Increasing mobility to improve patient experience

Improving patient experience and engagement are the top priorities for every hospital, health system, and doctor’s office in the country. In order to maximize opportunities for funding and reimbursement, every step in the patient process continuum, from admittance to discharge, is being heavily evaluated for areas of improvement.

One area under increased scrutiny is the physical workflow process as it pertains to patient-facing staff, particularly nurses and nurse practitioners. Nurses on the front lines of patient care, more often than not, have a direct impact on whether the patient views their care in a positive or negative light – a point emphasized in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.¹ Of note, the first three questions of the survey are centered on nurse interaction:

During this hospital stay, how often did nurses treat you with courtesy and respect?

During this hospital stay, how often did nurses listen carefully to you?

During this hospital stay, how often did nurses explain things in a way you could understand?

Clearly, there is a great deal of emphasis being placed on the ability of nurses to provide not only the highest level of care, but also emotional comfort to patients and their families. However, what else can healthcare facilities do to improve clinician workflow processes and ensure that nurses are being best positioned for success?

Bob Hill,
Global Manager, Healthcare, Ergotron

Nursing is an extremely demanding and taxing profession that often leads to issues that directly and indirectly affect the patient care experience. While progress has been made in this area in recent years, research suggests that there are still workflow and safety issues that must be addressed in order to improve frontline performance of today’s healthcare professionals – especially in the realm of a nurse’s own health. According to research commissioned by Ergotron, nursing has the third highest reported injury rate of any profession. In addition:

Forty-eight percent of nurses are likely to have wrist, back, and ankle sprains or strains;
Nurses typically walk upwards of five miles per 10-hour shift;
Fifty-three percent of reported injuries were due to overexertion;
Sixty percent of nurses believe their job is negatively impacting their overall health;
Twelve percent have been injured on the job during the past year.

While these statistics relate directly to the physical health hazards of the nursing profession, their impact on the overall quality of the patient experience cannot be discounted. While common injuries encountered by nurses have been well documented,² what has not received the right level of attention is how these injuries and varying levels of discomfort affect patient care. In the same Ergotron research, a direct link between physical discomfort and negative interactions with patients was established:

Twenty-two percent admit to being less friendly or engaging with patients;
Twenty-two percent modify or limit their activity on the job;
Seventeen percent admit to being distracted;
Fourteen percent often require additional assistance from other staff;
Forty-nine percent report feeling some level of discomfort while inputting chart data.

Based on this data, understanding the underlying reasons behind the physical discomfort, fatigue, and the challenges to physical clinician workflow will not only lead to a healthier and happier nursing staff, but will also impact overall patient care and satisfaction.³

Mobile, tablets, handheld devices, and wall-mounted solutions have all been introduced to the modern healthcare facility, and there is no turning back. In a recent survey from HIMSS Analytics, 71 percent of nurses reported they would not consider going back to paper-based medical records.⁴ In addition, nurses tend to agree that EHR benefits are good for patient safety: 72 percent believe EHRs improve patient safety and avoid medications errors, and 73 percent admit they enable collaboration with other healthcare professionals.

Despite the many positives that come through the implementation of technology, there are improvements to be made and many of them focus on improving poor workflow process designs. It is important to remember that, while technology can solve many of the problems facing healthcare facilities, technology cannot solve the problem by itself. To date, the use of technology in medical facilities has been emphasized heavily, but more thought or planning needs to be given to the actual implementation and daily use of these solutions. What do the technology and EHR workflow mean to clinicians?

The reality is that today’s exam and treatment rooms present challenges for integrating EHRs into the point of patient care – the triangle of care – and too often EHRs are awkwardly brought into a room where they do not promote a personal clinician-patient interaction, which can delay the caregiver interaction with the EHR.

For the most part, the design of exam or patient rooms reveals a lack of fundamental awareness of what is in the best interest of the healthcare worker in terms of safety and how much improper ergonomics can contribute to nurse fatigue. For example, even though charting at a patient’s bedside has been proven to reduce errors and improves the patient’s perceived quality of care, Ergotron’s study found that only 21 percent of nurses do the bulk of charting in the patient’s room. The main barriers to this activity included:

Forty-two percent cited lack of space to maneuver technology;
Thirty-nine percent mentioned the placement of fixed computer equipment;
Twenty-four percent indicated a lack of available power and long-lasting power options.

All of this is made more relevant when you consider how nurses spend roughly 35 percent of their typical 10-hour shift doing documentation. Ergotron’s study also highlighted the fact that when technology does not have the proper infrastructure to support its use, it can actually cause more harm and interruption to the patient care process. As it relates to EHR reform, responses indicated that:

Sixty-one percent of nurses and healthcare workers are concerned about the placement of technology within the rooms;
Fifty percent responded that they have experienced an increase in work-related stress;
Forty-two percent said there has been no increase in patient care time;
Thirty-six percent said there has been no improved patient interaction and engagement.

Technology will continue to evolve in healthcare practices, but so too must the mobility and flexibility of the solutions that are being deployed. Moving from paper to electronic record keeping can improve accuracy and efficiency, but what are commonly missed are the physical workflow implications for clinicians. Nurses are being required to learn emerging technologies on top of existing workloads, while still maintaining patient care requirements. As currently constituted, facilities are still only seeing a limited return on their investment. They are improving the collection and accuracy of data, but they are not adding value to the patient experience, as nurses are often being distracted by technology rather than using it to their advantage.

To combat this, a greater focus on design, ergonomics, and practical usage is in order. Having workstations in every room that are easily accessible and adjustable for all users accomplishes two goals: providing a safer, more ergonomic experience for the caregiver and bringing technology into the triangle of care by promoting further patient interaction. There are still challenges to clinicians, like dealing with multiple logins each time they go into a new patient room; however, working with IT can solve these challenges without sacrificing privacy or straining a nurse’s technology load tolerance. For example, some hospitals are adopting virtualized sessions and single sign-on.

There is no doubt that having equipment that works the way it is supposed to, when needed, will also greatly alleviate nursing pain points with technology. Ensuring that the proper power stations are provided so that all technology platforms are charged and ready for every shift change significantly relieves IT constraints – as well as the nurses. The optimal goal is to have the technology positioned and powered to let all involved deliver the best possible care and inspire confidence in patients during their hospital stay.

Proper EHR deployments should make patient records more accessible and easier to use for all ages. The amount of time spent on record keeping should be reduced, while the focus on patient care should increase. The concept of workflow needs to be continuously evaluated as new technologies are introduced into the practice. What worked five years ago – or even last year –may be ergonomically obsolete by today’s standards.

At the end of the day, patients are going to assess their experience not only by the care they received, but by their interactions with the nurses and front-line staff at the medical facility they visit. When nurses feel that they’ve done a good job, it improves their quality of care. Conversely, injuries and physical discomfort directly affect patient interaction. Having the proper ergonomically adjustable workstations is a win-win for nurse comfort and EHR implementation success. Whether it is HCAHPS or other initiatives that continue to drive reform in healthcare, the goal should be the same: to arm healthcare workers with the appropriate solutions and training they need in a supporting infrastructure that creates greater efficiencies and comfort for all and improves the patient-caregiver exchange.

Increased mobility and better workflow design alone will not cure all the problems of the healthcare industry or ensure that every patient experience meets the highest expectations. However, it will go a long way in improving the working conditions for those on the front lines of the patient/healthcare worker interaction. By improving the processes and conditions for these groups, we will ensure they are at their best and able to provide the highest levels of patient care possible. That is how we improve the patient experience.

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