Are you digitally ready?


The essence of the session I presented at #NIPEC18 today

Are you digitally ready?  I am hoping I am!

Maybe you are expecting a technical presentation; this is not that.  That’s because I actually believe that this whole agenda is about people.  Its not about a list of technical capabilities – its about how people respond to technology and its about everyone in this room, so how do you know if you are digitally ready?

First of all, for context, I would like to reflect back.

Its 1983 and I am a fresh faced student nurse. Much of the technology we have now didn’t even seem possible then.  We had no mobile phones and as a patient I was boiling my insulin syringe in a pan in the kitchen.

Over the decades since then I have assimilated technology into both my professional and my personal life, as I am sure you have too.

I have had no training in any of these things but I bank online, I order my meds online, I look loads up on google, I have an insulin pump and a Continuous Glucose Monitor.  I love the connections I gain on social media and I use this in both my social and professional life.

I feel I am digitally ready in many senses.

But what is it exactly that makes me so?

Here are the 5 characteristics that I think make me digitally ready:

The first is that I am change positive; that is I have a positive professional orientation towards change, seeing it as an opportunity rather than something to be avoided.  I like doing novel things.  I was the first complaints manager at our Trust, I was part of the team that set up NHS Direct, a nurse led telephone triage service and I think was one of the early nurses to work in an informatics role.  I experiment (safely of course) all the time, like I am experimenting today with you, presenting without slides.  You will have to let me know how it goes!

For me being change ready means exactly that, prepared to try new things, experiment and play.

I believe that all nurses need to be change positive as nursing as its taught today is unlikely to be the nursing of the future.  The pace of change is ramping up and technology is a large part of that, for example genomics and personalised medicine is likely to be come a reality in my lifetime.

I have already seen significant professional change. I used to be a staff nurse on a cadiology ward.  The only way we could do surgery on someone’s lungs was a large incision in someone’s chest.  It took days for them to recover.  It was painful. Now, today they can do this type of surgery using keyhole surgery. Think of the massive difference it makes.  It improves recovery but just think about the changes it makes to caring for these people!  It shifts the focus for nursing too.  And I predict it will be robotics next.

Being change ready is a good life skill as well as a professional skill too!

The second trait is Curiosity, when I mentor people I always advise them to remain curious.

Curiosity drives progress.  If we are not interested in ‘what if’ then things will always stay the same.

Curious people can be intimidating though – they challenge the status quo and make people feel uncomfortable.  I have often asked developers difficult questions about the art of the possible and hopefully driven better outcomes for patients as a result.  Its part of being able to see a wider perspective and to be able to see how technology and data can be used to a fuller strategic perspective.

So what am I currently curious about?  If we want to care for more people at home how can we lever technology to help?  I visited a brilliant care home near Coventry last week where these are using noise detectors in a large home to help to identify when things happen at night.  This increases rather than decreases privacy as it prevents the night staff having to actually go in to rooms at night for checks which in turn frees them up to support people who don’t sleep and focus on their ‘Wide awake club’ meaning care overall improves (and falls have reduced too).  I am interested in technology like Alexa and exploring how we can use it with patients.  Artificial intelligence too……. I could go on…… technology is a rich seam of interesting stuff for a curious person.

Curious people often have great imagination too and can describe how things might be, having conversations, visioning, and leading strategic change.

The third trait is a relentless focus on improvement.

I care deeply about the experience of people we care for, their carers and families.  This is fed from my own long term condition but everyone has the potential to empathise.

Sometimes the status quo is fine when you are on the right side of the service.  But it might be less so when you or your loved ones are unwell.  It changes the dynamic and you suddenly have what I call ‘real skin in the game’.

An example:

This week I received a letter from my GP.  It pointed out that I have a prescription for pre-filled insulin pens but I have no prescription for needles and it enclosed a  leaflet on how to give injections.  It concluded that they had set up an prescription for me to have needles.

What they failed to do was check my record.

The data they hold about me should have told them that I have an insulin pump.  I only use pens as a back up and rarely use them.  I have a box of 100s of needles prescribed 10 years ago that I have yet to use.

If the people focused hard on improvement using data they would have realised a number of things:

I am a pump user so don’t need many needles

I have had diabetes since 1979 and maybe sending me a leaflet about giving injections was slightly patronising (I suspect I have given more injections than the practice nurse).

I think using data is an important part of improvement science.  But use it well. Focus on outcomes and do proper PDSA cycles.

I would love to know what outcome they expected when they sent me the letter.

Improving my injection technique might be the aim and I am grateful for that but they need to use the data in a better way.

Data is the lifeblood of improvement science.

If they wanted to make things better what outcome are they measuring? And how will they judge if they have made a difference.

