An Iterative Assessment Approach to Improve Technology Adoption and Implementation Decisions by Healthcare Managers

Vital signs monitoring on general wards: clinical staff perceptions of current practices and the planned introduction of continuous monitoring technology

OBJECTIVE

Early detection of patient deterioration and prevention of adverse events are key challenges to patient safety. This study investigated clinical staff perceptions of current monitoring practices and the planned introduction of continuous monitoring devices on general wards.

DESIGN

Multi-method study comprising structured surveys, in-depth interviews and device trial with log book feedback.

SETTING

Two general wards in a large urban teaching hospital in Sydney, Australia.

PARTICIPANTS

Respiratory and neurosurgery nursing staff and two doctors.

RESULTS

Nurses were confident about their abilities to identify patients at risk of deterioration, using a combination of vital signs and visual assessment. There were concerns about the accuracy of current vital signs monitoring equipment and frequency of intermittent observation. Both the nurses and the doctors were enthusiastic about the prospect of continuous monitoring and perceived it would allow earlier identification of patient deterioration; provide reassurance to patients; and support interdisciplinary communication. There were also reservations about continuous monitoring, including potential decrease in bedside nurse-patient interactions; increase in inappropriate escalations of patient care; and discomfort to patients.

CONCLUSIONS

While continuous monitoring devices were seen as a potentially positive tool to support the identification of patient deterioration, drawbacks, such as the potential for reduced patient contact, revealed key areas that will require close surveillance following the implementation of devices. Training and improved interdisciplinary communication were identified as key requisites for successful implementation.

Integrating an evidence-based intervention into clinical practice: 'transitional relationship model'

The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi-experimental, action-oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on-ward hospital staff training and peer training; (2) presence of on-site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large-scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. This study highlights the need to address work environment issues, particularly interprofessional teams.

Integrating the transitional relationship model into clinical practice

BACKGROUND

The challenge of facilitating knowledge translation in clinical practice includes enabling practitioners and agencies to implement a common set of best practices, such as the Transitional Relationship Model (TRM). In 1992, a participatory action project implemented the TRM on a long-term psychiatric hospital ward in Ontario, Canada. All participants were successfully "bridged" to the community. Despite positive outcomes associated with the TRM, implementation of any best practice is difficult because it involves changing processes.

OBJECTIVE

It was hypothesized that using multiple implementation strategies developed by wards that had already implemented the model would result in improved TRM implementation.

METHOD

This study compared three groups of hospital wards; Group A wards had already adopted the TRM, Group B wards implemented the TRM in Year 1, and Group C wards implemented the TRM in Year 2. An iterative process was used in which strategies suggested by the A wards were used to enhance implementation on the B and C wards, respectively. These included enhancing staff participation, creating/maintaining supportive ward milieus, meeting specific educational needs, and supporting managers throughout the implementation process. The degree of actual implementation on each ward served as the primary outcome measure.

RESULTS

Group C implemented the TRM model significantly quicker than the other groups. Sustainability in the initial A wards required the implementation of additional strategies used by the later wards.

Electronic medical records: tools for competitive advantage

Purpose

The purpose of this article is to present a conceptual model that posits the strategic relationships between information technology, clinic operations and physicians and the subsequent outcomes to patients, physicians and clinics which can lead to competitive advantages in the healthcare environment.

Design/methodology/approach

This paper is based on a review of the literature and proposes a conceptual model of the strategic relationships essential for success. The scope of the paper is based on the legal, economic and political triggers impacting the strategic relationship between electronic medical records, clinic interoperability and physicians as owners/users.

Findings

The paper presents the formation of a conceptual model which identifies the strategic alignment between clinics, physicians and information technology, more specifically, electronic medical records.

Research limitations/implications

This paper is limited in that it is not an empirical investigation but a conceptual model of future research endeavours. Future research endeavours should seek empirical findings related to the relationships proposed in the model.

Practical implications

Physicians, clinics and patients should be aware of the impact electronic medical records have on the health environment as well as the potential competitiveness due to health consumerism enabled by electronic medical records.

Social implications

Electronic medical records, personal health records and electronic health records are infiltrating society; subsequently health consumers should determine how this technology may impact their healthcare.

Originality/value

The value of this paper is to provide a conceptual model as a basis for future empirical research and awareness of changes in the competitiveness of the healthcare environment.