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November 13, 2006
Saint Barnabas Medical Center in Livingston, N.J., has more than 4,000 employees who work in approximately 200 departments. All these employees—from the clinicians to administrators and support staff—routinely need to follow a vast number of policies and procedures. Since healthcare is a dynamic field, these policies and procedures—particularly those related to clinical care—change constantly, a situation that can be problematic. According to directives from JCAHO, healthcare providers need to provide all employees with access to updated policies and procedures at all times. The domino effect is considerable: When an administrator or clinician initiates a new policy or policy change, the updated information needs to be dispersed to approximately 200 department heads. These departmental managers then need to make sure all affected employees have access to the most recent information. In addition, JCAHO requirements stipulate that the outdated policies are archived instead of destroyed. Like other hospitals, Saint Barnabas was publishing its policies and procedures on paper. Using a paper-pushing manual process to keep policies and procedures updated, however, presents the following problems: • Potential for miscommunication. As the changes transverse from person to person and document to document, there’s ample potential for mistakes to be made or information to be added or omitted. • Propensity to fall behind. With so many policies and procedures, managers can easily let important new policies and changes sit at the “bottom of the pile” for days, weeks, even months before actually communicating the information to affected employees. • Poor access. With each department manager keeping individual records of policies and procedures, it’s often difficult for employees to know exactly how to locate current information. For example, some department managers may keep policies in a binder, while others could have the policies filed in hanging folders. Plus, many employees are subject to policies emanating from several departments. For example, a nurse may have to adhere to policies emanating from human resources, emergency services, and infection control, just to name a few. • Considerable ongoing costs. The copying and paper expenses when a simple policy change is initiated can add up. The costs multiply, however, when complicated, multipage policy documents are introduced into the mix. With so many inherent pitfalls in a manual policy and procedure process, administrators at Saint Barnabas decided they needed to find a better way to provide employees with access to current policies and procedures and satisfy related JCAHO requirements. As network manager in the IT department, I was charged with coming up with a solution. It quickly became apparent that we needed to explore the possibility of establishing an intranet that would provide up-to-date access to policies and procedures. But as I worked with departmental managers and other staff members to discover their needs, I discovered that the intranet would have to include sophisticated functions that would provide the following: • Easy document publishing and management. Instead of having to rely on IT professionals to update content on the intranet, Saint Barnabas needed to develop a system that would make it easy for individual users to update content. For example, we wanted to make it possible for department managers charged with keeping specific policies and procedures current to be able to upload new documents on the system independently and efficiently. • Security. Even though we wanted to enable managers and other staff members to update content on the system, we also wanted to make sure access was granted only to users responsible for and authorized to update specific policies. Plus, we wanted to develop an intranet that would make it possible for administrators to designate which users can change information at the portal level, page level, or a specific section of a page. • Automated archiving. While JCAHO requires that all employees have access to current policies, the accrediting organization also requires that healthcare providers keep a historic record of all policies. So, we also needed an automatic archival feature in the intranet system. • Policy review reminders. In addition, we required a system that would proactively alert administrators when policies needed to be reviewed. According to JCAHO, each and every policy needs to be reviewed and accessed for potential changes every two years, even if the policy is not slated for changes. With built-in alerts activated on an intranet system, administrators would not have to keep tabs on which policies are up for review. Instead, the system could automatically remind managers to conduct reviews. • Enhanced communications. To improve communication throughout the hospital, it was determined that the intranet should include features such as an online phone directory, a physician roster, and an on-call scheduling system. With this list of functionality in place, I decided we did not have the internal IT staff members available to develop an intranet that would meet all our needs. Instead of giving up on the project, though, I identified an outside vendor that could cost-efficiently provide the needed intranet functionality. Working closely with ProcessDATA LTD, a Schaumburg, Ill.-based company that specializes in intranet implementations for healthcare, I was able to develop an intranet that met Saint Barnabas’ needs. With the system in place, employees are finding it easy to comply with JCAHO policy and procedure requirements. In addition, employees now find it much easier to know where to find needed information and, as a result, are more likely to routinely check policies and procedures. What’s more, because the employee intranet contains a plethora of valuable information—from hospital news and events to phone numbers and cafeteria menus—employees routinely use the intranet and, therefore, routinely keep up to date on policy and procedure changes. And, of course, that’s the true intent of JCAHO’s policy and procedure access requirements. — John Das is network manager in the IT department
at Saint Barnabas Medical Center in Livingston, N.J.
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