Nurses who are digitally ready focus on service improvement informed by data!  I can’t stress strongly enough that a digital ready nurse understands the value of data and the contribution it makes to better outcomes.

My fourth point is resilience.  Its quite a trendy word right now so what exactly do I mean?

Resilient people keep trying.  They are bouncy and in this instance keep advocating for the technology no matter how many times they are shouted down or doors slammed in their faces. When you innovate using technology it doesn’t always go well but you have to keep adjusting, reframing until you get the best outcomes.

Its OK to say ‘That didn’t work did it?  Now how can we try to make it better?’  It takes a particular tenacity and resilience to safely fail and keep trying.  It’s a mind set.  I suppose another word for this might be an optimistic mindset.

I honestly think that technology and data create a great opportunity to make the lives of patients and nurses better.  But it’s a journey. Its not a one off.  It takes hard work, as an ongoing endless journey.

I have been in this space for 17 years and I have often felt like I was talking to myself.

Things are changing but digital nurses need to not fall over at the first hurdle but believe data and technology CAN make things better.

Finally trait five!

Networking and learning from each other.

I believe in stealing other peoples good ideas and building on them, if it improves care.  I don’t mean stealing patents, and those type of ideas, but I do mean the sort of mentality that looks around to see what other people are doing to see what you can learn!

Social media is one way of doing this.  Digital in this sense has created a whole new way of learning and communicating across the world.

Networks are a fantastic way to feed your curious traits, or your creative skills.  I urge you to connect and look around.  Are you well connected?  Do you have fantastic networks?

I am lucky that I am often these days asked to judge awards.  It shocks me how often nurses describe their projects to us and see them as unique, special – when in fact the trust in the next county or in NI or Scotland or wherever, are doing the same thing better!  Just think of the potential of networks when they are cumulative for the development of ideas.

Networks are generous spaces; if you don’t believe me take a look at the Fab NHS Stuff site where people are generously sharing their ideas.

So, finally – why do I think I might be digitally ready?

The five characteristics:

I am change positive, curious and relentlessly focussed on improving the experience of service users and importantly outcomes.  I am resilient, prepared to try new things and learn from others.

How are you digitally ready?

curiosity and my cat 🙂

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Cassandra and Nursing Terminology


Cassandra1I was once told I was like Cassandra.

I had to go and look up what on earth that meant. If you don’t know the story of Cassandra, she was cursed by the God Apollo who gave her the power of prophecy but when she refused his seduction he spat in her mouth, so people didn’t believe what she told them. She could speak prophecies that no one believed. In modern use her name is used to indicate someone whose accurate prophecies are not believed by those around them.

As I am getting nearer the end of my career I again feel a similar frustration about some of the things I see in nursing and my inability to help others to see what I can see. Perhaps I am not wise enough to speak prophecies, nor clever enough to explain what I think I see, but I do not seem to be able to explain my views to other nurses so that they take what I am saying seriously.

What is it I can see?

Many years ago, when I worked on wards, in the morning, at the end of a night shift, if the night had been uneventful for a patient we would write ‘Slept well’ in the patient’s record. In those days it was recorded in a Kardex system, on paper. I know that most of the information I recorded will have never been looked at again, it will have disappeared into the paper record and have added no value as time passed. Its half- life will have deteriorated very quickly. In the brave new digital world, data that we enter in record systems does not decay in the same way; data maintains its value and potentially has value beyond that of the individual’s care. The emergence of big data, machine learning and artificial intelligence (AI) mean that everything we record has the potential to be re-used.

This means that nursing must get serious about data quality.

If we don’t do this, we will be making decisions based on poor quality information. As Professor Alison Leary (@Alisonleary) says #GIGO or ‘garbage in, garbage out’. Sometimes this might not matter but in the future when we are using information for clinical decision support, for example, it might matter a great deal.

39321270 - folder and stethoscope (clipping path included)I also believe that merely ensuring that the data we enter is accurate and timely is only part of the story. We must get serious about information standards and the way we express what we do through a standard nursing terminology. What sorts of things do I mean? We need standards for how we record a patient’s weight across systems, as it could be used to calculate a dose of a medication. We need to ensure we consistently record nursing observations such as pressure ulcers, so we can measure improvement and compare across systems/organisations. We need to ensure we express care requirements in a standard way so that when we communicate across organisational boundaries and don’t lose meaning.

