Three strategies to make change happen in clinical environments
Strategy Practice Leader,
Healthcare is one of the toughest arenas in which to manage change successfully. It is no wonder considering its lengthy list of familiar challenges – the shortage of certain health professionals, issues with timely access to care, and chronic disease management, to name a few. In light of these challenges, the delivery of care is evolving to a team-based, patient-centred model and there are high expectations that the use of electronic health records and information systems will enhance the delivery of care and patient outcomes.
Three core strategies
Getting change right with clinicians is where most health IT projects seem to fall down. This article considers three core strategies that can serve any organization seeking to make change happen in a clinical environment. These strategies are distilled from the successes of two very different, complex acute care campuses. As McGill University Health Centre (MUHC) and the Virginia Commonwealth University Health System (VCUHS) demonstrate, the challenges faced in clinical healthcare environments and the strategies to avert or overcome them are remarkably similar in both Canada and the US.
1. Involve clinicians early and often
One of the main reasons health IT projects fail is that clinicians are not engaged effectively. Successfully managing change in healthcare is about much more than clinical endorsement of a solution or obtaining ‘wish lists’ of features and functionality. Oftentimes clinical involvement begins too late or is too superficial, or both. This is not the fault of clinicians, but is the result of well-intentioned approaches that put technology and its implementation at the centre of the effort rather than clinician workflow and patient outcomes.
Success starts by entrenching clinicians in the project from the beginning, asking what they need the proposed technology or system to do and cultivating an understanding of the best way to incorporate the technology into their clinical workflows. Clinicians also need to be leaders who collaborate with IT in developing the new system rather than ‘end users’ who are required to use a new software or service. They must see themselves as sharing responsibility for the successes (and challenges) as the initiative unfolds. It is essential that physicians are central players in the transformation, particularly when they are directly impacted by the introduction of new systems.i
Use clinical analysts as ‘clinical/IT translators’
In 2002 in anticipation of moving to a new state-of-the-art facility, Montreal’s MUHC and Centre hospitalier de l’Université de Montréal began working together to design their respective clinical information systems. Clinicians from both hospitals were engaged from the outset to define the needs. Working sessions identified the functions that were most important to different groups of clinicians and built consensus.
MUHC utilized clinical analysts as part of the core project team. Their clinical background and experience was instrumental in bridging the gap between technology and clinical workflow. For example, clinical analysts could articulate to clinicians why some of their ideas weren’t technologically feasible and, conversely, could articulate to IT why some of their ideas weren’t clinically feasible. As the clinical/IT ‘translator’ they effectively managed stakeholder expectations and avoided unnecessary investigation and debate of ideas for the new system.
Think on clinicians’ terms
MUHC’s project team also made it a priority to treat clinicians on their own terms. They understood that clinicians have multiple priorities focused on patient care, often unrelated to the implementation and that they cannot be expected to review and interpret technical specifications or requirements. Instead, their winning strategy was detailed preparation in advance of meeting with clinicians to articulate the need or gap and provide options with pros and cons to review. The team also took the time to meet clinicians at convenient, shift-friendly times and locations. These approaches limited ‘spinning wheels’ and enabled clinicians to quickly grasp any challenges and make decisions.
2. Focus on patient care and outcomes
Clinicians are passionate about providing the best possible care for their patients. The clinical value resulting from a new technology – how it will enhance patient care – needs to be front and centre and resonate with the clinical end users. Enhancing patient care is the raison d’ être for any IT department or Project Management Office in a healthcare organization. Yet, even the most experienced project teams must take caution against becoming so wrapped up in the technology they are implementing that they lose sight of this primary objective.
A recent article in the Pharos posited that clinicians, specifically physicians, have become the ‘tools of their tools’ii suggesting that technology has become the focal point in the physician’s workflow, rather than the patient. With technology implementations, the project team must be conscious of this sentiment and strive to enhance the existing clinical workflow; not divert or burden it. When workflows are fully considered at the outset, the resulting new technologies and solutions are more likely to be adopted and enable the clinician to provide greater care and value to patients.