The inside scoop of a virtual site visit

Author(s): Christie Tomaseski, MSN, RN-BC

Plan and prepare to ensure a successful visit.

Takeaways:

  • Gain insight into how to conduct a virtual site visit.
  • Learn how to adapt accreditation and recognition protocols to COVID-19 restrictions.

During the COVID-19 pandemic, healthcare communities have adapted to many restrictions. The effects trickled beyond patient care to include processes such as accreditations and recognitions.

In late March 2020, Bayhealth Medical Center (Dela­ware) received a phone call from the American Nurses Credentialing Center’s (ANCC’s) Magnet® office to offer alternative options for the third phase of our Magnet redesignation. An in-person site visit was originally scheduled for April 6-8, 2020, but had to be cancelled in light of newly implemented travel restrictions, World Health Organization and Centers for Disease Control and Prevention recommendations, and other COVID-19 transmission precautions. The options included keeping the planned site visit scheduled for just 2 weeks away, but conduct it virtually; postponing the visit until June 2020 in hopes that restrictions would be lifted; or cancelling the visit and foregoing our Magnet redesignation.

Decision

At the time of the call from ANCC’s Magnet office, the number of COVID-19 cases was slowly climbing in Dela­ware, but the overall occupancy of Bayhealth hospitals was cut in half. Bayhealth considered this and compared internal data to that of the Penn Medicine COVID-19 Hospital Impact Model for Epidemics (CHIME) model, which anticipated that COVID-19 cases would peak the week after the April 6-8 site visit. Although Bayhealth COVID-19 cases and hospital volume were low at the time of the call, the CHIME model indicated that the hospitals could expect COVID-19 cases to continue to rise, possibly beyond our hospital capacity through June. Delaying until June didn’t guarantee a traditional in-person site visit would be possible.

As we considered the possibility of a virtual site visit, our Magnet program director (MPD) reached out to the information technology (IT) department to confirm that we had the proper infrastructure to support a successful virtual site visit at each of our three locations. After carefully considering all factors, and knowing that the visit could be technologically supported and conducted without adversely impacting overall quality of care and patient and staff safety, we decided to move forward with a virtual visit on the original dates.

Bayhealth may have been one of the first healthcare systems in the United States to experience a virtual site visit, but we weren’t the last, as ANCC later required virtual site visits to ensure nurse, patient, and Magnet appraiser safety.

Bayhealth’s three locations transitioned from an expected on-site visit to a multiple-campus virtual visit in less than 3 weeks. (Although later dates were available, we felt this worked best for our organization.) As we made the shift, we collaborated with Magnet team members at ANCC, who provided valuable assistance. In addition, a collaborative partnership between the MPD and IT during the early planning phases was crucial to the visit’s success.

Preparation, resources, special considerations

A secure computer application software program that’s capable of video, voice, and document exchange is fundamental to a virtual site visit. Work with the accrediting body to choose an application that functions for everyone.

Confirm your organization has reliable Wi-Fi connectivity in all needed areas for both the appraisers and your organization. Don’t assume that the great connection you have on the first floor in the medical-surgical unit is just as reliable in the fifth-floor cardiac unit or at other campus locations.

Laptops on roving carts with the flexibility to operate via battery and electricity will allow you to explore various patient units as the appraisers verify, clarify, and amplify what you submitted in your application. You’ll need at least the same number of roving computers, escorts to transport the computer carts, and application host accounts as you have appraisers. If you have multiple locations that require more than a few minutes of travel time, additional roving computers and escorts should be set up at each location. (See Escorts and computer carts.)

Escorts and computer carts

Bayhealth Medical Center assigned an escort for each Magnet® appraiser. The escorts guided the appraisers through the day as they would during an on-site visit, but did so by conversing with the appraisers virtually while moving the computers through the scheduled units and conference rooms. We selected clinical nurses who were comfortable having informal conversations with appraisers as they navigated their assigned meeting and unit path. Each escort performed several practice runs of the path for each day’s agenda. During the practice runs, which were guided by the Magnet program director and followed the tentative agenda, the escorts learned to:

• navigate the virtual meeting application

• securely share documents

• perform basic troubleshooting

• find the optimal Wi-Fi spots on each unit.

Meetings and conference rooms

You’ll want to be able to conduct multiple virtual group or unit meetings simultaneously during your virtual site visit. Roving computer carts are great for exploring the units, but you’ll need conference rooms equipped with quality video, voice, and document-sharing capabilities for group meetings. Mounted wall cameras, projection screens, and microphones are great features to help secure a smooth group video conference. Test all of your technology with the application you’ve chosen for the video conference. You don’t want to find out on the day of the visit that the room’s microphone can’t capture the person’s voice in the far corner of the meeting room.

Conference rooms should be large enough to host the group so they can practice social distancing. This also may mean limiting the number of individuals who can participate in group interviews (check your state or local government’s current recommended maximum capacity). Reducing the number of participants for performance improvement project group interviews can be difficult. Choose the staff who can best represent the interprofessional perspective.

Units with special needs

Develop strategies to address access to units or areas that may not allow outside staff or visitors. For example, the Bayhealth Cancer Center isn’t allowing non-Cancer Center staff, family, or visitors during the pandemic to reduce transmission and handling risks for their immunocompromised patients. Before the virtual site visit, we created a separate virtual meeting that included a Cancer Center Magnet Champion and an appraiser connected via an iPad that was already being used within the center. The Cancer Center staff were relieved that we’d found a way for them to safely participate in the process.

Time zone considerations

Your appraisers may be in different time zones, so keep that in mind when planning the virtual visit. For example, the appraisers we were assigned were from three different time zones. Although appraisers understand they need to meet the organization’s needs, we felt it wasn’t reasonable to expect the appraiser who is 2 hours behind to join us at 0500 her time because our original plan was to begin at 0700 our time.

