Have you ever stopped to consider the number of industries where the employees may not understand the importance of the data they record to the business’ overall operations? In the restaurant sector, for example, employees may not be particularly diligent about exactly following the processes for regularly recording the temperature of certain ingredients that go into their menu items, for instance. That can be a problem when it’s time for a health inspection.  And in the healthcare sector, nurses tend to be more focused on caring for the patient than they are in the minutiae of documentation and Data Governance – especially when care hasn’t been taken to make it easy and quick to appropriately record that information.

That matters because documentation is how healthcare providers get paid and how successful they appear in the eyes of their potential patients. “It’s how things get reported out, how a facility looks compared to other hospitals on Hospital Compare or other patient safety organizations that report outcomes based on data submitted, [data] that might not get captured or isn’t captured correctly,” according to Krista Joy Casey, business advisor, McKesson/Relay Health Intelligence.

Patient care should be nurses’ priority, “but they need to understand what their impact is on everything else.” If a newborn’s weight is quickly jotted down in pounds, rather than the official reporting standard of grams, for instance, that hospital is going to stand out for the number of 413 pound babies born there!

In her past work at Lehigh Valley Health Network, where her roles included working with nurses on clinical quality improvement, Casey saw the disconnect that existed between nursing and departments like IT that sometimes contributed to the Data Governance and documentation dilemma. Healthcare professionals, she told an audience at the Enterprise Data World 2016 Conference in April, are big step counters. It’s understandable, given that they’re dealing with multiple patients and often urgent situations. So, if they perceive that something can be done in four steps but they’re being asked to do it in nine, that’s not going to fly.

If IT changed a documentation procedure so that it had the effect of multiplying or repeating data entry steps, it could lead to nurses finding ways to work around it. Without interaction across division lines, neither party would realize the impact that their actions ultimately could have on Data Analytics. And, when nurses feel overloaded simply by the amount of data they’re being asked to record because there’s a mismatch in the alignment between metric reporting, real quality improvement, and revenue, the chances that they’ll make incorrect entries that can lead to faulty analysis only grow.

Time for a Tune Up

While the mantra used to be “not documented, not done,” today it’s “document things in the right way, in the right place” so that it can be appropriately measured and correctly analyzed, she noted.

But how can those leading up Information Governance efforts make that happen given issues like the ones described above? In many respects it’s about understanding the nursing culture and the organization’s real requirements to assure that it doesn’t get dinged on payments or ranked lower than it should be in terms of patient metrics.

Here are some ideas she provided to help move healthcare facilities in the right direction when it comes to the linkage between Data Governance and healthcare Analytics:

• Spread the word to everyone in the hospital, nurses included, that if they’re recording information, they’re a Data Steward. And good documentation of the good patient care they are providing is part of the role of being a Data Steward.

• Encourage everyone, including nursing staff, to use plain English in discussing information with patients related to their medical background and status. For instance, instead of using the acronym “PCP” that may be the data field name in an electronic form, ask the patient who is their family physician – especially in the case of elderly patients who are likely to be even less familiar with the shorthand term and thus may provide incorrect information.

• Be wise about processes around core measurements. Find out if having to document essentially the same information in multiple fields can interfere with nurses’ ability to properly perform both their care and documentation jobs, and explore what options may exist to better the situation. For instance, if a form basically asks to document patient fall scores in eight places, just make sure the nurses know which of those places actually matter and must be filled out in order to inform reporting to insurers or other parties. Or perhaps see if there isn’t a way to have the seven other places on the form removed entirely.

• Excite nursing staff about the value of what they are doing when it comes to Data Governance and documentation. Most nurses, for instance, are likely to be attracted to the idea of working for hospitals that have earned Magnet status, an award given by the American Nurses’ Credentialing Center (ANCC), an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing.“They can relate to that,” Casey says.

Obviously, hospitals have to provide good data to showcase that. Only about 6% of U.S. hospitals achieve Magnet designation, so a high bar is set, but nurses that work in these facilities gain benefits such as enhanced interdisciplinary collaboration and professional growth opportunities.

Speaking of professional growth opportunities, the rise of the Chief Nursing Informatics Officer (CNIO) is on the rise. “The number is growing,” she said, and those nurses who are interested in pursuing that direction can be strong advocates of improved Data Governance among their peers, too.

• Make sure nurses understand that they’re valuable partners in the ongoing task of improving healthcare. In a world where evidence-based care is more common, the data they collect can have a significant impact on crafting individual patient treatment plans – sometimes very complicated ones – to achieve the best possible outcome for difficult diseases. They also can be the ones to bring up to IT that there’s a new diabetic regimen coming down the line, for instance, and that new fields will be needed in electronic forms to accommodate documenting it.

• Ensure that all parties understand strong Data Stewardship is critical to the hospital’s ability to collect fees for services. Pay for performance environments demand that hospitals document their care, and not doing so properly can threaten institutions’ viability. For example, nurses have to be as diligent about recording that they turned patients every two hours to avoid bed sores as they are about actually doing it, or that they record that the sore was there upon patient admission. That’s because today, if bed sores are deemed to be a hospital-acquired condition because such documentation was lacking, the hospital won’t be reimbursed for treating it, she said.

• Explain how improved data gathering can help them get the staffing they need to better support their own nursing units. If, for example, staff doesn’t regularly enter the true times that mothers and new babies are discharged but rather does it in a batch at the end of the day, it will never be clear that extra staff is needed in the maternity unit between 10 am and 2 pm, which is the actual time that the discharges usually take place.

“Nurses are very important in Information Governance,” Casey said, and should be helped to feel ownership and responsibility for Data Governance projects. “If they can see the vision of the organization for Analytics, they are more likely to come on board.”

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