A CIO at a hospital or health system researches, evaluates and selects new technology to improve operational efficiency, care team communication, and patient care.
He or she employs a top-down approach to implementing the solution throughout the system, gaining buy-in, adoption, and, if lucky, evangelism from at least a few physicians. Then, six months later, poof! The healthcare magic happens, the cost curve is bent, best practices emerge, patient satisfaction increases, and care team collaboration is better than ever. Right?
If this scenario seems uncommon, it’s because it is. Much more likely, a year later, clinician adoption rates of the new technology have stagnated or even declined. Meanwhile, doctors and nurses still using the solution are most likely using it in the same, introductory way they did on day one.
Doctors, nurses and other care team members have unique responsibilities, priorities and motivators. As a consequence, healthcare projects involving technology should be customized to address the varying clinical and administrative factors at play. An individualized user-centric approach to gain enthusiasm and adoption is necessary to engage clinicians who already feel overloaded with responsibilities, and may see new technology as an added burden.
If you are a hospital CIO or healthcare IT leader seeking to increase clinician adoption of new technology, consider these change management tips before selecting and implementing a solution.
1. Involve clinical staff from the get-go
In a recent HIMSS Analytics survey, about 51 percent of IT leaders reported collaborating with clinical peers to define requirements for selecting clinical technology systems, but only 14 percent said they consult with frontline team members before beginning the selection process. Clinical and IT leaders who participated in this research agreed that the most important value of healthcare technology is to help safeguard against clinical errors and ensure patient safety. As such, healthcare technologies are really clinical tools. It is therefore paramount that the specific problems the tools are meant to address have been identified prior to starting the selection process, and this is best achieved by clinicians. If the problems aren’t adequately identified at the beginning, then there’s no guarantee the tools selected will be appropriate for the job at hand.
If hospitals and health systems want to cultivate early adopters and hardwire new technology into clinical workflows, they must sow the seeds for widespread buy-in early in the project. Include all potential technology users: physicians, nurses, pharmacists, and other care team members, from day one. Ideally, a multidisciplinary group with frontline clinicians would help evaluate and select the new technology, which will help inspire ownership among the clinicians on the selection committee and position them to be evangelists when the technology is rolled out.
End users need to be represented at the beginning to verify that the technology in question can be used effectively under actual real-world clinical conditions, rather than anticipating abstract use cases under ideal circumstances. Insights from the proposed user community are critical to the long-term success of the project. They will continue to use the solution long after the IT implementation team has moved on to the next project.
2. Understand the difference between implementation and adoption
One pitfall hospitals and health systems make is to mistake implementation for adoption. The resources devoted to a large IT project are often disproportionately—or exclusively— focused on successful implementation and not successful adoption. Implementation is a technology-centric milestone that has little to do with achieving the specific patient-centric outcomes that inspired the project in the first place. The “go-live” moment is a far cry from adoption--when the hospital has made the solution part of its preferred way of doing business. Although IT resources are key to new technology deployment, only clinicians can inspire true clinical adoption. Therefore, those who championed the purchase and implementation of a solution may, in fact, be the wrong persons to drive lasting and meaningful adoption.
I like to compare the implementation/adoption process to joining two pieces of wood together: two components are required, a clamp (leadership), and glue (value). Like a clamp, constant sustained leadership is required when a new solution is put into place. At the same time, value, the glue, needs time to develop and be recognized. If the clamp is only intermittently applied or removed too early, the end result will be poor, uncertain, “messy” adoption at best. If there’s a clamp and no glue, no perceived or recognized value, then as soon as leadership falters, the project will quickly fall apart.
Because implementation and adoption represent two different end-points, they also need independent metrics. It’s insufficient to only assess implementation if long term adoption and problem-solving are the required outcomes. We need to consider a different set of metrics to really gauge the long-term success of health IT projects. Common implementation metrics answer questions such as: Was the project implemented on time, and on budget? Hospitals should instead focus on outcome metrics in an effort to establish whether or not the technology has truly been adopted, and most importantly, has use of the new tool and/or process solved the problems which were identified at the outset? Has the anticipated value of the project been achieved?
