With recognition in 2014, WakeMed, a health system that employs more than 8,000 people in the Research Triangle area of North Carolina, has garnered its fourth BEST Award. "Being a leader in education is a central part of our organizational values," says CEO Donald Gintzig.
"We believe it is important to continually push the bar and innovate to achieve excellence. Our commitment to education offers the platform to introduce the new skills, standardize processes, and accelerate improvements in quality, safety, and patient-and family-centered care," adds Gintzig.
All told, WakeMed provides more than 160,000 hours of formal classroom training for staff annually, spending more than $2 million. Four education departments report to the senior vice president of human resources and talent development: nursing education, staff development and training, workforce development, and the Center for Innovative Learning. Established in 2006, the center was designed to build WakeMed's capacity for simulation- and technology-based education, and focuses on delivery via innovative technologies.
Its director, Amar P. Patel, says that the four departments work together in an environment of collaboration that crosses the domains of clinical, compliance, and soft skills training. The senior leadership team and WakeMed's board of directors participate in an annual strategic planning process that generates enterprise-wide and function-specific learning needs, as do WakeMed's many committees and councils.
The most critical business issue facing WakeMed during the past two years has been transitioning all patient records from paper to electronic format, then integrating them from disparate parts of the system into a unified health record. The volume is immense: WakeMed sees more than 230,000 patients annually in its emergency departments and delivers more than 7,700 babies each year. Additionally, WakeMed primary care and specialty care physicians who practice across the region see more than 327,000 patients annually.
Before the universal adoption of the Epic electronic health record software, there were many different health record systems in use, according to Patel. Epic has been rolled out to the physician practices and will go live in the hospitals in February 2015.
To prepare for the transition with the physician practices, multiple departments worked together to devise a carefully planned learning strategy, designing training plans to best meet the needs of all disciplines, clinical and nonclinical. Training was delivered 24/7 in a variety of ways, including online modules, instructor-led classes, self-paced learning, computer-based training, and train-the-trainer competency validation.
"With unified electronic health records becoming our single source of patient information, it will be crucial that all using the system have training and competency validation," says Patel.
Harriet Stephenson is the director of nurse education for WakeMed; nurses have distinct and specialized education needs. One training initiative is designed to reduce errors in medication administration, a crucial patient safety issue. But to design a program that addresses gaps in knowledge and process, errors must first be reported.
"If staff do not report errors, how can we identify whether it is human error or system processes that need improving?" Stephenson asks.
Rather than design a prescriptive, top-down training program, learning staff decided to leverage the value of storytelling and the connective power of personal experience to create a safe space for error reporting and encourage it. They launched an internal patient safety blog with stories specific to medication administration, shared anonymously by nurses who had made medication errors.
"They shared their experiences, highlighting that we should be aware how easily errors can occur," says Stephenson. The team also drilled down to see where challenges were, and determined that constant interruptions were a huge issue that could distract nursing staff and cause medication errors. Therefore, they implemented system changes too, including "red zones," actual red-outlined work areas where nurses inputting information are not to be disturbed. Patel says that reporting of errors has increased, while errors in documentation and order entry have decreased.
WakeMed promotes and enhances social learning through blogs as well as other social media tools, continuously posting information in multiple mediums to provide education across all levels.
A key patient care need is to get critically ill heart patients, especially from rural areas, directly into WakeMed's Heart Center. In its most innovative learning initiative of the past 12 months, WakeMed learning staff set out to see whether the transport process could be streamlined and shortened, thus improving mortality rates.
Using a human patient simulator named Stan, Patel and his Center for Innovative Learning staff created a simulation-based learning initiative to document the admissions process, determine learning gaps, and understand the patient and provider experience. Stan, who weighs 160 pounds and cost $75,000, is capable of breathing, blinking, and dying; he can be given oxygen, CPR, and medication, generating more than 1,000 data points per minute. Stan's caregivers would call local emergency services, who would evaluate his condition, then request helicopter transport to the cardiac hospital two hours away. Helicopter transport can reduce travel time to 37 minutes at an estimated cost of $10,000. Once transported to the helicopter, Stan's condition would worsen progressively; staff would have to begin treatment by inserting a heart catheter.
"After the simulation, staff were able to clearly identify areas where additional education was needed and procedures they would like to practice before managing real patients," says Patel. "While we see cardiac patients every day, very few arrive by helicopter directly into the cardiac center. It was important for the organization to understand and improve this process and the patient experience."
As a result of the simulation, WakeMed is able to decrease mortality rates, prevent delays in catheter placement, and improve efficiency. These efforts also supported a business goal: to increase the number of cardiac patients who come to WakeMed (already the busiest heart center in the state) from rural areas of North Carolina.
View the entire list of 2014 BEST Award winners .