Applying the GROSS Principle in Clinical Information System Implementations

By Connie Munroe :

As we prepare for Halloween, I wanted to write about something GROSS. This mnemonic has been talked about by the American Medical Association and could be used anywhere in our lives, but today I am talking about?Getting Rid of Stupid Stuff?from Clinical Information Systems.

Let's think about your experiences with Clinical Information Systems. How many times have you asked why a question or query is where it is or, more likely, you have said “this is so stupid!” For users who have not been on the teams building these systems, there is likely little understanding on the thousands of decisions that get made and how those decisions are now impacting your workflow. Some of these decisions are required to meet regulatory requirements, others are made to mitigate risk, and so on.?

Getting a sucker when you wanted Rockets?

Some of these decisions are made quickly while others go through a very rigorous?process. The resulting impact may be seen immediately, commented on during training, or not fully understood until Go-Live. Anyone who has supported a Go-Live has experienced staff frustrations about information that is now required to be documented or has questioned why values cannot be recalled. If you are lucky, you were there for the build and can provide a little background. If not, the standard answer is normally to write the question down to be discussed at the next support huddle.

More and more we are hearing about how laborious it is becoming to document in Clinical Information Systems. This is leading to burnout and professional dissatisfaction.?

We have always believed in a?lean mindset of continuous improvement which sometimes requires being GROSS. My engineering colleagues talk about this as removing waste.?

With this mindset, leadership or the project champion needs to determine how they will capture information. This will be important when it comes to compilation. What is it you want to know from staff? How will it be captured – on a form, in an email to an email address to be compiled in Excel, or in a ticketing solution? Do not get bogged down in this process too much. It can always be improved; you just want to get started.?

Once information is gathered, how should it be prioritized? Often when we work with clients, we create a very simple PACE matrix and determine the anticipated benefit and the ease of implementation. We then prioritize these into Just Do Its (JDIs), Kaizen Events/Workshops, or Projects. These are often determined by the number of people who need to be present, and the effort required.?This can be more complicated with accreditation standards, professional regulations and other requirements but that is why having the right people around the table is important.

Sharing the haul

Thinking about people, who needs to be in the room to discuss these requested changes? That really depends on the impact of the change. Some potential impacted parties could be Information Technology, Informatics, representatives of the impacted staff (RNs, physicians etc.), risk/legal, change management, business intelligence, and potential vendor representatives.

Remember that workflows and other documentation may need to be updated to represent changes.?

Once improvements are completed you must think about potential training and communication of changes to staff, how you will evaluate the impact of the changes, and also how to celebrate successes.?

Planning for the next one

While this might seem like a straightforward process, remember that operational activities and changes are also being requested, new projects are likely being integrated into systems, staff is changing, and so on. Being GROSS can be frightening but don't be scared!

If you need any help in getting started?with your GROSS journey,?contact?the?Barrington Consulting Group.

https://barringtongrp.ca/

#informatics #optimization #healthcare #clinicalinformationsystems #gross