CAVITE STATE UNIVERSITY

Don Severino delas Alas campus

COLL EGE
OF
NU RSIN G NU RSIN G
IN F OR MATI CS
SECOND
SEMESTER,
A.Y. 2020-2021

NU RS 11
READING
MATERIAL

IVAN DEREK
VILLENA WYCOCO,
RN, MAN
INSTRUCTOR 1

2021
ABOUT THE
AUTHOR

3
 “There are no
secrets to
success. It is the
result of
preparation, 4.

hardwork, and
learning from
failure.”
-Colin Powell

4
READING MATERIAL

Duration: 2 hours

Methods/Instructional Technique
• Asynchronous Mode
• Reading material

Materials
• Paper and Pen
• Gadget

Content Outline
(Please refer on the provided teaching material as your guide)

Keywords:

o eHealth
o Nursing informatics
o Quality management
o Nursing workload measurement systems
o Nursing Systems

5
Introduction

Healthcare administrators face a variety of demands such as program planning, resource

management, fi nancial management, organizational reporting, and quality improvements.

Consequently, administrators have a need for accurate, timely information to support decision-

making, as well as tools to support the communication of such decisions. Information and data are

considered corporate assets, in that they provide the foundation for informed decisions. This chapter

covers both management information systems – those solutions that collect, synthesize and present

information and data to support decision making, and the offi ce automation systems which assist

administrators communicate their decisions.

Managers and caregivers throughout the healthcare system are constantly working to

increase the efficiency and effectiveness of patient care while simultaneously reducing or at least

maintaining existing levels of resource consumption. A principal strategy being used to achieve these

goals is to consider and use information as a corporate strategic resource and provide enhanced

information management methods and tools to caregivers and managers across the health sector.

The idea is to use information to help managers utilize available resources most effectively.

Administrative uses of information systems can be classified in two ways: those that provide

managers with information for decision making and those that help managers communicate the

decisions. In this material, the administrative uses of information systems that help managers with

decision making are called “management information systems.” Those applications of information

systems in nursing administration that help managers communicate their decisions are called “office

automation systems.” This material defines management information systems and describes the

information needs related to the management of clinical settings providing care to patients and

clients. It also concludes with the nursing role in the management of information and obstacles and

issues in management information systems.

The idea of management information systems was developed in the business and industrial

sectors. It has been studied, analyzed, and evaluated in detail by management scientists for

decades. In those sectors, there are many definitions of the concept of management information

systems (MISs). Some definitions place an emphasis on the physical elements and design of the

system, while others focus on the function of a MIS in an organization. In this material, MIS is a

“general term for information system that supports operations, management, analysis and decision

making functions within an organization; involves the use of computer hardware and software, data

and databases, and decision making”. The Health Information and Management Systems Society

definition of MIS “refers to either a class of software that provides management with tools for

organizing and evaluating their department, or the staff that supports information systems”.

Information Needs for the Management of Patient Care

Organizational information needs, as represented by its managers, are targeted to fulfill that

aspect of the mission related to the provision of patient or client care, regardless of the healthcare

setting where services are being delivered. Management information systems help nursing in the

areas of quality management, unit staffing, and ongoing reporting. Such systems also support

managers in their responsibilities for allocation and utilization of the following resources required to

deliver healthcare services in the patient/client care environments: human resources, fiscal

resources (including payroll, supplies, and material), and physical resources (including physical

facilities, equipment, and furniture). Patient care delivery can occur in many different healthcare

settings. This includes hospitals, long term care, health centres, community care centres, home care,

primary care (physicians’ and nurse practitioners’ offices), educational settings, correctional facilities,

and other community-based service agencies. As such, clinicians regardless of the physical setting

where they work, must have access to information for managing patient care. As patient care is being
delivered and documented electronically, data is being collected. This data can be transformed,

providing information that was previously not easily available in a paper environment. As more

technologies are made available at point of care, the data collected during the delivery of services

will provide a wealth of information and knowledge. This will allow for secondary use of data for other

purposes such as more customized health care delivery, quality management, system planning,

human resources planning, just to name a few. The use of data to demonstrate the value and use of

information in the continuum of care can be viewed in the attached documentation from the Canadian

Institute for Health Information (CIHI).

