https://ehealthforum.nz/t/urgent-poll-the-value-of-digital-literacy-in-health-workers/12598/22
Exactly Emma 
.
Hi
it was not my original intention to talk about systems (frustration led me there)
It was how do we define digital literacy, how do we asses it, who has to have it and at what level.
All of those topics in the circle are relevant.
If we are talking about our colleagues in health and the public then I believe it is an awareness assessed along the lines of competence as part of your employment contract. Easy to implement as a yearly or triennial certificate (employers like this as it offloads responsibility!). The public is a bit more difficult, they read and hear what they want to (back to smoking cessation again!); I think it is our responsibility as the health informatics profession to protect the public (I donāt mean as a ānannyā state) by setting down standards for information systems, in the widest context not just software.
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That is spot on, David, the integration of digital technology has to enhance nursing care, not take time from it, there is so much that could be integrated to free up nursing time currently taken recording data still on paper or transposed onto a computer away from the patient.
It all depends on the tech available in the hospital. The further away from a tertiary centre, the less there seems to be and the more challenges associated with internet stability and speed.
I work as an agency nurse ( currenly locked out of NZ and into WA) and the variability in tech access and skill base is as diverse as you can imagine. I was at the HINZ conerence last year, so know this is a similar situation in NZ (which is home and where I work between contracts)
I think the Covid 19 crisis has caterpulted everyone into using online communication for virtual meetings and has advanced integration into health care delivery positively to the most conservative of practitioners.
Necessity is the mother of all invention and that is why discussions around this topic must be and are urgent
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Hi @Judytime4nowc I agree with you as a nurse at the clinical IT table, integration and education are the keys. change management is hard enough but even harder if it does not make sense to all those using it or indeed takes more time away from core business.
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I agree @Mat the level of digital literacy required by a nurse on the floor is different to the level of digital literacy required by an informatician and by a member of the public. We have large sections of the healthcare population who have little or know knowledge around the basics of using digital devices. Thing such as finding a menu, breadcrumbs, home screen buttons on web pages to name but a few. Without these basic skills any training on top of this is going to be irrelevant. However I agree with @grahame.jelley that a good driver diagram could help us to clearly determine the problem so the solutions can be targeted. The webinar featuring Richard Corbridge from UK on 7/5 was really interesting and looked at a number of these issues. We are the right people to do this!
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Absolutely, Lisa,
There has to be understanding why the data is needed in such detail for research purposes.
The clinical nurse must feel that provision of data to improve health care in the future, is not at the expense of caring for the patient in the present, with time taken to log on, plough through menus etc, detracting from hands on care. Nurses often stay on after their shift ends to complete data entry, a time managememt issue that comes from prioritising patient care over data entry.
Judy
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One of the masters students at AUT is researching buy in from nurses in relation to trend care and developing some education related to this for WDHB.
I would love to look at drawing information form more digital sources and presenting this to nurses so that they could readily see the impact their data has. I believe nurses often donāt think of āresearchā as being forecasting and planning which much data is used for.
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This is a great topic! I see the role of Clinical Informatics to essentially act as the ātranslatorā between the clinicians and the engineers.
As a midwife, I became frustrated by what I saw were endless efforts to jeopardize my ācaring for patientsā time, by entering data requirements requested by DHBās, seemingly without the necessary thought process behind āwhatā data should be required (this was trendcare in a nutshell back in 2015).
I think one of the key issues behind e.g. electronic records is the fact that saving administrators administration time is a priority - which merely passes the requirement to the clinician. Creating frustration for the clinician and embeds firmly the understanding that electronic systems add to the workload.
I agree that the systems need to be based on the end-user requirements, and not training the end-user to learn the system. One of the pivotal questions here is, what does consumption of digital look like, to both the Clinician and the health consumer?
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Agree Ruth, I work in Allied Health and am grateful for the opportunity CoVID gave us to catapult AH into using digital media across the board - those who have experience and /or interest in digital literacy and those who suddenly had to learn how to be more digitally literate. There needs to be more investment in learning and self-development in digital media, and a sense of well-being in using technology. We had positive outcomes using TH during CoVID proving the value of digital practice.
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There are different levels of Digital literacy and I love Ruthās graphic as to the dimensions of digital literacy. But I think the conversation to date is across different skill levels in our organizations. At work, we have just been rolling out new devices and technologies to support the business to deliver the local COVID-19 response. For some staff, this was obviously a brave new frontier for them and learning the real basics in a supportive environment would make life easier.
Common support issues that we had to deal with;
- You do need to plug your PC into the wall before it works.
- Laptops come with an inbuilt camera.
- You donāt need a different iPad for each different application.
- Yes, we can provide support around how to use a browser.
- You do need to change the WiFi selection you use when you change location.
And that is before we get to basic numerical literacy or using productivity tools like a spreadsheet.
It was obvious the many folks had effectively rote learned their existing applications, so could not generalised the problem solving to a new application or delivery mechanism. Or had avoided engaging with technology for fear.
These are the people who need our help to support their transition into Digital Health. Their need with the very basics is both urgent given the situation but also something as Health Informaticists we are in a unique position to help them with. They deserve hope and compassion.
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@Greig brings the discussion down to earth in a specific way. Actually his examples bring to mind an ancient Chinese poem Iām trying to recall:
Tremble be fearful,
Night and day be careful.
Men do not trip over mountains -
they fall over earth mounds.
Iād like to suggest that āthe problemā represented here may appear technological in nature but is actually a broader issue that can and probably should be dealt with in quite a different way. Some people ( perhaps most?) are walking around with gaps in their knowledge that (a) they are probably quite aware of, if not painfully aware of or ashamed of and (b) they donāt appear to have routine ways to resolve those gaps ( aka āask for helpā) meaning these gaps persist and the personal, team, and social costs of their gymnastics trying to avoid having the gaps exposed are significant and continuing.
