British Computer Society
Centre for Health Informatics Research and Development
Cerner Logo

Transforming Healthcare: Nursing Leadership as the Critical Success Factor

25th September 2003

King Alfred's College, Winchester

A personal review by Rod Ward

This is not the official conference web site. The powerpoint presentations will be made available on the CHIRAD web site at: http://www.chirad.org.uk/

Speakers & Chairs
Speakers and Chairs for the day
(Click on the image for the larger picture)
An internationally renowned panel of speakers presented their own slants on a variety of issues impinging on the nursing informatics field during this invitational seminar, which was organised by IMIA, CHIRAD and the BCS with the support of the Cerner Corporation. The papers exploring the latest trends and technologies in healthcare information technology were appropriate for a context in which the NHS is investing heavily in IT suppliers at local and national level.

The seminar was attended by approximately 50 delegates from throughout the UK and from a variety of professional roles.

The delegate pack included a letter of welcome from Professor KC Lunn the IMIA president and inviting delegates to Medinfo 2004 in San Francisco

It should be noted that the Cerner Corporation is one of the (2 remaining) bidders to provide the Local Service Provider for London and the word on the street is that they are likely to win this contract.
The day was introduced by Professor Graham Wright, the UK's Nursing representative to IMIA-NI who was celebrating 35 years to the day since he started his nurse training ! Graham set out an overview of the International Medical Informatics Association (IMIA) and the British Computer Society Nursing Group with his usual quick tour through history and some of the key players in the field - many of whom were in the room. Graham Wright
Professor Graham Wright
Dr Beverly Malone
Dr. Beverly Malone
Dr. Beverly Malone opened the day with her take on Nursing Leadership in a Technological Environment. She did this, not as general secretary of the RCN, to get across some of her ideas about nursing leadership and it's importance in shaping the future of healthcare focussing on the development and implementation of vital infrastructure.

Beverly focused on aspects of leadership, exploring the difference between vision and hallucination, and the need for effective action plans to turn vision into reality (Vision without action=hallucination)

She identified something of the nature of nurses as "fixers and doers" who need to have space to dream, and went on to discuss risk taking particularly in the context of information system implementation - describing communication as underpinning every aspect of care. She touched on issues of boundaries (personal and professional) and how IT can help to build bridges between professional groups, and related this to interprofessional education suggesting that nurses need first to get to know who they are and what they do and then find out about others in the wider health and social care team.

Charisma was seen as important but without competence would not achieve our aims, and suggested that informatics was needed in the continuing education of all senior nurses.

Current and future drivers were identified including; the aging population, the increase in chronic disease, an ageing workforce and the need for consistency in the delivery of high quality care. Changes in the patient profile moving from a dependent to expert role with access to much more information will also change the role of the nurse. The "ageing" group of nurse educators were seen as key to technological and system change in healthcare.

She concluded with issues about the importance of IT to enhance communication for quality patient care and stressors on individuals and ways to handle them. She urged delegates to have the vision and be assertive enough to make it real.
After coffee Helen Sampson took over the chair to introduce the following speakers. She briefly described her roles as chair of the BCS Nursing Specialist Group and Nursing Professions Information Group (NPIG)and The UK Council for Health Informatics Professions (UKCHIP). Following questions from the audience about the new UKCHIP body Helen gave further information about the need for regulation, support and recognition of health informatics in the UK. Helen Sampson
Helen Sampson
Professor Denis Protti
Professor Denis Protti
The next speaker was Professor Denis Protti from the University of Victoria School of Health Information Science, British Columbia, Canada who has done a great deal of work looking at and advising on the development of IT in the NHS and developed the evaluation tool being used within the national health information strategy.

He had changed his title of "Out of the Trenches - On to the High Ground" several times and focused on the development and status of evidence based medicine (or evidence based clinical decision making) with some definitions and an overview of current literature and research in the area.

He set out the need for a combination of clinical expertise and current best evidence in tackling the mortality and morbidity resulting from medical errors and enhancing patient safety. He touched on the work of the US leapfrog group of large US employers setting standards for healthcare settings and the federal and state legislatures.

He mentioned problems related to the medical model and urged medical practice to catch up with medical knowledge. While recognising the difficulties produced by the explosion of medical knowledge and the information overload suffered by clinicians he set out some of the leading information sources aiming to help support best practice.

Denis advocated the integration of computerised record systems with clinical decision support enabling the integration of knowledge based tools to provide rules based alerts and decision support at various stages in the care process, but skipped over the difficulties surrounding a standardised medical vocabulary. He explored current developments and priorities and some of the hurdles to be overcome.