Quality Management

Total quality management (TQM) and continuous quality improvement (CQI) continue to be

commonly encountered approaches to quality management and improvement. TQM is an important

process for staff nurses and administrators alike. It is useful to staff nurses in two ways: it provides

them with feedback about the nature of their individual practice and provides them with opportunity

to infl uence patient care in their organization. Administrators use it to assess the general quality of

patient care provided within their organizations and as a process to receive and communicate

opportunities to enhance patient care and organizational effectiveness. A process of establishing

and maintaining organizational effectiveness (i.e., the quality of care provided to patients), TQM is

an institutional plan of action to empower staff to infl uence corporate achievement of the highest

possible standards for patient care. The delivery of patient care is monitored by all staff to ensure

that established standards are met or surpassed. Implicit in the concept of TQM is the ongoing

evaluation of the standards themselves, thus ensuring that they refl ect current norms and practices

in healthcare. Organizations use a variety of formal and informal means to gather information to

evaluate the quality of care provided to patients. The formal means are encompassed in a quality

assurance program. Information needs associated with quality assurance might include patient care
databases, patient evaluations of care received, nurses’ notes on the chart, patient care plans,

performance appraisals, and incident reports. These sources of information are reviewed by either

a concurrent or retrospective audit. Concurrent nursing audits occur during the patient’s stay in the

hospital, whereas retrospective nursing audits occur after the patient leaves the hospital. Audit

reviews are a major tool for any TQM program.

As the pressure continued to increase regarding enhanced data quality, documentation

comprehensiveness and the need for timely health information to assist clinicians in delivering

healthcare, integrated hospital information systems made their entry into the healthcare delivery

system. Quality assurance/improvement programs in nursing needed two things to succeed:

standardized terminology and standardized care plans. These two elements were also required if

information systems were to be any help to nurses in providing nursing care regardless of the health

care setting while ensuring seamless delivery of care across the continuum of care. The

standardization of terminology required for computerized documentation of nurses’ notes, and the

development of standardized care plans, coincided with the need for standardized terminology,

development of patient care standards and quality improvement programs. Quality assurance or

quality improvement programs are now implemented in most healthcare organizations and are key

for management at all organizational levels.

There is a growing emphasis on patient care outcomes as the major focus of nursing TQM

programs. Similarly, there is a growing trend away from the problem resolution model to a planning

model as the major criterion for measuring quality assurance. Simultaneously, there is an increasing

demand from the public for better resource management in the healthcare sector, and the public has

an increasing awareness of quality as a cost component of healthcare. As nursing leaders, we need

to process, analyze, and make timely decisions ranging from practice to management and planning

perspectives. These factors are creating a demand for more sophisticated computerized information

systems that are able to handle and process data which can be transformed into information to will

support decision making.

In the past, innumerable nurse leaders and supervisors in healthcare organizations and

agencies around the world spent countless hours each day “doing the time.” Even when master

rotation plans were used, manual scheduling of personnel work rotations could not eliminate all the

problems, such as vulnerability to accusations of bias when assigning days off or shift rotation,

difficulty establishing minimum staffi ng to avoid wasting manpower, and dependence on an

individual’s memory in the nursing administrative structure. Consequently, automated staff

scheduling is a highly desired component of a management information system for patient care

administration. Frequently, when an organization has limited resources and limited computerized

patient management information system, it mobilizes resources to set up a computerized staffi ng

system. This is becoming more critical as managers must plan for services that include not only

nursing but other healthcare professionals for the delivery of comprehensive patient care in many

different healthcare settings such as hospitals, long term care, community care centres, home care,

or anywhere where services are provided. Researchers at many healthcare organizations have

developed diverse systems for personnel time assignment. The complexity of these systems varies

greatly. Some merely use the computer to print names into what was formerly a manual master

rotation schedule; others adjust staffing interactively and dynamically on a shift-to-shift basis by

considering patient acuity, workload levels for one or more healthcare discipline, and the expertise

of available personnel. To develop complex, sophisticated systems for automated personnel

scheduling, a great deal of planning and data gathering is required: the workload must be identified

in the organization; the different healthcare professionals delivering services must be identified; the

various levels of expertise of staff members must be categorized and documented; criteria for

determining patient acuity and nursing workload must be established; personnel policies must be

clearly defined; and the elements of union contracts must be summarized. When all this information

is available, a computer program is designed to schedule clinical staff (nursing, physiotherapy,

respiratory therapy, etc.) on patient care units. The capacity of the computer to manipulate large
numbers of variables consistently and quickly makes personnel time assignment an excellent use of

this technology. Documented advantages of automated scheduling of personnel include the

following.

