Healthcare technologies have significantly improved in recent years. However, the success or failure of digitization is mainly determined by change management rather than by technology. It’s a mixture or the right solution, well-designed processes, strong digital culture, and employee engagement. Here is the summary of my lecture “Successful implementation of healthcare IT solutions” delivered for MBA Health Care Management Programme students.
Regardless of whether it is new functionality for creating electronic medical records, a clinical decision support system, or a completely new integrated IT system, the medical facility manager is responsible for its implementation. And the final result, success or failure depends on their ability to manage change, personnel and, above all, projects.
Healthcare managers do not always have the knowledge and competence to carry out large investments in IT. This is because the process is very different than all standard operations performed in a hospital. The staff has to learn how to use any new medical equipment purchased to begin working with it. The digitization is an undertaking that has practically no specified end, requiring continuous development, interfering with the employees’ way of work, procedures, and habits. It can become a best-case or a carefully hidden organizational failure.
There are many answers to the question of what should the first essential step in any IT project be. Some say it is necessary to start by identifying needs and comparing IT vendors’ offers. Others claim that design should be first. However, two elements may be crucial before a decision is made at all: identification of problems to be solved and analysis of readiness to change. One of the principles of digitization is that imposing an IT system on old, inefficient processes leads to the same inefficient processes and means that a lot of money has been spent. As a result, healthcare facility does not gain much. Digitization does not boil down to changing paper into a computer, but to improving processes, rebuilding work organization, or collecting data via new tools.
A reasonably classic mistake at this stage is analyzing the bottlenecks in a hospital or clinic from the manager’s perspective, from above, noticing the whole, but not seeing the minor congestion camouflaged at the lowest organizational levels and in the smallest processes of patient service. An even worse case is the presumption that employees do not know much about computerization or their attitudes are negative, so why bother asking them. The management often does not know about processes in the doctor’s office, at the reception desk, or in the emergency room.
Recognizing them is sometimes a big challenge. A useful technique could be an anonymous survey or, even better, case scenarios to be completed by staff. A patient talking to the doctors while they are looking at the computer – dialogs completed by the team sometimes reveal deeply hidden problems, while unmasking what employees really think. Just asking doctors, nurses, or a front desk receptionist for an opinion is the beginning of cooperation and trust-building. And it’s a critical element of any change.
Now that we know what should be improved, we still need to check readiness for change. The analysis should include scoring and should specify different levels: ready, in preparation, not ready. Consequently, if readiness in a given area is low, for example, there are workers or investment restrictions, attempts should be made to remove the obstacles, or the process is to be postponed. Otherwise, you will crash into the wall of obvious obstacles that were ignored at the very beginning.
Design thinking and patient journey
Although it seems that we already know everything about a given medical facility, a process map can help us become aware of relations and understand organizational and information dependencies. The second element is to accurately draw up the patient path, broken down into stages, procedures, and administrative tasks. It should preferably be done in graphic form to make it easier to find potential shortcuts, possible modifications, or points where something goes wrong. To be useful, an experience map must feature the comments of those in contact with the patient at a given stage.
This can be done in a design thinking model, attempting to reproduce as accurately as possible each step, the patient’s feelings (hence the necessary patient participation), and the staff perspective. If we do this superficially, we will not learn anything new. Therefore, we will not be able to introduce changes to improve the quality of patient service as well as the convenience and efficiency of staff work, and as a result – the quality of treatment, which consists of many elements. As it turns out, when analyzing internal processes and bottlenecks in the design thinking method, healthcare organizations often ignore patient recruitment, using the difficulty in recruiting them as an excuse. Without the patient, the analysis will remain in the bubble of an internal point of view, so it can be just useless.
Every investment in IT involves risk. But any risk can be estimated and managed, including a plan B prepared in case something goes wrong. The so-called “risk matrix” is often ignored, even though it is an integral part of every digitization project. Many managers guided by intuition believe in the success or prefer to react spontaneously when a problem occurs. Because risk analysis takes a long time, it is considered as unnecessary bureaucracy. However, additional effort can pay off – preparation of worst-case scenarios is a source of new ideas. Besides, when something goes really wrong, we may just respond as planned instead of looking for solutions in haste.
