Realizing the full value of electronic health records is truly a people-centric mission. Machines are simple. The human element is complex. Engaging team members in the design and optimization process — from top executives, to providers, to data consumers — is the key to enabling better information access, tighter care coordination and more data-based decision making. Strong people engagement begins from the start as leaders build alignment around an EHR-vision, and it continues as teams incorporate electronic documentation into new ways of working to achieve meaningful results. Following are five instrumental strategies for making engagement a catalyst for EHR success at all points along the implementation journey.
Build a community of true champions at the executive level. Leadership's acceptance of EHR's inevitability is a far cry from fully processing its implications, agreeing on measureable outcomes and understanding rollout milestones. There will be resistance to change — particularly from physicians — so hospital leaders need to be lockstep in their prioritization of the initiative and how they respond to pushback. The timeline for full realization of EHR benefits typically extends many years, so it's important to set a cadence for ongoing leadership discussion. Recently, our clients at a large healthcare system pursuing a significant EHR transition set monthly check-ins to assess progress and troubleshoot issues. This type of structured regular dialogue helped executives surface concerns, calibrate their thinking and move quickly to remove obstacles to progress.
Reflect a higher purpose in the EHR vision. Institutions that have successfully implemented EHRs understand what motivates hospital team members to come to work everyday: saving lives. Accordingly, the EHR vision must tie back to quality, safety and healthier, happier patients. Referencing these outcomes in the messages communicated when bringing people onboard is key to building enthusiasm, coordination and effort. As rollout continues, there should be a process for collecting and sharing success stories that show how EHRs are driving improved patient outcomes and experiences. Our clients considered expanding the scope of super-users — those team members who are technologically savvy and enthusiastic about helping others make the EHR transition — to harvest and spread, via word of mouth, examples of positive change brought on by the shift towards electronic documentation. People tend to focus on the immediate pain of changing behavior. Frequent reminders of progress toward higher-level goals will help shift the focus from frustration to value.
Make an investment in communication on par with the scope of change. Hospitals are notoriously difficult places in which to communicate. Role diversity, shift patterns and ongoing emergencies all contribute to the complexity. But the scale of an EHR implementation demands more than email blasts and training announcements. Effective communication efforts respond to individual stakeholder needs with customized messages, tactics and timing. Communication is not the place to cut corners. The technology aspect of an EHR transition is a multi-million dollar investment. Hospital leaders must set aside the budget to build and manage an effective communication plan that appropriately positions the work ahead and establishes a continuous feedback loop for users. Attaining 100 percent buy-in for the proposed technology implementation approach may be impossible, but engaging the people who will be affected in conversations and effectively explaining the logic behind change helps broaden the base of support.
Make metrics an engagement driver. Hospitals are science-driven. Team members are used to speaking the language of data and numbers. Leaders should leverage this preference in the way they communicate. Quantify the goals and outcomes of the EHR effort and develop an implementation scorecard to keep work on track and signal that the organization is making real progress. Our clients have grappled with a wide variety of potential metrics to gauge success. Their challenge was to select the critical few to best measure impact. Some were straightforward: system utilization, coder productivity, provider satisfaction, etc. Others were more clinically compelling, but less closely correlated, such as patient satisfaction, number of sentinel events and average length of stay. There is not a one-size-fits-all scorecard solution and every hospital must establish its own priorities. What's critical is that all team members know which direction is true north and are updated on headway so they know how to make the right adjustments — and are motivated to make them happen.
Maximize opportunities for experimentation, learning and results. The best way to get people up to speed with new technology is to challenge them to use it to achieve compelling near-term goals. Hospital leaders should organize cross-functional teams to champion top hospital priorities via rapid-cycle projects that demand (and use) better EHR implementation, functions and documentation. Examples include:
• Resolve 100 percent of EHR "helpdesk" issues in under an hour within 30 days of "go-live."
• Decrease the number of follow-up calls from coders to cardiologists by 25 percent within 100 days.
• Within two months, ensure that 100 percent of primary care practitioners receive patients' discharge planning notes within a week post discharge.
Adding these types of initiatives to already packed project plans may feel frivolous, particularly given all the activity necessary to pull off the average go-live. But achieving results early demonstrates the full power of EHR to impact the issues hospital team members care about. These types of challenges also build confidence in leadership and commitment to the long-term implementation approach.
Effective EHR implementation demands a tremendous amount of empathy for those who have to change the way they work to accommodate new technology. By shifting the focus from how to get team members to "embrace what we build" to engaging them in a process to "create a more perfect solution together," leaders can significantly speed up and broaden the impact of EHRs.
Daniel Dworkin is a principal at Schaffer Consulting, a global management consulting firm. Celia Kirwan is a partner and Evan Smith, a senior partner, at Schaffer.