• Easier recruitment and increased job satisfaction because schedules are known well in

advance

• Less time spent on manual scheduling, thereby providing more time for nurse managers to

carry out other duties

• Advance notice of staff shortages requiring temporary replacements

• Unbiased assignment of days off and shift rotation

• More effective utilization and distribution of personnel throughout the institution or agency •

Capacity to document the effect of staff size on quality of care

• Ability to relate quantity and quality of nursing staff to patient acuity.

Workload measurement systems function with automated scheduling. Nursing workload

measurement systems (NWMSs), sometimes called patient classification systems (PCSs) are tools

that measure the number of direct, indirect, and nonclinical patient care hours by patient acuity on a

daily basis. PCSs and NWMSs have evolved to focus on providing uniform, reliable productivity

information to help with staffing, budgeting, planning, and quality assurance.

Management of people on a patient care unit is a complex, time-consuming task. In the

increasingly decentralized administrative structures that characterize healthcare organizations,

managers need information related to all aspects of the allocation and utilization of staff on patient

care units.

For example, the manager must have immediate access to such information as the following.

• Skills and education of all employees

• Job classification and salary level for all staff on the unit

• Dates for performance reviews

• Dates for recertifi cation of medically delegated and transferred functions, other professional

delegated activities

• Dates for annual education and ongoing educational sessions, whether required by contract, by

organizational policy, or by accreditation standards (e.g., back care, cardiopulmonary resuscitation,

fire and disaster response, restraints)

• Annual vacation schedule summary for the unit

• Statutory holiday schedules

• Labor relationships contracts for all collective bargaining units representing employees employed

on the unit, including grievance procedures

• Sick time records for each employee

• Seniority level

• Union requirements

Through access to the information systems using different platforms and databases, the manager is

quickly able to obtain the necessary information without the need to maintain duplicate records in
different formats. The Canadian Institute for Health Information (CIHI) has published a number of

reports that outline trends in human resources.

Nursing’s Role in Managing Information in Healthcare Organizations

In most healthcare organizations, the manager is responsible for a program that may include

a number of patient care units, nursing and different healthcare professionals. The healthcare

organizations are as varied as the settings where services are provided, and can include hospitals,

long term care, health centres, community care centres, home care, primary care (physicians’ and

nurse practitioners’ offi ces), educational settings, correctional facilities, and other community based

service agencies. In some healthcare settings, nurse clinicians are responsible for the clinical

practice and nursing process components, allowing the manager to focus on the administrative and

management components of the program/patient care units within the organization. Therefore,

nursing’s role in the management of information generally has been considered to include the

information necessary to manage nursing care using the nursing process and the information

necessary for managing patient care units in the organization (e.g., resource allocation and

utilization, personnel management, planning and policymaking, decision support). As the role of

nurses in organizational governance and decision making diversifies, their role and H. Clément

responsibility for information management to support these decision-making responsibilities

continues to evolve. Information related to organizational management, planning and policies, as

well as resource allocation and utilization, widely available to nursing staff, supports these roles and

responsibilities. During the last decade, we have seen nursing involvement increase in the Health

Information Management field. Clinical expertise combined with knowledge of the health care

environment and its intricacies have provided nurses with diverse employment opportunities such as

with software development companies, consulting firms implementing clinical systems, in change

management, project management and other transformational roles. COACH, Canada’s Health
Informatics Association has developed a career matrix that depicts the key role played by clinicians

in the health informatics field ([Link]). As a result, clinical use of technologies for

service delivery, management, planning and other key components are an integral part of Health

Informatics Associations around the world. These include associations such as the Health

Informatics Society of Australia ([Link]. [Link]), COACH Canada’s Health Informatics

Association ([Link]. com), the American Medical Informatics Association ([Link]),

the Healthcare Information and Management Systems Society ([Link]) and the Health

Informatics Society of Ireland ([Link]).

Management information systems and office automation systems enable the manager to

contribute to organizational efforts to increase the effi ciency and effectiveness of patient care and

program planning while simultaneously reducing or at least maintaining levels of resource

consumption. This can be accomplished in part by considering information as a corporate strategic

resource and thinking of the clinical managers’ use of information as a management method and

tool, thereby empowering the clinical managers to utilize available resources most effectively.

Suggested Websites

Canada Institute for Health Information, [Link]

Healthcare Information and Management Systems Society (HIMSS), [Link]

American Nurses Association, [Link]

Canadian Nurses Association,[Link]

Australian Nursing Federation, [Link]

Society for Quality Assurance, [Link]

Current nursing, [Link] NANDA [Link]

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