Community participation

Community members who can’t enter the hospital during the pandemic can be asked to connect to the virtual meetings from their homes or offices so they can still have the opportunity to be part of the site visit. Be mindful that some community members may not have access to the required technology or may not feel comfortable operating it. Consider preserving community member participation by locating a meeting place off-campus where the required technologies can be offered and social distancing practiced.

Testing

Although IT would normally have little involvement during a traditional on-site Magnet visit, collaboration with the IT leadership team is imperative for a virtual visit.

During both testing and the live virtual visit, Bayhealth engineers monitored the quality of connectivity so they could actively address issues. A designated

IT member roved with us during practice runs and coached us through any challenges we encountered. The IT department taught the MPD and appraiser escorts how to use the virtual meeting application, and they helped us obtain last-minute equipment such as speakers after we realized that the volume of the built-in speakers wasn’t adequate for people standing 6 feet from the computer as a result of social distancing requirements. Our IT department dedicated a team member to each campus and to each roving escort for the site visit days to ensure immediate availability to address any hiccups.

Test your technology’s ability to share screens via a secure online platform. Consult with the Manger program analyst about the best way to share files. Know that an appraiser may request accreditation documentation—such as performance reviews, self-appraisals, peer feedback, correlated annual developmental goals, and proof of certification and education levels—before the start of the site visit.

Introduce the virtual appraiser equipment (roving cart, camera, microphone, and the appearance of someone on the screen posing as an appraiser) to staff on each unit in advance of the site visit. This will help them become familiar with it, learn how to effectively interact with a virtual appraiser, and reduce anxiety.

Connect with your appraisers for a practice virtual meeting to ensure everyone’s software, equipment, and connections work appropriately. Conduct this test with enough time left to secure additional or replacement parts for your computers and other equipment. For example, one of our appraisers switched internet providers because she experienced spotty connections with her original provider. (See Overcoming communication challenges.)

Overcoming communication challenges

Virtual site visits present some communication challenges. For example, participants can’t make connections during informal conversations between sessions, and detecting tone and reading in-room cues can be difficult. One way to overcome these challenges is to conduct recorded practice sessions before the visit to develop strategies for conveying tone and energy. Review recorded practice sessions to identify adjustments to enhance communication and the overall virtual experience. Additional tips include the following:

  • Smiles can be seen through the eyes and cheeks even when wearing a mask; encourage staff to smile as appropriate.
  • Masks can muffle voices; everyone should project their voices a little more than usual.
  • To overcome delays in voice translation during a video conference, take slightly longer pauses between words to address this lag.
  • Avoid side conversations; they’re easily picked up on the microphone, which can be confusing to the receiver.
  • Introduce and reintroduce yourselves each time you speak.

Adapting to change

Some of the biggest lessons we learned during this experience weren’t directly related to the virtual visit itself, but rather to how we were underutilizing our available technologies for everyday functioning during the pandemic. We were amazed at what we discovered when we were forced to think outside of the box.

Fast or slow, as our work environments change, we must find ways to adapt. Taking on the challenge of navigating the uncharted territory of a virtual site visit with such short notice demonstrated that our organization is Magnet-ready. The Magnet component of transformational leadership was modeled when we empowered staff to drive innovation, made use of current technology, and improved outcomes with interdisciplinary partnerships and nurse involvement in the redesign of our work environment.

Christie Tomaseski is the Magnet® program manager and National Database of Nursing Quality Indicators™ (NDNQI®) site coordinator at Bayhealth Medical Center in Dover, Delaware.

Editor’s note: Since this organization’s experience, the ANCC Magnet Recognition Program has developed several resources to help organizations with virtual site visits.

Virtual site visit checklist

Use this checklist to make sure you cover all of your bases in preparation for your Magnet® virtual site visit.

√ Choose secure computer software for communication and file sharing.

√ Ensure reliable online connectivity; test connections ahead of time in all locations.

√Ensure sufficient equipment is available, and test it ahead of time:

      • laptops on carts to provide virtual unit visits
      • cameras
      • microphones
      • projection screens.

√Be sure large files can be sent in advance or shared in real-time.

      • Ask appraisers how they prefer to receive documentation.

√ Choose conference rooms of sufficient size to accommodate people and equipment and that allow for social distancing.

√ Select escorts.

      • Escorts should be comfortable conversing with thevirtual appraisers.
      • Escorts should participate in several practice runs toget familiar with the equipment, technology, and agenda.

√ Create a schedule in partnership with the appraiser team leader.

    • Consider the appraisers’ time zones when scheduling start and stop times.

√ Arrange for remote community participation.

    • Consider an off-campus location with necessary technology and equipment and enough room for social distancing.

√ Review recorded practice sessions.

    • What is the tone of the room?
    • Can everyone be heard while talking through masks?
    • Is everyone consistently introducing themselves be-fore they speak?

References

American Nurses Credentialing Center (ANCC). 2019 Magnet® Application Manual. Silver Spring, MD: ANCC; 2017.

Becker M, Chivers C. Announcing CHIME, a tool for COVID-19 capacity planning. Penn Medicine. March 14, 2020. predictivehealthcare.pennmedicine.org/2020/03/14/accouncing-chime.html

Centers for Disease Control. Travelers’ health: Vaccines. Medicines. Advice. cdc.gov/travel/notices

Commission on Peer Review & Accreditation, The. Virtual Site Visits 2020. March 13, 2020. naspaa.org/sites/default/files/docs/2020-03/Advice%20for%20moving%20SV%20online%203.13.pdf

World Health Organization. Coronavirus disease (COVID-19) advice for the public. June 4, 2020. who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

 

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