanding of nursing and nursing contributions,
a standardized and structured language is needed that is embedded
in the documentation system.

joyce sensmeier,

cochair

alliance for nursing informatics

nurses play an important role in leveraging health information technology
to improve patient safety, quality, and the efficiency of care delivery,
sensmeier said. they are also integral to achieving a vision to
adopt and implement electronic health record (ehr) systems in a meaningful
way. sensmeier said that meaningful use of health information
technology, when combined with best practice and evidence-based care,
will improve health care for all americans. the future of nursing relies
on this transformation as well as on the important role of nurses in
achieving a digital revolution.
sensmeier indicated that nurses must be supported in a health care
environment that adequately enables their knowledge-based work in a
variety of roles. these roles include being leaders in the effective design
and use of ehrs; integrators of information; full partners in decision
making; care coordinators across disciplines; experts in improving quality,
safety, and efficiency and in reducing health disparities; advocates
for engaging patients and families; contributors to standardized ehr infrastructure; researchers on safe patient care; and educators for preparing the workforce.

missbutton · May 16, 2010

COOL! Thanks for sharing.

PostOpPrincess, BSN, RN · May 16, 2010

NRS Karen,

May I say with my leadership council?

I am not sure they were able to attend--or have this info--if they haven't at least, they will now.

J

PostOpPrincess, BSN, RN · May 16, 2010

If this is the path of nursing, I really do advocate for this.

We have too many people who think that "bedside" is a stepping stone and beneath them.

Perhaps this will change the waves of all the young kids who think they can "bypass" this and go straight into higher liability they're not really prepared for--degree wise yes, but not in experience.