The HCI Group is proud to announce that our Healthcare IT Podcast series is officially underway. Our show, which airs weekly on Monday mornings, will consist of conversations between our host, HCI’s Tom Letro, and various subject matter experts in the healthcare field. The conversations will answer some of the important questions that are being asked in the healthcare field today, from EHR system selection to ongoing optimization, and everything in between. You can subscribe to the podcast here.
Our first episode sits us down with David Chou, the Vice President and Chief Informational Officer at Mercy Children’s Hospital. David is also widely known as one of Twitter’s most-followed CIO’s (his Twitter page can be found here). David and Tom will be discussing the various things that should be expected when an organization is going through change management during an EHR implementation.
Transcript
Tom:
Hello and welcome, everyone. My name is Tom Letro of the HCI Group, and today I will be joined by David Chou, the current VP and CIO at Mercy Children’s Hospital. Thanks again for being here with us today David, we really appreciate your time as we discuss change management, mainly as it pertains to communication and leadership.
Expectations Prior to Go-Live
Now, starting with communication during change management, what would you say an organization should expect prior to go-live?
David:
Sure, thank you for having me Tom. I will say, prior to go-live any changes, that really involves communication and preparation so, preparing for the change, getting the communication ready, internally and externally, you have lots of partners that you are working with externally. We have to make sure that communication is established and is very clear as far as roles and expectations. And also internally, one thing I would love to, I always want to over-emphasize is we must focus on over-communicating internally, just because we have to make sure everyone is on the same page, we have to make sure everyone is aware of the challenges that lie ahead, and really one of the key messages is to make sure this is a journey, not a sprint.
Anxieties of New System Implementation
Tom:
Ok and on that note, how does an organization help deal with some of these concerns and anxieties that a new system implementation can cause within its staff?
David:
Yeah, there’s always anxiety when change is in the process, especially with new systems, a lot of that has to do with – you must educate them, as far as the new system. Really focus on training and educating them, and also there are going to be pitfalls within a new system, so being very transparent as far as the pros and cons, and the decisions as far as why the change is being made.
Tom:
Now how can an organization accomplish that, David?
David:
I usually overemphasize the education portion and training up front, just because I want my team, who is supporting the system, to be aware of the changes coming down the pipe, but also on the end user side, the changes they can expect, even a subtle change such as a different screen location, or a button looking different, or in a different section of the system. That’s a big change for a lot of folks, so really highlighting those differentiators and being really transparent early on, that’s a key theme in order to be successful.
Communication During an EHR Implementation
Tom:
Ok and, with regards to transparency, one thing that I always feel is important to make people understand is the fact that implementations like these are more than just software changes, they affect everyone, which is part of why it is such a change for the whole organization. How do you go about communicating this to your staff?
David:
Yeah, most of the time when people think, especially nowadays, every project that you work on technology, is to solve a business outcome. So if you’re going through an EMR implementation, you’re not doing it just for the sake of having a new system, you’re doing it because you’re trying to have a tool, an electronic tool, that can provide better care, that is going to allow your organization to be more efficient. And at the end of the day you want to provide the best care to the patient possible by utilizing this tool. So when you rephrase the EMR implementation as this is a business project, this is something that can transform our industry to provide better care. It’s a different message than saying “well, we are going through a new install for an EMR because we want to follow regulatory requirements, or adhere to regulatory requirements, or we want to deal with the qualifying of meaningful use.” That is a different objective than when you are trying to transform an organization and provide better outcomes for the patient.
Questions Leaders Need to Answer
Tom:
And, switching gears here a bit David, I feel as if your staff will have a great deal of questions that need to be answered as well, and I feel like an obvious source for these answers would come from leadership. What questions should leaders be expecting to answer during this time of change?
David:
The first question you always hear is “how is my life going to improve with this change?” So it is important that as leaders, you really have to emphasize the benefits of this change, we do not want to make a change just to make a change. So highlight the benefits, highlight the improvement and experience of this change, and really focus on how this change is going to benefit someone’s life. So if they are clinicians, I would assume that making this change would make their life a lot easier, a lot better. Same for all the ancillary staff, even on the financial revenue cycle side, just highlighting how this new change and this new tool is really going to help them do their job better and more effectively.
Tom:
Ok, and what other things are people worried about?
