It’s no small feat to create tools that help clinical nurses become data fluent and help leaders analyze and respond to data. That was the challenge we faced at our large academic medical center. To help prepare for our journey toward Magnet Recognition®, nursing leaders examined tools for data display and action planning—and realized improvements were needed. Bedside clinicians couldn’t access the electronic quality dashboard, and leaders who had access were challenged by inconsistent formats and data representation. The action-planning system was hard to use, and action-planning compliance was low.
The first step in correcting these problems was to convene the right group of people for a task force—nursing leaders, data analysts from nursing and the Quality and Performance Improvement (QPI) program, a senior applications system analyst from information technologies, and the QPI director. Initially, the task force met twice monthly to fully evaluate our organization’s needs and establish goals. Identifying goals helped to keep us focused during the initial phase, and continues to be helpful as tools and systems are refined. (See Task-force goals by clicking the PDF icon above.)
The next phase of work involved gaining access to the quality dashboard and improving the format of its home page and graphs. Restricted access to the dashboard posed a real barrier. How¬-ever, the chief nursing officer (CNO) and chief quality officers in the senior leadership team endorsed open access to the dashboard. As a result, all health-system employees can now view the dashboard using their secure log-on, with quality data protected by a firewall.
After reviewing how the data are organized, the task force decided to create dedicated organizational, nursing, and ambulatory dashboards. This would allow nursing leaders to navigate easily to nursing-focused metrics. Creating graphs with a consistent format and benchmark representation for all metrics greatly improved data interpretation. Units now have easy-to-understand graphs with color-coded data tables.
The next step was creating a mechanism allowing nurses to see and interact with the data posted in their clinical areas. Our CNO gave direction for all units to display specified data in public areas. The task force worked with internal marketing partners to create a nursing tagline and images for use on the quality bulletin boards. Unit staff were coached in creating posters that pinpointed improvement efforts for clinical and satisfaction levels, along with resulting outcomes. Once the poster content was complete, units received bulletin-board materials. The posters helped nurses to link their actions toward improvement with their accomplishments and to refine their understanding of what a patient outcome really is.
Overhauling electronic action-planning tools
After reorganizing data display and creating connections for clinical nurses, the next step was to overhaul the electronic action-planning tools. To gain a better understanding of the “lived experience” for those responsible for action plans, we held focus groups with unit managers. Conducted in a computer lab, these focus groups allowed us to gather feedback on current tools, as well as responses to the task force’s ideas on revisions. Focus-group results validated the need for easier-to-use tools and education on action planning.
The task force used this feedback to build an action-planning tool that walks users through evaluation of unit data and performance analysis, followed by a best-practice evaluation for each metric. Custom forms for key metrics, such as catheter-associated urinary tract infections and patient falls, provide a consistent structure and metric-specific best practices to address. Organizational content experts for each metric contributed to the material included on each form. Specific fields on the form populate a dashboard that upper management can access to view action-plan activity by unit and metric. Making reports available for action-plan completion supports a culture of accountability for this critical activity.
The task force identified “one-stop shopping” as an overarching goal to meet their original objectives. We wanted to ensure easy access to all tools that might be needed when staff evaluates and responds to unit-level data. We used Micro¬soft SharePoint, a content-management system, to centralize quality data, educational materials, audit tools, and links to such resources as procedures, protocols, and guidelines—along with the action-plan portal. We achieved this goal by linking resources to the home page of the electronic quality dashboard. Resources accessible from this single site include the educational PowerPoint used in training, clinical-practice audit tools, links to nursing and organizational clinical resources (such as procedures, protocols, and guidelines), and the action-plan portal.
The new action-planning tool was introduced in the computer lab setting. Managers were required to attend a 1-hour training session on action-planning principles and to experience a hands-on demonstration. Co-led by nurses and a QPI analyst, the training included dashboard navigation, basic quality methodology, SMART (Specific, Measurable, Attainable, Responsible person, Time-bound) goal development, and a guided tour of the new tools. Learners were able to begin drafts of their action plans using their own data during the class.
The quarterly process of data review and action planning is now well established. When new benchmarked data are posted, managers receive a notification that prompts them to update their unit bulletin boards and action plans. They have a 2-week window to update plans; directors and administrators can monitor that activity through built-in action-plan activity reports. Real-time awareness is supported through raw data counts of patient falls, infections, and pressure ulcers on the dashboard. This allows leaders to be nimble in monitoring unit performance.
We’re confident that we’ve established the right structure and process for data review and action planning, but we know there’s room to grow. Task-force members continue to engage in one-on-one coaching with managers as needed, evaluate tools and resources constantly, and collaborate continuously with other departments to maintain the best framework possible. Promoting clinical nurse data fluency and daily interaction with the data remains an important goal. Leaders now have better tools to analyze the data and monitor the response and action planning.
Our journey to improving quality outcomes has demonstrated the essential connections among nursing, quality improvement, and IT needed to support clinical excellence. Given the changing landscape of health care, meeting the demands for accessible and accurate data and the tools with which to respond to the data is a must for all healthcare organizations.
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The authors work at the University of Virginia Health System in Charlottesville. Jennifer T. Hall is the Magnet® Program Director. Christine M. Kelly is a system administrator and reporting analyst.