MSTI eWhiteboard is a Triple Aim Hit

The journey to transform health care is a long and difficult one, but I have never doubted that St. Luke’s would be successful. I think you need several ingredients to be successful – inspired leadership committed to a vision, a governing board that is well educated and committed to supporting management and the organization through challenging times, aligned physicians who are committed to new care and business models, an engaged community, strong communication internally and externally, and a culture of innovation. I think we have all the ingredients. 

Today, I have asked blog editor Roya Camp to write about St. Luke’s Mountain States Tumor Institute’s electronic whiteboard, an example of innovation originating at our Twin Falls site. We visited MSTI in Twin Falls while I was there with my fall forums. 

I had heard how two St. Luke’s pharmacists and one of our information technology staff members had confronted a problem and come up with an innovative solution. The problem? The infusion pharmacy was not within sight of the nurses caring for infusion patients. Communication was through multiple phone calls that would cause disruptions and therefore increase the risk for errors in a very high-risk area of our operations and through wasted trips by nurses, who had to move back and forth repeatedly between the infusion station and the pharmacy. 

These pharmacists and the supporting information technologist realized that there was an opportunity to create exceptional patient experiences and achieve exceptional outcomes through TEAMwork, St. Luke’s lean methodology. Their solution? An electronic whiteboard incorporating lean principles. 

To me, the key to success in healthcare innovation is that it must start at the level where staff members intersect with patient care. It must arise out of solving real-world problems. And the best solutions will come from multidisciplinary teams working together to utilize technology in new ways. I think you’ll agree that this MSTI innovation is a success on all those fronts. 

Here’s how I determined it was a success: I asked the nurses, and each one told me that it saved them time, effort, and a lot of unproductive time away from their patients. We call that waste.  

Better care, safer care, more efficiently provided, with more time spent with patients – a resounding success. Read on.

Exceptional experiences and outcomes, the two goals St. Luke’s is organizing its efforts around, start as great ideas in all corners of our organization.

In the case of breakthrough communications between the clinicians taking care of some of our sickest patients, that corner belongs to pharmacists Dave Green and Debbi Burr.

The two are with Mountain States Tumor Institute at St. Luke’s Magic Valley, and have figured out a highly effective mode of ensuring that all those involved with the patients under their care stay up to speed throughout the chemotherapy treatment process.

Oncology Pharmacist Dave Green explains how the electronic whiteboard has replaced use of a clipboard and paper records.

Green, Burr, and their colleagues need to prioritize tasks and communicate effectively while lots of patients and clinicians are flowing through their work areas. Frequent interruptions are common and expected, but raise the risk of error and the amount of waste of time and resources.

At various times, staff members previously had used a conventional whiteboard and marker, posted near the pharmacy window, or notes on paper to keep track of chemotherapy treatments. Nurses would make multiple trips from their desk space to the pharmacy to see if pre-medications were ready, the chemo was ready, and to attend to other parts of the process. The pharmacists would wait for the nurses to come by or would call the nurses for information they needed before they could prepare or distribute the chemotherapy. 

Green envisioned a better system, one that would reduce waste and improve efficiency and care. The idea: an electronic whiteboard that would allow the pharmacists to communicate more readily with the nurses who were giving chemo.

Courtney Gard of information technology helped the team develop the idea, which also incorporated visual management and efficiency lean principles, adopted at St. Luke’s as TEAMwork. Green and Burr took charge of education and designed metrics to measure the success of the new electronic whiteboard. 

The system, which is accessible to staff members via computers in the chemotherapy infusion suites and in the pharmacy, has dramatically reduced work interruptions and the possibility of errors caused when work is interrupted since the team started using it this spring.

Staff members are easily able to see which patients are having treatments and when, get information about the status of premedication and lab work, and track medications throughout the process. The nearly two-dozen nurses, pharmacists, and pharmacy technicians who are involved at various stages of the process can update information and track the progression of medications and patients throughout treatments.

The program is dynamic and updates are taken up and visible immediately. Color-coded status tags and open notes fields have made the program user-friendly and provided quick access points to need-to-know information.

Oncology Pharmacist Dave Green shows how the pharmacists can do quality checks to make sure the medications match the order’s dosage designation. It’s the last step before the nurses collect the medications for infusions. Nurses are alerted through the whiteboard when medications are ready.

And because the treatment process for MSTI’s patients occurs in several stages, with a set of pre-medications preceding the chemo treatments that also must be prepared and delivered appropriately, the new system is building in new levels of quality and safety assurance. The multiple checks of all lab work, preparations, and timing are made much more visible and timely.

 Here’s what Melissa W. Fenderson R.N., Twin Falls MSTI director, had to say: “The nurses and pharmacists LOVE IT! They implemented the board on a VERY busy day, and the nurses reported immediate time savings and step savings. 

