The reasons for implementing changes to your EHR can vary from the need for new workflows, improving existing workflows and processes, regulatory requirements, or introducing new technology. So how do you overcome hurdles and implement change without adverse consequences and in a way that minimizes resistance from clinicians and physicians?
Consider the following scenarios while you read through the steps for implementing change successfully.
Save time with online documentation
The fact is that no EHR implementation is ever complete – there is always more we can do that streamlines the delivery of patient care. When we started working with a hospital in Savannah, GA, their radiology department was completing exam protocols on paper, and they often completed this task after making phone calls, faxing information, or physically walking to different locations. After the exam, the clinical staff would scan the paper documents into their EHR for future reference.
The good news is this hospital could take advantage of the Imaging Protocols activity in Epic to complete this documentation electronically. After implementing a few changes, clinical staff reported saving at least two to three minutes per patient and sometimes more. They no longer needed to print, scan, call, or walk back and forth to the reading room so they not only saved time but they also saved on additional resources like paper. And, the streamlined process improved documentation and data retention.
Though some staff may be reluctant to embrace change at first, explaining how the change will help them is the first step in gaining their support. Implementing this functionality transformed the way the staff performed the task and staff were excited about the new workflow.
Improve patient care with electronic order and scheduling questions
We helped a hospital in Alaska improve their process for scheduling MRI patients with pacemakers. The MRI department has to coordinate with necessary resources, including outside vendors who must be present during the exam. The schedulers were following a time-consuming process to print and complete paper forms and then call and/or fax the MRI department. Missed phone calls and misplaced paperwork at the fax machine resulted in miscommunication and scheduling delays which often prevented patients from getting a timely MRI.
To improve the process and patient care, we created electronic order and scheduling questions to flag patients with pacemakers/defibrillators. Providers and schedulers were able to document the manufacturer and serial number, and the information files to a report in one convenient location that can be accessed by the MRI department directly via the Status Board activity in Epic.
Now, the staff can follow up with the vendor(s) as necessary and document any additional appointment notes directly in the EHR. Implementing this change will improve patient satisfaction and reduce the time spent by staff per patient to schedule an MRI appropriately.
How to implement change successfully
I encourage my fellow healthcare system analysts to think of the scenarios that can give the gift of time to care providers. While the examples in this article focus on implementing changes to an EHR such as Epic, Cerner, or MEDITECH, you can apply these same steps below to other technology projects where change will have a significant impact on end users.
1. Prepare for change.
A specific initiative may have concrete beginning and ending phases from planning to implementation, but change is an ongoing process. Often change helps organizations uncover inefficiencies and address difficulties for employees. However, before you begin implementation, it's best to plan ahead and prepare stakeholders and end users. A few lessons learned in working with clients over the years:
- Prepare to be flexible.
- Be ready to pivot when things don’t go as planned.
- Have a backup plan.
2. Do your research.
The best laid plans for implementing a change begin with pre-planning. Seek and gather data to understand the need for change, be prepared to propose solutions, and know what your roadblocks may be. Be sure to find champions in the space where the change is being implemented. End users are closest to the issues and processes and can provide a wealth of knowledge and input as well as create excitement and an accepting culture for change.
As you do your research, here are some questions to ask:
- Understand the reason for the change. In our work with the hospital in GA, we met with the Radiology department to understand the pain points of their day-to-day workflow and how optimizing the use of their EHR could help improve patient care and their overall efficiency.
- What is driving the change? Will it fix an existing problem, improve a process, or introduce something new?
- What are the issues? What are the proposed solutions?
- Engage your audience. Early active engagement is more likely to reduce resistance.
- What are their needs?
- What do they value?
- What is their expected outcome?
- What are their concerns? Be prepared to address concerns.
- Evaluate any additional impacts the change may have on other workflows, patient safety, data retention, or other operational considerations. Investigate and ask questions early on so you can prevent undesired outcomes.
3. Lay the ground work and create a plan.
Help users understand the need for the impending change and outline the vision and plan for achieving it. Define the scope and strategy and establish the team and stakeholders. Use different strategies to meet the communication and education needs of your end users such as newsletters, graphics, and virtual or live demos.
- Use clear communication and active listening
- Collaboration allows users to feel empowered to provide input and feedback for changes that will impact them.
- Be truthful and transparent.
- Be structured and systematic in communication.
- Set realistic expectations for all involved
- Not having a clear strategy and desired goal is one major reason why change initiatives fail. Involve stakeholders, product champions, implementation team members and others who are vital to the success of the project in discussions that define expectations.
- Empty promises create mistrust and can derail change initiatives now and in the future.
- Set a realistic timeline. Give ample time for review, building, testing, and education. This will allow time for your stakeholders and users to digest and understand new information, ask questions, and will also build confidence and reduce resistance.
- Define a way to measure success or failure
- Plan how you will collect feedback or determine metrics that can be used to evaluate the implementation. At the end of the day, we all want to understand the value the change brought to the organization.
4. Implement the change.
This may be the most exciting but nerve-racking part of the process. The day has finally come to put the change in place. The research has been done, the plan has been followed, the build or process is complete, and all changes have been tested, communicated and educated. So, what now?
- Determine when to implement the change.
- Understand the ramifications to hospital operations and choose a day/time that will cause the least impact to your physicians, clinicians, patients, workflow, and implementation team.
- Explain the process for communicating and addressing immediate issues
- Plan for the time when direct support may be needed and be sure it will be available and easily accessible.
5. Assess and follow up.
Once a change is implemented, it needs to be assessed. For example, we incorporate a post go-live meeting into our project closure process and evaluate the success of the project by gathering feedback and discussing topics such as these:
- Ensure that the need has been met with intended results. This could be as simple as talking with stakeholders and end users to make sure they are pleased with the new technology workflow or feature.
- Make sure your end user is supported after the change is implemented.
- Are they comfortable and confident performing their job with the new change?
- What else can you do to ensure compliance with the change going forward?
Remember, not every change is going to be perfect, but the more prepared you are, the better the chance of successful outcomes. Don’t miss the opportunities to learn from mistakes. Acknowledge errors and perform a productive review.
Continual improvement often begins at the end of a project during a lessons learned debrief session where you ask questions like these:
- What went well?
- What went wrong?
- What did we learn?
- What could we do better next time?
6. Celebrate success
Finally, don’t forget to celebrate success, even the small wins are important. Each successful change will build momentum, engagement, and excitement for participation in future change projects.
If you are in the midst of planning or navigating technology change for your organization, we are here to help.