This is not really an āeducationā problem because at the speed life will be changing from now on, we all will be facing such issues with new things we never learned or only half learned and now all our wisdom is obsolete. It is not only a problem of RNās, or nurses in general, or health care front-line workers in general ā every level manager and supervisor and leader and Chief Executive Officer has areas they really wish the discussion would not force them into. Many large scale systems have been pushed on hospitals in the US by unscrupulous vendors who exploit managersā reluctance to admit they have no idea whats being discussed.
In the Toyota Way of management, totally opposite typical Western styles, mistakes and problems are consciously and intentionally surfaced, embraced, and solved, even those that upper level management is the cause of. The result is a very high performance system.
So my focus question is ā are people working in an environment of psychological trust where they are free to openly admit they donāt know things and ask for help? This is considered by researchers a key factor in a high-performance team. See Amy Edmondsonās work: https://journals.sagepub.com/doi/pdf/10.2307/2666999
Someone in an earlier post mentioned whether we needed a 3 hour education in use of a cell phone. In fact, in my own experience, I was taking a remote course at Johns Hopkins University in I think 2006 and asked if we could set up a video conference to chat about something and none of the world-renowned PhD faculty knew how to do that. At the same time cell phones were coming out with advanced features and I observed at a friendās house that every 8 to 12 year old child seemed comfortable with using a mobile phone. It struck me then, and has continued to burn in my mind as something profound, that a GGG = Giggling Gaggle of Girls ( excuse the sexism ) could master technology easily while an entire school full of PhD level faculty could not.
This is not an issue of āeducationā or ātrainingā ā if anything, our concept of competitive training and competitive work places and emphasis on very high performance has paradoxically created a learning-disabled elite of lonely and scared individuals.
That I suggest is what we need to fix. The rest of the knowledge will then flow unobstructed with no further requirement for scholastic courses and exams.
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@Srgurr. Great post . Is the same for GP. Many hours non contact after hours ensuring notes correct and timely, results reviewed and filed and patient care ensured. Issue must change from ācount what you can measure ā to ā measure what countsā. Always easy to add measures without considering impact on foot soldiers and always difficult to remove the measures once implemented. Many reports never see light of day Based on some of these ānice to measureā measures
Grahame
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Very nicely said @Greig. I find that many health professionals are worried about looking stupid and the tech just gets too much for them. Compassion and hope 
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If increasing digital literacy means that:
- My colleagues will no longer be told by research funders that our proposed electronic tools donāt exist, as a sole reason to have funding declined, when weāve just spent the entire proposal explaining how we are going to use the said existing, functioning tools;
- My departmentās Quality Assurance committee turns to Quality Improvement because QA has been automated by getting clinical data directly from the source of truth (and not yet another audit form);
- My CD understands that spending resource on writeable PDFs is an unnecessary waste and should be pushed back against in exchange for a better solution (all without me splitting hairs in crafting a carefully and uber-sensitively worded email to explain why, without treading on someoneās toes somewhere ā¦ how dare I).
ā¦ then yes, I think itās important and should be done.
If it means:
- Corporate kumbaya and brainstorming sessions ā¦and then total trampling over those by management, in favour of a clunky cheaper system, which we are supposed to accept b/c we are now more digitally literate;
- Continued perseverance to fund and maintain, however poorly, 20 culturally distinct health IT systems for 5million people, because we are digitally literate and can make it all work;
- Ongoing self directed learning in my own time to adapt a past sales analytics program to dynamic health data needs, with no support because Iām supposed to just know how it works.
ā¦ eek, no thank you.
We need centralised, uniform direction on where we want to be in Dec 2021, as well as 2025 and 2030, without reliance on digital natives and adaptation of static systems for dynamic needs.
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Great examples, @eras, Era - thank you!
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The other arm of digital literacy is a collaborative approach to integrating new tools into clinical work flows. Even if the software were to be well designed with clinical input and intuitive usability at the forefront from the earliest stages of development , the turn it on and walk away approach to implementation will still mean that the uptake is slow, patchy and that users will adopt unpredictable approaches to software that make the tools less effective.
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No problem, 5 out of 6 of them are just from last week, unfortunately.
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This is Extremely Important
Great post @Greig. Couldnāt put it better. As a senior healthcare professional these are the people I deal with every day and these are the people who need the most urgent help and support.
I agree with @rose.laing ā any great software product should be a living system which converges more and more on what the end users actually need, not what the developers originally thought they needed. I ran a software team and we found users were generally quite gracious about putting up with gaps or ill-fits if the solution was in the works, but were not so happy if a solution seemed far away or a never-event. Regardless we had a saying on the wall, that happy users can make almost anything work, and unhappy users can make almost anything fail.
These days, however, long inexplicable delays on the developers part on fixing stuff are inexcusable. The days of manually ācodingā software behavior are gone, along with most of the jobs for ācodersā. Automated software development Integrate Development Environments with drag-and-drop functionality let a new system be āwrittenā in days, not years. There will always be long times gathering specs, and long times doing validation testing before release of a critical-life-safety system, but those are explainable and one can follow along. Failure for 2 years to fix a field that is the wrong size for the data that goes into it is inexcusable.
In fact, new applications are developed in frameworks like GitLab, which are based around continuous improvement and a āpipelineā that sucks up feedback from end users, converts it to improved software, and automates the whole regression testing, validation, new documentation process.
Meanwhile of course , there is the unspoken reality that there will be gaps between what the software does and what happens on the clinical floor ā and that means there will be a whole sort of epigenetic aura of āwork-aroundsā that real nurses have to use to get real work done.
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