“This new whiteboard saves nurses steps, saves pharmacists and nurses time, and has provided a clear means of communication that allows the staff more

MSTI Pharmacist Debbi Burr dispenses for a patient. Burr and Dave Green are credited for launching the effort to improve the communications process that led to the electronic whiteboard.

time for the patients.”

As with several of St. Luke’s new clinics that focus on population health, increasing use of our electronic health records, our Project Zero initiative targeting surgical site infections, and many other initiatives, the MSTI team’s identification of an opportunity goes to the heart of our Triple Aim of better health, better care, and lower cost.

“In the end, it makes more efficient patient care,” Fenderson said, adding that the complexities and expenses of oncology treatments make it important that waste of all resources be minimized.

“We can know the medication is ready, and that kind of communication’s very crucial,” she said. “It saves nurses time, it saves pharmacists time, it’s safer, because there’s an up-to-date record …

 “It improved care immediately,” Fenderson said.

Before and after staff surveys have shown that users of the new system are pleased with its functions, and other MSTI sites now are looking to adopt the approach.

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8 Responses to “MSTI eWhiteboard is a Triple Aim Hit on “MSTI eWhiteboard is a Triple Aim Hit”

  • As a sometimes chemo nurse, I find the electronic whiteboard to be crucial in keeping me up to date on what is happening with the medications for my patients. I can alert the pharmacy when labs are back and they let me know when meds are ready to be picked up. I DO get to spend more time with my patients, making sure they are receiving treatments in a safe and efficient manner.
    Our congrats to Dave, Debbi, and Courtney for making this happen! You all ROCK!

  • Many of the communications technologies that have greatly improved the efficiency of business globally still are underutilized in Healthcare organizations who have established, paper-based workflows. That innovation to do something different, using e-tools that are readily available, needs to be sparked at the end-user level.
    It still amazes me in Print Services to see the amount of paper used to cascade information to staff, stakeholders, and patients. The critical step would be education, working with folks to increase the comfort level with modern technology. Then, workflows are optimized, information is transferred efficiently and securely, and productivity enhanced. Just look at what email has done with corporate communication.

  • Thanks for your comment, Peggy!

    I was pleased to hear repeatedly from nurses at the infusion center that this system was much more efficient and allowed the nurses to spend more time with patients. That has become one of my standards for our TEAMwork initiatives – does it allow caregivers to spend more time with patients?

    Thanks for your comment and for following the blog!

  • Hi, Ron.

    You are so right! Last week’s blog post highlighted a new use for current technology to improve communications with patients, especially those who are intubated. We are doing a lot more with technology to make care more patient-centered – myChart, tablets in the ICU, and our online patient information; we are using technology to extend our services to rural areas of Idaho without specialists through our eICU and telemedicine; and we are using technology to a greater extent for communication through my blog, Lync, our St. Luke’s Provider Finder app and other mobile health channels, social media, and our digital strategy, but we certainly have a long way to go. Other industries also have been able to use technology to lower costs, whereas in health care, our costs often go up when we deploy new technology.

    We will continue our journey to make greater and more innovative use of technology. It is one of the many opportunities facing health care today.

    Thanks for your comment and for following the blog!

  • How long did it take to work out the process including and up to getting the whiteboard on the computer at the unit level? What if any was the initial expense and the cost saving?
    I am really glad that this innovation has helped the nurses in saving time and unneccesary steps, thereby increasing the time they spend with the patients. Congratulations!

  • Hi Evelyn,
    Great questions.
    We used a piece of software that the system already had access to, so in terms of software or hardware there was no added cost. The only costs were staff hours. On the IT side, I think it was fairly minimal as well. IT just had to grant access to the program to the proper individuals. We then took about a month piloting it in the pharmacy and another couple of weeks to train the staff in one-on-one as well as group sessions. Within a half-hour of using the whiteboard, most users are very comfortable with it.
    I would think, since we worked through the early bugs in a pilot, a given unit could make this happen within a couple of weeks. And it doesn’t have to be just nursing-to-pharmacy. Within the first week of using it, our nurses realized this would be a great tool to work with scheduling, so they created a nursing/scheduling whiteboard which is just a second tab on the same whiteboard template. Although it is hard to quantify cost and time savings, I think most users would agree it is saving both.
    Thanks,
    Dave

  • You left out one very important ingredient to what is needed to transform health care: nurses. If you don’t have buy-in from them, there would be no change.

    As a frontline, hands-on, bedside vet of 37 years, I know how important it is for nurses to feel valued, and this feeling is fueled by adequate compensation and remembering the vital role nurses play in delivering quality healthcare. Not including them in the list of ingredients necessary for systemic change is a mind-boggling omission and lagging behind in nursing compensation is inexcusable, in light of the rate of increase in compensation at the executive level.

  • Thank you for this interesting article. From a technology side, can you say what you are actually using?

    Thank you.

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