Complexities of a Provincial CIS Implementation: Thinking Beyond Scale.

CIS implementations are complex processes involving numerous teams, planning changes to both business and technical processes, and extensive change management. The complexity of implementation increases exponentially when dealing with implementation across an entire province rather than just a single site implementation. This paper addresses the One Person One Record Program in Nova Scotia, Canada where a single CIS will be implemented across the entire province involving 47 acute care facilities and 1400 individual ambulatory clinics. Developing and delivering localized role-specific training to end users is directly affected by the extensive arrange of unique user roles and is part of the complexity in this transformation program. Challenges arising from the additional complexity will be shared as well as lessons learned to support the implementations of future leaders with plans to lead such transformations in their own regions.

Supporting the Development of Informatics Competencies Among Senior Nurse Leaders in Canada.

This poster will provide an overview of the various initiatives completed to support the development of informatics competencies among senior nurse leaders in Canada. These initiatives have included a literature review to uncover competencies of relevance to the Canadian context, and a Delphi study to achieve consensus on the competencies for Canada. Current and future plans will be discussed to translate these competencies into practice among senior nurse leaders.

Digital and informatics competencies: Requirements for nursing leaders in Canada.

The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.

Adapting and validating informatics competencies for senior nurse leaders in the Canadian context: Results of a Delphi study.

BACKGROUND: Nurse leaders in senior leadership positions in various parts of the world can play an important role in the acquisition, implementation and use of health information technologies. To date, international research related to nurse leader informatics competencies has been carried out in specific healthcare delivery contexts with very specific health information technology environments. In this body of literature, the definition of a 'nurse leader' has not been clearly defined. As a result, it is challenging for senior nurse leaders in leadership and management positions in other countries to apply this research to their unique contexts. PURPOSE: The objective of this study was to obtain consensus on the informatics competencies of priority to senior Canadian nurse leaders. The goal of completing this work was to adapt and validate a set of nurse leader informatics competencies to be endorsed and supported nationally. METHODS: This study used a modified Delphi technique with a panel of nurse leaders with significant informatics knowledge from across Canada. Three rounds of information gathering were completed electronically. In Round 1, participants were provided a series of 26 potential competency statements obtained from a review of the literature; they were asked to comment on the clarity and wording of each statement. Two statements were eliminated after Round 1 due to redundancy. In Rounds 2 and 3, participants rated the remaining competency statements on a 7-point Likert scale for relative priority to nurse leaders. RESULTS: A total of 25, 24 and 23 participants completed the survey in Rounds 1, 2 and 3 respectively. Consensus was achieved at the end of Round 3 with the inclusion of 24 competency statements. All of the statements had a mean of 5 or greater on a 7-point Likert scale (1=low priority and 7=high priority). CONCLUSIONS: The study participants agreed upon 24 informatics competency statements of priority to Canadian nurse leaders. These competencies will be presented to senior national nursing leaders and nursing informatics organizations for endorsement. Inspired by work completed in the United States, the authors plan to develop a self-assessment instrument for use by Canadian nurse leaders using the identified competency statements. Future anticipated work includes identifying and creating resources for nurse leaders to develop these important informatics competencies.

Nurse Leadership and Informatics Competencies: Shaping Transformation of Professional Practice.

Nurse leaders must demonstrate capacities and develop specific informatics competencies in order to provide meaningful leadership and support ongoing transformation of the healthcare system. Concurrently, staff informatics competencies must be planned and fostered to support critical principles of transformation and patient safety in practice, advance evidence-informed practice, and enable nursing to flourish in complex digital environments across the healthcare continuum. In addition to nurse leader competencies, two key aspects of leadership and informatics competencies will be addressed in this chapter - namely, the transformation of health care and preparation of the nursing workforce.

Tripartite Governance: Enabling Successful Implementations with Vulnerable Populations.

