From The Editor | March 25, 2011

The Role Of Nurses In Successful HIT Deployments


By Ken Congdon, editor in chief, Health IT Outcomes

"No one can sabotage a healthcare technology deployment faster than a staff nurse." This quote from Linda Groah, executive director and CEO of AORN (Association of periOperative Nurses) made a significant impact on me as I attended my first-ever AORN Annual Conference on March 21-22. In fact, this statement, uttered during an introductory meeting between Linda and myself, set the tone for my interactions with technology vendors and hospitals throughout the event.

Exactly how involved is the nursing staff in the technology decision-making processes at most hospitals? How involved should they be? According to Linda, nurses should be intimately involved in any technology decision that will impact their day-to-day activities and workflows. In fact, that's one of the many objectives of the AORN Annual Conference — to provide perioperative nurses with first-hand exposure and access to the technologies making the most significant impact on their profession.

It's hard to contest Linda's viewpoint, but I wondered how many hospitals take Linda's sentiments to heart in the real world. I began to ask many of the nursing leaders in attendance at the show about their role in the technology decisions made at their hospitals and got some interesting feedback. Some nurses said they've never been asked for their opinions on their hospital's technology purchases, and referenced (with much disdain) horror story after horror story about how the new technology system not only made their lives a living hell, but also jeopardized patient care.

Luckily, these scenarios proved to be the exception rather than the rule. Much more common was the inclusion of outspoken or senior staff nurses in hospital "product selection committees." Most often, these committees are formed by the IT or C-Level leaders within a hospital. In most cases, leading physicians and nurses are asked to be part of a product selection committee after the list of possible technology solutions have been narrowed in line with the hospitals budget and system requirements. Select doctors and nurses are then asked to evaluate the remaining technologies and offer their opinions and suggestions as to which products fit best with their operational processes.

The stories told by nurses that were involved in a product selection committee were much more positive than those referenced by nurses who were never asked for their opinions. In most cases, nurses held the new technology system in high regard and offered numerous examples of how the new technology system (whether it was a new EHR, workforce optimization, asset tracking, or patient flow system) improved their productivity, effectiveness, and quality of care.

If your healthcare facility doesn't currently leverage product selection committees in its technology purchasing and implementation processes, you may want to start. Without the input of the doctors and nurses that ultimately need to use the system, you may be dooming your technology deployment to failure. If the doctors and nurses aren't on-board, they can refuse to use the system or develop workarounds, ultimately proving the technology deployment to be a wasted investment.

Hospital Cultures Impede Technology Effectiveness
The good news is, when nurses feel included in the technology decisions that affect them, they willingly adopt the technology. However, applying technology to a process doesn't always result in increased nursing staff efficiency or better care for the patient. Troubling enough, it appears as if the ineffectiveness of these systems has little to do with weaknesses in the technology itself and more to do with communication breakdowns due to damaged hospital cultures.

The results of a recent study called The Silent Treatment: Why Safety Tools And Checklists Aren't Enough To Save Lives were released during a special media event at the AORN conference. The report, compiled by AORN, The American Association Of Critical Care Nurses, and VitalSmarts, surveyed 6,500 ICU nurses and AORN members about the effectiveness of safety tools such as handoff protocols, checklists, CPOE (computerized physician order entry systems), and medication administration systems. According to the survey, 85% of respondents had been in a situation where the safety procedure or technology was effective in alerting the nurse to a potential risk. Sounds like a great percentage, right? The problem is 58% of these respondents said while they got the warning, they failed to effectively speak up to solve the problem and protect the patient. In other words, nurses failed to inform the treating physician that their actions posed a potential safety risk to the patient, or the doctor chose to ignore the nurses' warnings.

The study highlights a dangerous culture of silence that has emerged among nurses in hospitals. This behavior seems to have been instilled in nurses through years of incompetence and disrespect demonstrated by their colleagues. For example, 82% of the nurses surveyed said that they have witnessed physician incompetence, 19% of which put the patient at risk, yet 79% of respondents elected not to inform the physician of this safety breach or discuss it with them. Why would these nurses choose not to confront the offending physicians about their actions? Maybe it's because of the way they feel doctors treat them. 85% of nurses surveyed said they've been openly disrespected by physicians. Obviously, this data is coming fron the nurses' point of view, but it appears as if the broken communication chain between the doctors and nurses that provide care to the patient need to be repaired before any technology tool will have a marked impact on improving patient care. To access the complete Silent Treatment report, click here.

Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at