by John Rossheim
Implementing a health-care IT system would be relatively simple if clinicians were automatons: Reprogram them and you’re done. However, surgical robots aside, those who care for patients are people with minds that must learn a new way of working and hearts that must be persuaded that innovation will improve the lives of their patients.
Minding the gaps between technology and humanity, between the streamlining of operations and the social realities of workflows, is what organizational change management is all about. Bringing human factors into the innovation equation is critical to success, because change doesn’t come easily to mere mortals.
“Change is resisted, even a welcome change,” says consultant Erik Van Slyke, founding partner of Princeton, N.J.-based Solleva Group, which has advised hospital management on health-care information technology (HIT) implementations. Nurses, for example, may worry about risks to patient safety when physicians’ orders are computerized.
On the organizational level, executives often delay change with the goal of reducing the risks of innovation, real or imagined. Even with billions of ARRA dollars devoted to stimulating adoption of electronic health records, change management is needed to change minds about HIT adoption. “Our concern is that the subsidies won’t change health-care providers’ late-adopter mindsets about information technology,” writes Austin Merritt in The Medical Blog.
It’s Not the Technology, It’s the Humanity.
A prerequisite for any successful HIT project is the acknowledgement that new technology should be built around the best practices of health-care professionals, not the other way around. “Human factors are the very challenges that can prevent the technical objectives from being achieved,” says Van Slyke.
Technology projects that don’t meet expectations are all too common, although the root cause of the disappointment is often misunderstood. “Failures are typically not due to the technology – it’s the change management,” says Scott Coplan, president of Coplan & Co., a Seattle consulting firm.
Step One: Identify the Stakeholders.
To create an IT system that will be broadly accepted by employees and will serve them and their patients well, managers must determine who all the stakeholders are, and bring them on board at the beginning of the project.
“Involve the providers in the decision to do the IT project and in the choice of new technology,” Van Slyke. “Make sure the end users are involved in specing out the requirements.”
Health-care employees, from data-entry clerks to medical technologists to neurosurgeons, all have ideas about how to build a better system to electronically record and share lab test data, for example. But to involve everyone, especially the lower-ranking employees, you’ve got to invite them.
A Group Effort to Map the Future.
“Get everyone engaged; they will start coming up with their own analyses,” says Van Slyke. “When you engage everyone, it’s emotionally powerful, because stakeholders will discover the needed changes themselves.”
HIT systems won’t succeed if they don’t incorporate best practices from the top down to the finest nuance. “You can’t buy a car or a CPOE without knowing what your requirements are,” says Coplan. The requirements for computerized physician order entry must be in tune with both business requirements and clinical realities. For example, “you want to have a patient scheduling system that lets you over-schedule,” Coplan says.
Executives and line workers should also try to anticipate key organizational consequences of technological change. “Technology will change a work process, which might change someone’s role, and all of that requires change to organizational structure, governance and decision-making,” says Van Slyke. “So in the change-management process, one of the first things to examine is, what will be the downstream impact of the technology implementation?”
Get Real About Workflows.
When it comes to assessing existing workflows and designing revamped procedures that will mesh with a new HIT system, many reality checks are needed.
In process redesign, “you have to look at how people do their work, how they interact with their coworkers,” says William Bria, M.D., chairman of the Association of Medical Directors of Information Systems. As chief medical information officer at Shriners Hospital for Children in Tampa, Fla., Dr. Bria’s team recently implemented Cerner, an EMR system, including functions such as CPOE, radiology, pharmacology and documentation scanning.
Adding to the complexity of redesigning workflows is the fact that hospital executives and middle managers may not know how the work gets done at the micro level. “Any assumption about continuation of old workflows is wrong,” says Dr. Bria. “You have to do actual charting of workflows.”
During a System Transition, Expect Worries About Patient Safety.
Clinicians who put their patients first will be deeply concerned about maintaining patient safety through a system changeover.
“The no. 1 concern for health-care providers is assuring there’s not the slightest glitch in providing patient care,” says Van Slyke. “The moment the nursing staff sees that there will be an impact on patient care, they will chatter. This will go upstream to executives and this will make them push back” on the project.
One approach to maintaining patient safety is to implement a new IT system in small steps. “It’s very important to take your time, to introduce things incrementally,” says Dr. Bria.
Communication Should Drive Change Management for HIT.
No matter what the job responsibilities of stakeholders, they don’t want to find out about a major IT project by accident or when it’s already well under way. “One of the most important methods to overcome resistance to change is to communicate about it beforehand,” writes Pattarin Mekanontchai, a researcher at the University of Oregon.
Worse yet, many IT project managers don’t even bother with a communications strategy, according to Coplan. This strategy should answers such as: What are the communications objectives? Who are the audiences? What’s the key message? What are the best channels of communication? What should the timing be for various communications? What resources will be required?
Speaking of resources, a communications program and other key elements of change management won’t come free. “You have to budget for human processes, like getting stakeholders onboard, training and so on,” says Van Slyke. “Executives can get frustrated when these factors are brought in,” so managers should be prepared to justify these line items.
And a successful technology launch is only the beginning for a health-care enterprise that is determined to meet unanticipated human-factors challenges. “After the information system is implemented, you have to measure turnaround time, throughput, and patient and provider satisfaction,” says Dr. Bria. “The information system must continue to evolve. You must continue to evaluate data on the impact on care and outcomes, and continue to refine.”
John Rossheim is a writer and editor who covers information technology, careers and other topics in health care.
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