David:
People are always concerned about their roles and responsibilities. People may be unsure of their roles after a change, so it is important to make it cultural, from a leadership perspective just emphasize the structure and the roles and responsibilities after going through major change. I usually deal with that up front as well just so people have that expectation, and then make sure it is in line with what they are working on. But usually, there is a lot of anxiety throughout the entire organization. It is really up to the senior leaders, and everyone who is working on the system, just to be calm, and at the same time be very transparent with the organization. There will be hiccups, there will be bumps down the road, but we will get through it. It is expected, and there will never be a perfect journey.
Organization Timelines
Tom:
Naturally, and during a project such as this, it is prudent for timelines that have been set to be adhered to. What can an organization do to hold people responsible, and make sure that these timelines are met?
David:
Transparency really is the key to that in terms of making sure people are responsible. One of the key messages that I have is: it’s ok to be red on a project plan as long as we have a plan to get it back to green, as long as we have an action plan to get it back on track. So that’s one of the areas where you really allow the leaders and the team members to be accountable, where we are very transparent, but as long as they have a plan to get it back on track they’re held accountable. And also really allowing the teams to understand the bigger picture, because if there is one area that is delayed or off track, it may derail the entire project. So having that visibility across the entire enterprise, making sure that every leader understands the role that they play, and the value that they play, is important. And when people feel that they are a part of a bigger mission and they’re accountable for an entire project that they could potentially derail with their actions, I think that allows them to take more accountability and responsibility at the same time.
Elements to Ensure Successful Implementation
Tom:
Right, so the staff obviously needs to be meeting timelines so as to not derail the project. In addition to helping them with that, what else should leaders be doing during this phase in order to help ensure that the implementation will be successful?
David:
Leaders have to really, especially I would say, the job of the CIO who is leading the charge, really have to partner with the senior leaders throughout an organization. Making sure that everyone is in this together. I have seen a lot of failed implementations because the executive sponsor, whether it is the CIO, did not gather the executive support, so when something went wrong all the blame went to the CIO. But when you are talking about a massive transformation such as an EMR implementation, this is an organizational project, it is not an IT project. So it is important for executive leaders to get the buy-in, making sure that the organization recognizes that this is an organizational project. This is not something that you fingerpoint and blame on one individual if something does fail. If something does not go well, the organization fails. So that’s one of the key things that I highly recommend a senior leader take if they are accounting for a project like an EMR, whether you’re a CIO, a CMO, or a CMIO who is leading the charge, make sure you have the executive sponsorship from the organization.
Management Follow-up
Tom:
Ok, and how important is it for management to check back in 6-8 weeks after your go-live to make sure that everything is moving along smoothly?
David:
It’s really important to follow-up, most of the time people have a starting project plan with expectations of having certain requirements met. Post-implementation, 6-8 weeks, it is important to follow-up, making sure that, number one, you have met your objectives, and number two, if you have missed some parts because there is a decision to delay implementation on certain modules or certain features or workflows, this is a good time to reinvent that and get that back on the radar, because the last thing an executive would want is to set an expectation early on prior to implementation that the system is going to perform ‘function X’, but somehow ‘function X’ was delayed, or a decision was made to delay it for a second phase, and, post-implementation, no one ever followed up to perform that ‘function X’. So it is really important, post go-live to really reflect back as far as the targets that you had set – what percentage of the targets have you hit? If you have hit 100%, great to you, I won’t see too many people saying that 100% because things do always change, but most importantly you should really go back and revisit what your initial target was prior to implementation, and revisiting how to get that back on track.
Post Go-Live Optimization
Tom:
Right, and naturally if your goals have all been met, you’ll probably be looking to optimize your system. What message should leaders be giving their staff as they prepare for the process of optimization?
David:
So that’s a really important step, so once you have gone live, after 6-8 weeks you start to assess your goals from the start. But this is also the time you want to focus on getting the system stable. So once the system is stable, I’d say give it 6-8 months, then it’s like “Ok, now have a foundation in place, there are a lot of features we want to turn on, to optimize certain features or turn on certain features, it is a very good time to revisit that while people are still in that mode of implementation.” The way I view an EMR implementation is that it never ends. You’re always trying to improve the quality of the system, always trying to do things better. There are always going to be new features that are being provided by the vendor, and the decision has to be made whether you take advantage of it or not. So you will always be in that cycle of optimization, but it is important to prioritize what areas you want to optimize first. Whether you are going to focus on the clinical outcomes, or the do you want to focus on the financial aspect of the system. It is an ongoing process, so when I think of optimization, I think of that as the normal system maintenance and system processes that need to take place in order to have any enterprise system.
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