Great post and great questions. A couple of thoughts as they relate to your questions:
1) What are the key differences in the markets that have adopted this shift and the ones that have not? Is it people, culture, financial? That could help you determine if target setting and deployment will suffice to make the change.
2) Is there a clear, simple plan for what “adoption” of this new culture looks like? Do you need to get more people involved who would be evangelist for this new philosophy? Is this new philosophy being communicated at all team meetings? It must be established that this is not “the flavor of the month” but rather the new direction that the whole company is going.
3) How aligned are the short term targets with the long term goals? Or said another way: if country managers consistently meet short term targets will that lead to the achievement of the long term goals?
We experience the same issue but one thing that has helped at our system is to do conferences centered on specific topics by specialty. We just did one on Advance Care Planning and Palliative Care. This has allowed us to bring physicians from all across the continuum together to discuss pertinent issues. Often times breakfast will be served and there is time for networking. This gives all of the providers a reason to be there (the conference) but gives them time to get to know each other, discuss patients, etc.
We are currently going through this process and will go-live on July 1st of this year. The thing that has been particularly challenging for our implementation is that we are not just implementing this at 5 hospitals and 35+ owned ambulatory practices but we are also including facilities that are not part of the hospital system but are part of the continuum of care (Skilled Nursing Facilities, Rehab centers, FQHC’s).
-Creating a sense of urgency: In order to create a sense of urgency we appealed to the altruistic motives that most everyone has in healthcare: a concern for the well being of the patient. It was easy to find examples of where a disintegrated medical record was at best a hindrance to providing quality care and at worst actually harmful to the patient. To fight the abstract nature of this implementation we did this with real-world examples that everyone (clinical and non-clinical individuals) could understand.
-Creating ownership: We then had 2 weeks of demonstrations from the top two EHR vendors and asked that all hospital staff vote on their preference. Two thirds of the system’s employees voted and one of the EHR vendors over 80% of the votes. This helped to create ownership in the decision. Interestingly, that vote has been referenced multiple times during stressful moments of the implementation. It is apparent that the Physicians and staff feel much more buy-in because they chose this system and it wasn’t prescribed to them.
-Keeping the patient at the center: During meetings where decisions are to be made we establish one person as the “patient advocate” (when possible this person is an actual patient from our Patient Advisory Board) their vote carries the most weight. In several instances this has allowed us to break down barriers caused by stakeholders having different perspectives and allows us to make a decision of compromise based on what is best for the patient.
-Keeping physicians engaged: We established physician champions in each specialty (i.e. pediatrics, surgery, Primary Care, cardiology, etc.) and asked them to sign a contract outlining expectations for their involvement in the project. The system also agreed to compensate them for their involvement. We also transferred two very well-respected physicians to full time positions on the project and they have become certified in the system and intricately involved in the actual IT build. We have done the same with nurses. That way even the small decisions have clinical input. We have also spent the time and money to train the physician champions to become Super-Users and they will train their peers on the system. We begin training next month but this train-the-trainer philosophy has proven productive for other systems.
-Go-Live Support: We are investing a lot of resources in “At the elbow” go-live support with robust analytics. We feel that this will be critical to a successful go-live.
-Keeping it front of mind: We have also prioritized keeping it front of mind for all of our front line staff by doing regular “show and tells” in practices or via a webinar. The intention is to help staff feel more comfortable with what the system looks like so that when they go to actual training it is not so overwhelming.
This is one of the biggest projects the system has undertaken and we will see in several months how successful the above initiatives have been. I am happy to share what worked well and what we should have done differently. Make sure you have plenty of coffee and power bars available and don’t be afraid to lean on lessons learned from the thousands of systems who have recently gone through an EMR implementation.