He concluded with comments about changing the way in which healthcare is delivered, including the use of pathways and workflow systems, much more than automating paper systems, and avoiding a "cook book" approach. In response to questions he suggested that clinical staff will use the systems on offer if it can demonstrate clear benefits, but their use may need to be mandatory for all.
The next speaker was Dr. Margaret McClure president of the American Academy of Nursing and a professor at New York University who described her work on Magnet Hospitals: Attraction and Retention of Professional Nurses, which she coauthored under the auspices of the American Academy of Nursing. She recently completed a new volume, a compilation of all the work that has been done to date regarding this subject, the title of which is Magnet Hospitals Revisited.

Margaret drew from these studies and her experience to examine the role of the nurse as both a caregiver and integrator, linking the importance of education to the quality of care and the incidence of "failure to rescue" cases. The integrator role is key in complex organisations (e.g. hospitals) to pull information from various departments and subcultures together to enable the quality of care to be improved. Various features of "Magnet hospitals" were linked to this nursing role; nurse physician relationships, interdisciplinary education, autonomy & control, adequate staffing and supportive management.

Along with other speakers she discussed shortages of nursing and other care staff and how we need to address both supply and demand by changing work practices to release nurses from the "busy work" of administration and enabling them to spend more time on direct patient care.
Dr. Margaret McClure
Dr. Margaret McClure
Heather Strachen
Heather Strachen
The afternoon session was chaired by Heather Strachen the chair of IMIA-NI who emphasised the importance of the issues under discussion today.
The first representative from Cerner was Charlotte Weaver, their chief nursing officer and vice president who took as her title "Making Technology Work for Nurses".

She addressed the transformation of health systems for value, safety and appropriateness from her experience in the US and Australia and identified potential advantages for the UK system, again focusing on innovative ways to tackle the skills shortage and highlighting the correlation between nurse staffing and patient outcomes. - "We don't have a nursing shortage - We just have the wrong people doing the wrong things".

She described the automation of workflow processes and methods of "closing the loop" leaving no dead ends or uncompleted tasks. She sees the technology as providing a safety net for patients and nurses within the acute care team;
  • preventing errors of omission
  • providing best practice guidelines
  • pushing the relevant information to staff at the appropriate time
  • supplying real time alerts
She showed how a variety of devices, from trolleys to hand held devices can bring the information system to the point of care and provided screen shots of the Cerner product (without doing a selling job) to illustrate some of the areas of data entry and retrieval and the elimination of double charting. Demonstrating how information is gained from other assessments to automatically calculate a pressure sore risk for the patient.

During questions she explained how the "busy" screens can be adapted for the individual organisation and that most trusts would start with limited applications and then build in more as they were needed. She also responded to questions about psychosocial and qualitative data with information about free text entry and "sticky tabs". Another question was raised about confidentiality and security of the information and she said that the product provided audit trails of who had looked at information and complied with HIPPA regulations in the US and she was confident it would comply with UK systems.
Dr. Charlotte Weaver
Dr. Charlotte Weaver
Dr. Marion Ball
Dr. Marion Ball
Dr Marion Ball, who has been working in the field of nursing informatics for many years, was the next speaker and considered "Enhancing Patient Safety Supported by proven Technology Tools". She emphasised and reiterated many of the points made in earlier presentations, under that areas of;
  • Where are we?
  • What can we do?
  • Where are we going?
She used various survey statistics to illustrate the crisis in patient safety (particularly medication errors), and advocated a move away from the ABP (Accuse, Blame & Punish) culture within healthcare.

She highlighted various benefits of IT systems and some of the barriers to the introduction.
The final presentation was from Roy Simpson a mental health nurse in the US who is now vice president of nursing informatics for Cerner Corporation. His title was Patients and the Profession: How We Will Look with IT.

Roy's enthusiastic presentation and advocacy for the development of nursing care as ever motivated and excited the audience about technological innovation as a driver for social change. He focused on the data, knowledge and information needed for nursing care and organisational modernisation.

He highlighted the opportunities IT provide in each of 10 defined areas of professionalism and provided strategies for the management of complex change.
Roy Simpson
Roy Simpson
The venue for the seminar was the West Downs Conference Centre, King Alfred's College, Winchester, a nice building but I'm not sure about the choice of the chapel as the meeting room - perhaps this provided some inspiration, (especially after it was described as Hogwarts College) Coffee and lunch were very pleasant and provided a good opportunity for colleagues and friends old and new to exchange ideas and develop collaborations between practice and education, NHS and suppliers across geographical; and professional boundaries.
The Chapel
The Chapel !
(Click on the image for the larger picture)
West Downs Conference Centre, King Alfreds college
West Downs Conference Centre, King Alfred's College, Winchester.
(Click on the image for the larger picture)
Lunch - it what could have passed for an old school hall.
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Coffee & chat
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If you have comments or would like to find out more about the activities listed above please mail me. Rod@RodSpace.co.uk

Page Created: 25.9.03

Last Updated: 26.9.03