Vulnerable populations are often at a distinct disadvantage when it comes to the implementation of health information systems in an equitable, appropriate, and timely manner. The disadvantages experienced by vulnerable populations are innumerable and include lack of representation, lack of appropriate levels of funding, lack of resources and capacity, and lack of representation. Increasingly, models of representation for complex implementations involve a tripartite project governance model. This tripartite partnership distributes accountability across all partners, and ensures that vulnerable populations have an equitable contribution to the direction of implementation according to their needs. This article shares lessons learned and best practices from complex tripartite partnerships supporting implementations with vulnerable populations in Canada.

Adaptive Practice: Next Generation Evidence-Based Practice in Digital Environments.

Evidence-based practice in nursing is considered foundational to safe, competent care. To date, rigid traditional perceptions of what constitutes 'evidence' have constrained the recognition and use of practice-based evidence and the exploitation of novel forms of evidence from data rich environments. Advancements such as the conceptualization of clinical intelligence, the prevalence of increasingly sophisticated digital health information systems, and the advancement of the Big Data phenomenon have converged to generate a new contemporary context. In today's dynamic data-rich environments, clinicians have new sources of valid evidence, and need a new paradigm supporting clinical practice that is adaptive to information generated by diverse electronic sources. This opinion paper presents adaptive practice as the next generation of evidence-based practice in contemporary evidence-rich environments and provides recommendations for the next phase of evolution.

Instantiating informatics in nursing practice for integrated patient centred holistic models of care: a discussion paper.

AIM: A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. BACKGROUND: Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. DESIGN: Discussion paper. DATA SOURCES: A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. DISCUSSION: The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. IMPLICATIONS FOR NURSING: A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. CONCLUSION: Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models.

Innovation in transformative nursing leadership: nursing informatics competencies and roles.

In a recent brief to the Canadian Nurses Association's National Expert Commission on the Health of Our Nation, the Academy of Canadian Executive Nurses (ACEN) discussed leadership needs in the Canadian healthcare system, and promoted the pivotal role of nursing executives in transforming Canada's healthcare system into an integrated patient-centric system. Included among several recommendations was the need to develop innovative leadership competencies that enable nurse leaders to lead and advance transformative health system change. This paper focuses on an emerging "avant-garde executive leadership competency" recommended for today's health leaders to guide health system transformation. Specifically, this competency is articulated as "state of the art communication and technology savvy," and it implies linkages between nursing informatics competencies and transformational leadership roles for nurse executive. The authors of this paper propose that distinct nursing informatics competencies are required to augment traditional executive skills to support transformational outcomes of safe, integrated, high-quality care delivery through knowledge-driven care. International trends involving nursing informatics competencies and the evolution of new corporate informatics roles, such as chief nursing informatics officers (CNIOs), are demonstrating value and advanced transformational leadership as nursing executive roles that are informed by clinical data.

C-HOBIC - Standardized Information to Support Clinical Practice and Quality Patient Care across Canada.

Canadian Health Outcomes for Better Information and Care (C-HOBIC) is leading the collection of standardized clinical outcomes reflective of nursing practice. C-HOBIC introduces a systematic structured language for patient assessments across the health care system enabling abstraction of information into jurisdictional EHRs Thus the information is available to clinicians across the health care system. This paper provides the background to C-HOBIC with an overview of the evidence supporting the clinical outcomes; the methodology for the electronic collection and abstraction of outcomes including the implications of including nursing information on databases; and describes the approach to coding information for interoperability and comparability of clinical information across the health care system.

Representing nursing practice: evaluating the effectiveness of a nursing classification system.

The purpose of this study was to examine the effectiveness of the International Classification for Nursing Practice (ICNP) in representing the contributions of nursing to health-care outcomes in Canada. The ICNP BetaVersion was used to code retrospective nursing data extracted from patient records originating in acute care, in-patient mental health care, home care, and long-term-care practice settings. In spite of wide variation in documentation practices, ICNP achieved matches with the majority of nursing data. The study revealed areas for improvement in the ICNP BetaVersion, specifically with regard to granularity related to the use of natural language terms and professional terms. Recommendations for further development through research in nursing-sensitive outcomes are discussed.