Last week we discussed that when implementing an EHR – or any other new application(s) - the workflow design and decisions are often the most challenging component of the project   What follows is an interview that was published in Inside Healthcare Computing Vol. 20, #7 February 8, 2010.  In it, I discussed seven ideas for helping to handle the resistance to change and therefore one of the ways to best address the need for workflow design during the implementation of an EHR with CPOE system implementation. 

Seven Tips for Managing Change in Your Healthcare Organization

During her career as a nurse and then as a hospital CIO, Karen Hollingsworth, RN, MS, CPHIMS dealt with her share of technology implementations and the challenges of integrating those new technologies into patient care.

Now as an Associate Partner with Michigan-based Santa Rosa Consulting, she spends most of her time sharing her expertise with others. She recently gave us her thoughts about managing the changes that go hand-in-hand with new technology.

1. It’s all in a name. Sometimes hospital personnel just need a little change in nomenclature to feel comfortable with a technology change. For example, Hollingsworth says that she sometimes refers to CPOE as CPOM or “Computer Physician Order Management.” “It’s a mind game, particularly with the medical staff. We say, look, you’re not really entering orders, you’re managing orders – and that’s something they’re used to doing.”  Hollingsworth says that in her experience, when the focus shifts from “entry” to “management,” the comfort level of everyone involved in the project increases.

2. Everyone matters. Anytime a hospital implements new technology, regardless of the department, patient care is impacted. “We all know we have to pay special attention to the medical staff, but they really are a small percentage of the people in the hospital who are providing care to the patients,” says Hollingsworth. “It’s also really important to include other caregivers – nurses, dieticians, pharmacists, therapists, social workers, etc. — all of whom will be impacted by a technology implementation like CPOE, for example.” She says it’s critical to identify and engage stakeholders from the very beginning, acknowledging the special role everyone who is responsible for patient care has. “It’s much easier to spend some time upfront thinking carefully about who needs to have a place at the table rather than moving into the process and then realizing you have to backtrack because you left someone out.” However, she notes, it’s important that hospitals recognize the unseen costs of all that outreach. Hollingsworth says that the time that the unit staff spends evaluating their workflow and helping the project team make decisions is time lost in providing patient care and that leaders will have to plan for appropriate coverage levels.

3. Spend lots of time educating and communicating.
Just as everyone matters, everyone’s concerns are valid and need to be listened to and addressed. “If you’re going to have implementation success, you have to set up a structure in the project that creates communication tentacles into all areas of the operations,” Hollingsworth advises. She stresses that it is important to use a communication structure that respects a unit’s typical means of communications. “Don’t post information on the hospital’s intranet and then make people go hunting for it if that’s not where they’re used to going to find things out. Make sure the information is in people’s faces and easily available.” Hollingsworth recommends that when planning a project’s governance structure, it’s important to think about communication as a separate function. “We create project managers for order sets and other functions. Why not one for communication? Someone should be tasked with making sure that effective communication takes place upward and downward, internally and externally.”

4. Understand clinicians’ workflow and develop technology around it. Hollingsworth believes that as much as possible, it’s important to identify problem areas and develop appropriate responses early on. For example, she recently worked with a hospital that had implemented a single sign-on solution to help its clinicians deal with the various clinical systems. Hollingsworth says that the hospital’s IT department thought this was a great solution, and in theory, it made a lot of sense. However, it ended up taking ED physicians an extra five minutes every time they needed to sign on to use the system, which wasn’t practical from their end. “It’s really important for IT to understand the clinician’s workflow and make decisions in the context of that workflow so that it’s not negatively impacted.” That, she believes, will go a long way in making change more palatable for those who must actually use the system.

5. It’s not all about IT. In Hollingsworth’s experience, projects, and the ensuing change that goes along with them, have a better chance of success when they’re seen as institution-wide, not just IT-driven. That’s why she suggests that CIOs step aside from the steering committee chairperson role and let the COO or another C-level executive sit at the helm. “It’s key to the project’s success if the leadership committee can demonstrate that the COO, the CNO, the CMO, the CIO, and everyone else in a leadership position are in lockstep together.”

6. Identify peer champions to deal with resistance and communicate concerns. One of the benefits of identifying and targeting stakeholder groups is that it in turn helps identify leaders within those groups who can help communicate the benefits of the project to peers and who can bring the concerns of their respective group back to the steering committee. “It’s important to find those leaders who you can count on to connect with their constituencies,” Hollingsworth notes.

7. Reassess and revisit. Managing change is something that has to happen continuously through a project, Hollingsworth says. “If it’s been more than a year since you’ve looked at an area and then gone on and developed your implementation plan, it’s time to go back and revisit that area.” For example, a hospital she worked with is preparing to go live with a new system and prior to go-live, is revisiting workflow issues at patient transfer points. “Things can change really quickly in large hospitals and one thing I tell hospitals to think about doing is going through a dry-run before going live, just to ensure that things will go smoothly and as planned. It’s better to troubleshoot before go-live rather than after.”