We need national nursing information standards that we can apply across all professional practice that will enable us to measure nursing outcomes, compare performance, share information and, for the future, provide data that will support accurate AI.  A wonderful informatics nurse called Anne Casey wrote about some of this in an RCN paper ‘Making Nursing Visible’ (I can’t find the date of publication, but the review date is set at 2014). Anne’s paper is still true today and indeed I can see an even greater imperative. We need to do this for the whole profession; if we continue to believe that each organisation is a digital island, with its on special requirements and its own way of recording nursing practice, we will fail to capitalise on the potential data offers nursing.  Exactly how many versions of a fluid balance chart do we need to create?

The doctors are much further on with this agenda and indeed the Allied Health Professional Community too are making progress. In nursing a small number of senior nurses have more vision, usually where electronic nursing records are becoming more mature. They can see the power of structured data about nursing. The trouble is we need to do comprehensively across the profession and we need to agree standards before we digitise, so we can embed those standards and terms in the systems from the start.

FlorenceI don’t see many people listening; it’s a complicated story that uses strange words such as terminology and classification systems. Nurses who might understand are often still at the margins of the profession; nursing who work in informatics are increasingly sought but still do not have high status, unlike in the US where they seem to value nurses with informatics experience more highly and the presence of a Chief Nursing Information Officer (CNIO) is much more common.

This is not a technology issue, it’s a nursing one. Whether we chose NANDA or the International Classification of Nursing Practice (ICNP), or another system, do nurses have the vision to see that we need standards, so we can look at outcomes, share data and in future use it for AI.

Do we understand that the data we record may contribute to the future care of other patients beyond the patient we are caring for now, unlike my ‘Slept well’ notes of the past?

I hope so, I hope that for once my prophecy; that nursing is not taking this agenda seriously and may be leaving it too late, will not come true. I have been trying unsuccessfully for years to get the profession to listen.  I think Florence Nightingale with her interest in data would have seen the need for a standard nursing terminology.

Let me know if you are interested in this agenda. I’m not sure what we can do but more voices might make a difference #nursingterminology

Links/further reading:

Why use ICNP?

CNC – Overview: Nursing Interventions Classification (NIC)

What is nursing diagnosis and why should I care?

What is Deep Mind Health?

 

 

 

People Drive Digital Reflections


networkI have been to NHS EXPO today. As always it was great to meet lots of people I have met and worked with over a number of years; I love seeing them, giving them a hug and re-connecting with them (you all know who you are). It is one of the privileges of my working life that I have met so many fabulous people.

Today was interesting for me as I didn’t go to EXPO in my professional capacity but in a personal one, as someone who has an interest in digital innovation but from the perspective of a citizen and patient and today felt very different – but is it EXPO that has changed or me?

PDDigitalToday I briefly presented with Victoria Betton and Mark Brown the work we have done on People Driven Digital and the PDD Awards (HT to the others too Michael Seres, Kat McComack). I realised that I had changed from a year ago.

I spent many years as a nurse giving patients advice and information. We thought it was the right thing to do and of course it is but it’s also paternalistic, based on the assumption that ‘we’ know and ‘they’ don’t.

Over the last year my experiences of working in collaboration with other people like my fellow collaborators for #PDDigital, and many others in my social network with Diabetes, has made me realise that the system doesn’t know what problems people face as intimately as they do. We can make assumptions, we can guess and in doing so we may well get it wrong; we may hit the target and miss the point. Mark spoke eloquently today (you can read what he said here http://thenewmentalhealth.org/?p=182 and it’s well worth a read) about focussing on trying to find digital solutions to those issues that really matter to people, not necessarily the big things but those that in people’s lives make a real difference. You can see our presentation here

So today, whilst I wandered around EXPO, I reflected on what felt ‘real’ and what maybe mattered the most. There was little evidence of people driving solutions and creating ideas and I realised I had changed. I have come to realise that unless we engage at the start with the citizens, we are unlikely to make the differences we need to make. We might create elaborate solutions but may completely miss the point. We need People Driven Digital Innovation.

pump openerI have an example: I was a grateful receiver of a new insulin pump a few months ago. It has a snazzy screen and some new functionality that means if you are a user of a continuous glucose monitor (I am not funded to be one) then it will switch off the delivery of insulin if your blood glucose goes too low – very clever indeed. But what was it that delighted me when I collected my pump? On my old pump, in order to access the battery to replace it (yes insulin pump are powered by a traditional AA battery!!) I had to carry a 20p coin in my bag. It’s the only reliable way to be able to open the battery space – it’s tricky but fairly crucial to be able to get in! On my new pump there is a removable clip that had a snazzy little device on the end that enables you to open the battery space. A simple remoulding of the clip – inexpensive and functional – I know, I know, so simple – but it was the snazzy solution for the battery opener that delighted me. A small but delightful improvement and now I don’t worry about 20p pieces. Let’s try focussing on the small things that might matter to people.

How do you think we could develop the ideas from #PDDigital? Let us know.