A conversation: with Naomi Dobroff
24 June 2021
Adjunct Associate Professor Naomi Dobroff, chief nursing and midwifery information officer (CNMIO) at Monash Health sat down with our very own Michael Draheim to share some insights around her experiences as a CNMIO and her passion for the profession.
Welcome Naomi and thanks for the opportunity to speak with you today. I want to start by asking what it is that you most value and enjoy about your role as the CNMIO at Monash Health and the Victorian Heart Hospital?
I love the variety! I love that every day I turn up to work and there is something different that I need to do. Whether that’s a professional meeting, navigating an issue that we’re having, being part of a working group that’s looking at workflows, or something specific to EMR – every day is completely different. I also love constantly advocating for nursing, midwifery, and our consumers. What gets me out of bed each morning is knowing that we’re doing to best we can to really work on clinical information systems and digital health solutions that support nurses, midwives and our patients.
What advice would you share with someone who is considering taking on a CNMIO role or has just started in that job?
The key thing for me is that you really need to be a professional and patient advocate. That’s really important in this role because quite often you’re the only person in the room advocating particularly for nursing and midwifery. Nursing and midwives have a different approach to advocacy, and I think that – along with leadership – are huge factors in this role. Another important piece is not being afraid to have a voice in a room. In fact, quite often I’ve had to reflect on the fact that I’m in this role and I do have a voice – otherwise what’s the point?
That takes the concept of advocacy, which is embedded in our professional standards, and moves it into a broader, different aspect.
Yes, that’s right, and I think that’s where people say “how can you still be a nurse? You haven’t looked after a patient for however many years.” It may be true in a sense, however when I look at our professional standards – I meet them every day with the work that I do, it’s just in a different way.
We’re coming up to the second anniversary of Monash Health's digital go-live, which is a great milestone, and there is currently a lot of work being done around the Victorian Heart Hospital (VHH). What are some of the benefits and challenges that you’ve observed through your work at both Monash and VHH to date?
It is very exciting – I can’t believe that it’s nearly two years! The first thing that comes to mind is the real requirement to engage as many people as you can. Certainly, with our first implementation it was across every site and service – it was massive. If I had my time again and I got the chance to really engage even more broadly I would. That engagement and change management piece is really important as we go from that phase one into a specialty hospital (VHH). In terms of challenges, it has been equally about getting people to adopt workflows. Particularly because we didn’t get the chance to go back and engage in the way we probably normally would because of COVID. Nurses being nurses, we’re very much ‘people’ people and we like to go and be face-to-face and at the elbow to provide support. We weren’t able to do that, so there is still some work to do around adoption. At the same time, we’ve got another group that we’re uplifting with the Victorian Heart Hospital and progressing that, so it’s probably a challenge but also quite an opportunity in this scenario as well.
What has been your reflection on the nursing profession’s ability to adapt and adopt under the challenging circumstances?
I think it’s extraordinary. To go from nurses and midwives at the bedside using paper – and only really a paper workflow – which included folders at the end of the bed and big histories at the nurse’s station – to now having WOWs, computers and scanners, and tapping on and off to devices and being able to still provide amazing patient care is extraordinary. Every nurse and midwife has absolutely risen to the challenge, and we’re all very grateful to have had an EMR in place during COVID. The amount of change that we have been able to implement and what people have really been on board for has been extraordinary.
We’ve spoken before about one of your passions of ensuring that in the digital world, nurses are able to spend the right amount of time at the bedside - because ultimately, we’re here to care. From a nursing profession point of view, what are some of the strategies that yourself and the leadership at the bedside have put in place to ensure that this can be driven through the organisation?
We did a huge change program and a huge training program, and although there was a degree of nervousness, every single one of our nurse managers and staff were incredibly enthusiastic about that. Being able to get any time back is extraordinary, as is being able to document care at the bedside whilst with the patient. Care and documentation are the same thing, and they have to be seen as the same thing. So, being able to provide the workflows that enable that has been extraordinary. Also, the amazing ongoing work that my colleagues are doing around training really continues to drive that adoption. It’s a huge change.
From a professional point of view, have you seen the digital approach embed itself into what is your traditional governance, strategy and development process?
It’s been interesting because nursing education operates separately to us and all of a sudden, every time there is a change to a nursing education piece, they’re on the phone saying, “what does this look like in EMR?” We’ve certainly come together much more closely than I think we all expected that we would, but it was amazing how quickly that happened. As we continue to work together, although we’re separate departments, we are thinking much more as a cohesive group now.
There is a big shift happening in the industry towards value-based and consumer-driven care. What does that mean for organisations like Monash Health and how you will operate in a consumer-driven world?
The VHH program is bringing with it some really amazing pieces for our consumers – the consumer patient portal for example. We had a lot of consumers involved in our phase one program, so we are picking up the work that we’ve done there and further including and in fact co-designing pieces of EMR with our patients, which is extraordinary. The requirement to include patients is key and I think that we’re very fortunate to be able to do that, because we have such a broad range of consumers who participate in all sorts of committees and work across Monash that we’re able to tee into. Co-designing with consumers is going to be really fun!
Are you also starting to think about online PREMs and PROMs?
Absolutely, we are looking at how we support that. One of the key things for us is that a lot of our patients don’t necessarily have English as a first language and aren’t necessarily as IT literate as others – there’s always variation. So, how do we support the broadest range of patients that we can in that environment? The ability to get a lot of those experiences from patients before they’ve even entered the health service will be extraordinary. I’m really looking forward to the PROM and PREM work and being able to talk to consumers about the impact that will have. Those conversations are going to be really rewarding.
Are you seeing a different approach in your digital world to how you manage data and analytics with regards to the concept of value-based care?
Yes, there is an absolute hunger for data, and of course one of the roles that we have is turning that data into information that can be consumed and understood and provides value to people. We have an absolute appetite for anything and everything and we get requests all the time, so that we can really make sure that we understand what’s happening with our patients and we’re able to make sure that we’re fulfilling all of those requirements. Our business intelligence (BI) team is amazing and we’re working with them all the time to progress our work in this area.
If we look back at what’s happened over the last 18 months to two years, what’s the one thing that you’re most proud of?
I think it would be the resilience of the nurses and midwives at Monash Health. They have been able to implement and change their practice, and really the whole paradigm of health changed for our inpatient teams and to be able to swing to that and then of course somehow get through a pandemic and somewhat out the other side, plus we’ve always got little optimisation pieces that we’re working on, and just at the end of the day to see how they’ve managed has just been extraordinary. Also, the fact that we’ve been able to broaden our informatics team and better understand how we can work together with nurses and midwives across the health service is great. The whole multi-disciplinary team have just slotted back in together – there are always tweaks that need to happen, but every day they’re coming to work and contributing so much – it’s just amazing.
Yes, the pace of change and the ability of teams to adapt has been amazing. Thank you for sharing your insights Naomi, it’s been a pleasure chatting!