LAS VEGAS—The deployment of an EHR served as the impetus for change at California Pacific Medical Center in San Francisco, said Amy Berlin, MD, physician consultant and psychiatrist of the Sutter Health affiliate. Berlin and Claire McCarthy, MA, system organizational readiness director, Providence Health and Services, based in Seattle, spoke about change management during the 2012 Healthcare Managing and Information Management Society (HIMSS) conference.
Berlin said Sutter Health adopted the Toyota Lean management system in an effort to transform the organization’s structure.
There is a growing appreciation of time as a commodity, she said, and because training is a huge time commitment, it requires executive sponsorship and active involvement from day one. Leadership heads the process, but they are as immersed in the process as everyone else.
Once people get involved in the process and talk about new ways to optimize processes, inevitably someone throws their hands up and asks, isn’t there a piece of technology that can do this? “There will be resistance to detailed, complex process improvement. That indicates how overwhelmed people [have] become," she said. “Resistance is a very natural response to any change. Resistance [happens] because it’s really difficult to think about the complexity of the process. The wish is for technology to make the complexity go away.” She cited her chief process officer who went from being a skeptic to a real enthusiast because he got his questions answered. “When questions are responded to appropriately and satisfactorily, that generates trust.”
The Toyota management strategy includes capitalizing on an organization’s self-awareness and offers relief from the futility of chasing short-term results, she said. There’s an “extensive here and now focus.” Berlin said the staff had to scrutinize how they do things and understand that the way to change is not through passive education but in immersion.
Getting there is very intense, Berlin cautioned, and there’s no doubt that change is hard. But, because the Toyota system shifts the focus from people to process, “more rich dialogue can emerge. When we have reliable standard work built into workflow then there’s room for our creative minds to be innovative.” That reliability creates safety and predictability. “That creates an environment much more ready for change and has the capacity to absorb change.”
A big challenge can be preventing attrition. Many implementations come with aggressive timelines that don’t allow for adequate efforts to prevent people leaving. “I have real appreciation for how much time it takes for trust to be built across an organization and sometimes we can underestimate how long it takes for people to become comfortable and how much we have to do to get people comfortable,” Berlin said. People need to feel supported and reassured about what the change means for them and their individual role. “How well people are prepared for change has a lot to do with preventing attrition.”
Part of that change is getting people to respect data that don’t “necessarily make them look good. It’s about building trust so that people can appreciate that the metrics are improving patient care.”
McCarthy said her facility’s leaders wanted to know how to convince people to accept the idea that change management is critical to a successful EHR implementation. However, the project managers and others on the deployment team were not accustomed to working with change management.
There are a lot of opportunities to help the technical community better understand user issues when implementing change, she continued.
Change management roles included the responsibility for leading the dress rehearsal process—the point at which all the dots begin to connect for users, she said. This step is extremely important because “when you actually do role-playing people begin to understand what’s going to happen.” It’s also essential to have the right support in place to help people feel heard and valued. You want users to “feel like your organization is investing in them not just in the technology.”
Change management team members also provided a calming presence which is important since tempers can flare. They also lead during indecision without being stressed. They are liaisons between clinical staff and the command center.
McCarthy cautioned that some people can feel that everything they did before the implementation was wrong when, in truth,