CMIO Summit: Projects don't end at implementation
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NorthBay is attempting to achieve the benefits of its fairly mature clinical information systems implementation, meaning a shift away from the concept that a project has an end date of go-live to the idea that “this is our lives and our operations,” said Graham.
Health IT must be embedded in a system’s organizational strategy: “It has to be inter-digitated with everything that your organization is doing,” he said. Health IT systems should be structurally embedded in the organization’s strategic plan because resistance to change is natural, as Graham stated: “Culture eats strategy for breakfast.
“This is how human beings accept change. You may still have to fight these battles and lead the change management enterprise for many years to come.”
Part of managing change over the long haul is evolving governance, Graham said. His organization developed a governance model for projects, but once projects go live, it's not a good idea to stick with that governance model. For example, with CPOE implemented at NorthBay, “It became clear that we were in real operations mode [and] we needed to undergo governance retooling [to an enterprise health IT focus]. IT has become too important to be left to just the IT department,” he said.
Graham urged his audience to be realistic because project failure is far more likely than project success. “To some extent, we’re stuck with some of these legacy architectural decisions from our EHR providers, the needs of the organization, culture of medicine and physicians who don’t want to adopt. We’re trying to get informatics to be more democratized, more federalized. We don’t want it to be the exclusive domain of the CMIO or the IT department.”
Expect an avalanche of requests and demands following a go-live, Graham said, because in most facilities, IT has "never considered itself a conduit for PDSA [Plan-Do-Study-Act] cycles.” To keep IT from becoming a bottleneck and avoiding post-go-live deluges, Northbay created a workflow around what it takes to implement a change request process, as well as a scoring matrix for projects.
Communication is key
Better communication is also part of fine-tuning change management processes, said Brian McDonough, MD, CMIO of St. Francis Hospital in Wilmington, Del. Managing the message and finding the right person to deliver the information are critical, he said.
For example, a non-IT approach might be best when convincing physicians. “Most [clinicians] have no idea how much of a change CPOE is going to be,” McDonough said.
Communication management is "also how you manage up, how you tell leaders what they need to know in an appropriate way.”
Get the project leaders and champions together, McDonough urged. “All stakeholders have to understand the project. When I’m on rounds, that’s my best chance to get [physicians on board]. You want to make it personal.” It's also vital to have a ready answer for “Why are we doing this?” he said. Quality improvement and safety must be part of the discussion.
Organizations need a communication plan for every phase in a project, he said. "Match your communicator to the audience. In some cases, a physician is your best person; information has to be in the language of the audience."
The best path of communication is “anything that works for you,” McDonough concluded. “Be honest, accurate and, to the best of your ability, stay ahead of the curve.”