Embracing change to improve performance

The implementation team: neil gruber, pamela puccia, doreen kadric, susan bruce, and jim darragh
The implementation team: Neil Gruber, Pamela Puccia, Doreen Kadric, Susan Bruce, and Jim Darragh

The identification and implementation of a new electronic health record (EHR) system at Helen Porter Healthcare and Rehabilitation Center (HPHRC), a 105-bed hospital-related facility in Middlebury, Vermont, spanned nearly two years, cost approximately $250,000, and was led by a multidisciplinary team of clinical, technical, and administrative staff.

Five implementation elements

The HPHRC team decided at the beginning of the project to pursue a system that integrated both clinical and financial information, with the specific goals of improving quality, advancing operational efficiency, and enhancing revenue. After identifying its goals and selecting the software program, the team recognized that to be successful it would need to incorporate five key elements for implementation of the new system:

  • Establish a strong/diverse implementation team

  • Prepare staff and other stakeholders for change

  • Create a dedicated classroom/training space

  • Communicate frequently and widely to all stakeholders

  • Be persistent…implementation is hard!

Key element 1: The implementation team

Our implementation team was comprised of the administrator, the director of nursing, assistant administrator/business office manager, rehabilitation director, and our administrative assistant. This group included individuals with clinical, administrative, financial, and technical (computer savvy) skills; thereby creating a diverse and well-rounded team with considerable depth and the ability to see the big picture while still understanding how the day-to-day changes were affecting frontline staff.

Having the implementation team with a broad range of skills was perceived as a vital element in our success.

Key element 2: Preparing staff, key stakeholders

The team decided early on that an important goal would be to not lose a single nurse because of the conversion to a computer-based EHR; thereby becoming a major focus of the team to totally prepare the entire staff for implementation. This preparation included providing staff a vision by which the new EHR would require less time completing necessary documentation giving them more time for direct care with the residents. Before introducing staff to the new EHR software, all were assessed for their computer skills. During computer boot camps, users were aggregated at similar levels. Only when staff developed and demonstrated basic computer competencies were they then introduced to and trained on the EHR system.

Having the implementation team with a broad range of skills was perceived as a vital element in our success.

Key element 3: Create a dedicated training space

The assessing of the staff’s computer skills and the requisite staff training required a space. Our main conference room was converted to an “as needed” classroom by installing an LCD projector, screen, dedicated computer workstation, and wireless capabilities. Group training was provided using laptop computers connected to the wireless network. Having a well-equipped training space was essential to our success.

Key element 4: Communicate, communicate…

Concurrently, the team created a special newsletter, drafted frequent written updates, practiced “CBWA” (communication by walking about) and constantly provided positive and encouraging feedback to employees.

In addition to the frontline staff, the implementation team recognized the unique and important role of the physicians who would be required to use the EHR. Physicians’ support was determined to be paramount. To that end, the facility’s medical director was invited to play a key role in planning, implementation, and communication. There were special training sessions for physicians. Their feedback was solicited and appropriately responded to. Communication among all staff/stakeholders was a critical element to our success.

Neil Gruber has been an administrator since 1980. He has been the administrator for 12 years at HPHRC. During his tenure he has overseen four major nursing home software conversions. In December, he completed his third term as President of the Vermont Health Care Association. He has just completed paddling Lake Champlain end to end (110 miles) as a special fundraiser for his nursing home residents.

Jim Darragh has 25 years of physical plant maintenance experience including 21 years of U.S. Navy shipboard engineering experience, including master trainer certification, physical plant supervisor at Porter Hospital, director of maintenance at HPHRC, and most recently assistant administrator.

Pamela H. Puccia is a registered nurse with 30 years of experience in healthcare. She has held a community college faculty position and has remained close to academia as the long-term care representative on the Vermont-based Freeman Nurse Scholarship Governing Board, recently joined the Vermont Nurse in Partnership Board, and is a longtime member of the Vermont Technical College Advisory Council.

Doreen S. Kadric is rehabilitation director, admission coordinator, and ECS clinical system supervisor. She has been with HPHRC since 1998 and has been a speech language pathologist for 20 years within a variety of settings, including acute and sub-acute care setting, and inpatient and outpatient rehabilitation in both a staff therapist position and management role. She is currently providing skilled nursing facility and hospital-based rehabilitation services from pediatrics through geriatrics.

Susan Bruce serves as the administrative assistant and front office manager at HPHRC and is currently enrolled as a continuing education student at the University of Vermont to earn a certificate in gerontology. To send your comments to the editor, e-mail mhrehocik@iadvanceseniorcare.com.

Key element 5: Be persistent; implementation is hard

Left to right: kelly murphy and julie hurlburt use the ehr system
Left to right: Kelly Murphy and Julie Hurlburt use the EHR system

Throughout the entire implementation process the HPHRC leadership team met weekly. Every meeting had a specific agenda of immediate goals, tasks, and schedules necessary for implementation. As necessary with any major operational change, the team must remain positive, be supportive of each other, and consistently set reasonable deadlines while remaining flexible.

The team continually sought input from the frontline staff or “end users” (as they are called in the computer world) about their working interactions with the EHR. Periodically, frontline staff were invited to the weekly implementation meetings to provide feedback on how well the EHR system was being implemented. Adjustments were made based upon theit feedback. Implementation is always hard but with steadfast persistence success will be attained.

Project evaluation

The current phase of our project is centered around evaluation of results to date and the celebration of our achievements. Following the use of the new system for several months, the team was able to measure improvements in quality parameters such as fewer medication errors and improved documentation in less time, thus allowing more quality time with residents.

Other specific examples of success included a smaller than expected increase in overall operating expenses (just 1.2% from 2007 to 2008), a reduction in administrative staff work hours, and increased staff satisfaction. These results, along with a steady increase in case-mix scores and commensurate increases in Medicare A reimbursement, represented clear evidence that this project had been a worthwhile effort and an important accomplishment by the team and staff.

Looking ahead, HPHRC is already anticipating the next steps of interfacing the system with its sister hospital, as well as exploring other opportunities to use the new technologies for staff education and other vital business applications.

Neil Gruber, administrator of HPHRC, cites the commitment of his team and the frontline staff as being key to the success of this project, as well as their willingness to embrace change in order to improve resident care and the facility’s bottom line. He also recognizes, however, that in the world of technology, you never truly get to the “end” of the project…or as he puts it, “Our technological journey continues.”

Long-Term Living 2010 January;59(1):28-31

Topics: Articles , Technology & IT