It is also worthwhile to develop interim metrics to maintain focus on the project between implementation and assessment of final outcomes measures. The interim metrics should include a qualitative component, so that leadership can receive honest feedback from clinicians about how they are using the tool: its successes as well as any limitations or stumbling blocks. Interim goals can help teams build on smaller successes as they continue to work towards larger long-term objectives. Interim assessments may have an additional side benefit, uncovering unanticipated consequences of the new technology, which when identified and addressed at an earlier stage of the process, may make mitigation a much easier task.
3. Select the right leader for the “crawl, walk, run” journey
It is often recommended that implementation of healthcare IT should follow a “crawl, walk, run” model. This is commonly the case when there is a perceived risk of overwhelming the end-user community as a new technology is employed, new workflows are adopted, and old processes discarded. But this progression is not automatic, and it cannot be left to the user community alone to drive the journey. Incremental system use requires a number of inflection points where clinicians are expected to modify the way they do business, integrating an increasing number of technological capabilities while modifying workflows. But expecting clinicians alone to lead this process is unrealistic. Physicians can be famously conservative and adverse to changing their working practice. Many in the IT world lament the fact that doctors can be “set in their ways.” This is an unfortunate mischaracterization, and instead is reflective of physicians following that hallmark tenet of medicine— “First, do no harm.” Changing workflows can introduce variation and inconsistency that, in many clinicians’ minds, can lead to patient harm.
As an example, physicians are taught to always approach a patient’s bed from the right side, providing consistency and hopefully minimizing the risk of missed findings from one set of rounds to the next. Hard-learned and proven methods are ingrained into medical practice. That’s partially responsible for the 15- to 17-year lag time between the latest medical discoveries, such as a new set of surgical tools, and their incorporation into routine care delivery.
IT leaders must understand that introducing a novel healthcare technology into clinical practice is like introducing a new scalpel into the O.R. Both are clinical tools which, if used correctly, can lead to substantial improvements in patient care. However, an IT tool misused, may, like a scalpel used without training or expertise, cause patient harm. Health IT tools need careful consideration along the path to mature usage, to make sure they are applied with precision and do not introduce new challenges for patient care. Clinicians devote a tremendous amount of time and attention to avoiding errors; standardizing workflows makes it easier to safeguard patients and deliver the best possible care. Physicians recognize that change is inevitable and is a key ingredient of growth and maturation, but too much change, occurring too soon or poorly managed leads to chaos and unacceptable risk, and so it should come as no surprise that physicians often push back.
4. Find the right technology partner
Most healthcare technology vendors sell to CIOs because the IT department will lead and manage solution implementation. But there are some vendors who seek to partner with both IT and clinical leaders in an effort to move health systems from an “implementation mindset” to an “adoption mindset.” Healthcare organizations looking for a sustainable technology that clinicians will more readily adopt should value vendors who understand clinical workflows and offer solutions that can easily standardize or simplify processes.
Seek out vendors who not only have IT experts in house, but also nurses and physicians on staff who can leverage their real-world expertise and assist your hospital’s clinicians. Before selecting a technology, ask prospective vendors to conduct a clinical workflow assessment showing the impact of their solutions or platforms. Mapping gaps in certain processes will shed light on how the technology will actually perform at critical points in patient care delivery. Healthcare technology vendors must also understand the importance of security and be knowledgeable about the latest regulations and privacy protocols. Be sure to check out the vendor’s experience working with hospitals and health systems, and also ask for a list of the security credentials they have earned.
About the Author: Benjamin Kanter, MD, FCCP, is the Chief Medical Information Officer (CMIO) at Vocera Communications, Inc. Prior to joining Vocera, Dr. Kanter worked as an industry consultant and thought leader with innovative healthcare IT companies, including Extension Healthcare. He is also the former CMIO at Palomar Health in San Diego, where he spent seven years on the executive management team. Dr. Kanter earned his medical degree and completed internal medicine training at Northwestern University. He completed post-doctoral studies at the U.C.S.D. Medical Center in California and is board certified in internal medicine, pulmonary disease and medical informatics. Dr. Kanter is also a published author and frequent speaker on ways to seamlessly and securely integrate technology with medical practice.
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