The fundamental risk matrix consists of eight columns: the type of risk (e.g., unjustified warnings in the clinical decision support system), the risk probability mitigation method (work analysis, test run), the risk impact reduction method (introduction of adequate functions), scenarios of action in case of risk (verification of messages in the decision support system) and the score specifying the risk probability, impact, and priority (probability multiplied by risk impact). The last column should also determine who is responsible for specific actions in a crisis situation. An exercise involving creating worst-case scenarios of IT system implementation helps in generating a list of risks. Staff at all levels covered by digitization answer questions, which may influence the failure of the entire project, at the same time proposing actions to prevent the failure. There are many more risk management tools. Their use can professionally prepare for project implementation and protect against accusations that “something could have been predicted.”
The success of IT projects is often a litmus test of organizational culture. Digitization can be a test for teamwork, highlighting existing problems, or emphasizing the strengths of management. This is because, like no other project within a healthcare organization, it applies to virtually all staff and organizational levels, so it requires good cooperation and communication between management and employees. And above all, it is based on trust.
If the team was convinced by the vision and plan presented by the leader, the introduction of new work tools will be much easier. How can we build trust then? There are no simple guidelines, as every organization is different. However, we can utilize proven change management methods, for example, those based on Kotter’s 8 steps. Start by making the staff aware of the urgency of changes. The need should be inside (e.g., low quality of patient service), not outside the organization (switching to electronic medical records) for employees to identify with the goal. We should not expect that everyone will be enthusiastic about the plans; hence it is so important to form a coalition of new technology enthusiasts. The next step is to prepare a vision giving a sense of direction, operational objectives, and an action plan. It is time to develop an IT project implementation strategy.
Then the vision and the plan should be communicated to the employees at all organizational levels to mobilize the staff. The first successes and effects must always be celebrated to make everyone realize that extra effort pays off. When the initial enthusiasm subsides, do not forget to maintain the pace of change, react to the first problems resulting from idealistic plans facing reality. Finally, the change must be consolidated until it replaces old procedures and ways of work.
We all have our prejudices, beliefs, and opinions based on experience. Before a digitization project is presented to the team, each employee already has an opinion and belongs to one of the groups: supporters, opponents, and neutrals. These initial attitudes (starting points) are based on emotions, less on arguments. That is why it is so difficult to change them. Naturally, you can hold an employee meeting and open discussions to answer the team’s questions. However, these will be almost exclusively negative questions, and therefore the manager may be overwhelmed with contrary opinions, while the positive ones will not be articulated. This creates the impression of a skeptical attitude of the staff.
A better way is to conduct simple workshops. Divide the team into two groups. They will represent the arguments of the opponents and supporters, respectively. Of course, the compositions of teams must be random. When working in groups, the teams write down arguments for and against, present them, and discuss with each other. In this way, you can not only learn about the team’s fears and hopes but also increase the likelihood that the opponents will be convinced by the supporters. The basic principle works here – any change takes place in consultation with all employees, not behind the doors of the IT department or the director’s office.
Project is not an unnecessary bureaucracy – it’s a must
Every organization needs a strategy that will guide changes, including digital ones. Health IT system implementation is a project with a specific time range, goals, and budget. We assume that every manager has at least a basic knowledge of project management, which can be found in numerous books and free online courses. In my opinion, the most critical element of projects is defining specific and measurable success goals and criteria (goal X achieved if Y occurs). There can be many goals, but it is a good idea to choose the critical and essential ones, which will be communicated to the team.
A basic framework should also be adopted – what we cannot change and what limitations cannot be overcome. This might be a budget or time, for example. Also, specify critical risks at the beginning to always keep an eye on them. Each project contains a very detailed budget, with a time budget broken down into years and the total cost of implementation, including the purchase of licenses, system updates, and others. The so-called responsibility matrix clearly specifies who is responsible for the implementation of each task, and what role they play (project manager, the person responsible, consultant, informed person). Every project is carried out in a specific environment and must be communicated to relevant persons and institutions, for example, an IT company providing the system, management board, owners, etc. The project features the said risk matrix and a detailed schedule of actions, which is the most time-consuming element next to the budget.
Focus on the process
Digitization is a complicated change made in healthcare organizations. We could even say that its success depends up to 80% on change management capabilities, and 20% on the technology itself, assuming that the latter meets the necessary functional and quality requirements. It is also a test of leadership and organizational culture. That is why we should prepare for it well before thinking about which system will be bought.
* MBA Health Care Management Studies organized by Warsaw Medical University and Warsaw School of Economics.
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