Improving staff member satisfaction and productivity through technology

AORN Journal, Sept, 2004 by Noreen McHugh

Nineteenth-century medicine vendors often peddled tonics as a cure-all for symptoms as varied as a mild cough or severe rash. Some even advertised their wares as infallible and guaranteed. In health care today, technology often has been labeled as a cure-all for what ails health care facilities. A less-than-successful software rollout, however, can leave caregivers doubting such promises.

A WELCOME CHANGE

In 2000, staff members in the perioperative services department at the Hospital of the University of Pennsylvania (HUP), Philadelphia, which has 27 ORs and performs approximately 22,000 surgical procedures each year, were introduced to a new patient flow management system. The system installed at HUP uses personal computers (PCs) to track patients through each stage of the surgical process, from induction to discharge. The system also collects and communicates information about a patient's location, procedure, and status in real time throughout the surgical services department. Immediate access to this critical data helped

* improve communication,

* streamline patient flow,

* promote employee satisfaction,

* improve quality of care, and

* increase productivity and revenue.

IMPROVED COMMUNICATION. Many people prefer to avoid change, especially when it comes to adopting new technology. Within hours of the automated patient flow management system going live, however, perioperative staff members at HUP embraced the system and readily discarded the antiquated white board and paper-and-pencil system that was used previously. The automated patient flow management system helped staff members put an end to telephone calls, faxes, pages, and time spent walking around trying to locate a single patient or physician. Staff members quickly learned to rely on the new system to determine patient status and the schedules of attending medical personnel.

The system in place at HUP uses colorful and intuitive icons to represent the more than 80 steps in the continuum of care. For instance, after a patient leaves the admitting area and a staff member updates his or her status on the system, a walking stick figure appears on the screen to inform users that the patient is on his or her way to the preoperative care area. When a patient is in surgery, a gas bag icon indicates induction, and a scalpel represents incision.

Surgeons, anesthesia care providers, nurses, and surgical and administrative staff members can quickly determine what is taking place throughout the perioperative services department with a glance at one of the 184 PCs in the department. Each OR contains a PC, and multiple, high-resolution, flat-panel monitors are mounted on walls in the department. Individuals also can inform their colleagues about patient events and milestones by using point-of-care, one-touch keypads; an interactive voice response feature (ie, via telephone); or PC workstations where information is input directly into the system. Data are time stamped so staff members know about delays in a patient's care and can act accordingly.

STREANLINED PATIENT FLOW. Each weekday at 7 AM, the perioperative department at HUP begins a regular schedule that includes an average of 100 procedures per day. Before implementation of the patient flow management system, each perioperative nurse in the department was issued a photocopy of the day's schedule, which usually was obsolete before the day even started. Now, however, when staff members meet in the morning to discuss scheduling and staffing demands, they have a real-time view of patient status. This allows them to make necessary adjustments and plan how to handle the scheduled caseload.

No matter how well patients are moved through the perioperative department, delays happen. Difficult surgeries, missing paperwork, tardy patients, unforeseen complications, and add-on procedures all may contribute to delays in the surgical schedule. The Hospital of the University of Pennsylvania is a leading trauma and transplantation center for the region, so the surgical services department must be ready to handle additional procedures as they arrive, regardless of previously scheduled surgeries. Before the patient flow management system was installed, adding a patient to the schedule would take nurses 20 to 30 minutes and countless telephone calls. Now the perioperative charge nurse can review a screen within the system, determine which OR has a flexible schedule, and make appropriate adjustments to the schedule in less than one minute. In addition, everyone in the department knows about the change instantly.

EMPLOYEE SATISFACTION. Ensuring that employees have the right tools can help them be more productive and contribute to the goals of the organization, The former methods of tracking patients and dealing with delays frustrated HUP staff members. Employees often blamed each other when turnover times were too long. The patient flow management system, however, gives staff members a sense of accomplishment because when they glance at the monitors or PC screens, they actually see their workloads decreasing. In addition, the data collection and analysis capability of the system creates a picture of when and why delays occur, which usually ends the blame game.