Engaging Clinician Leadership to Adopt Healthcare Technology – Breakaway Thinking

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc

In many healthcare organizations, IT leaders are given the ultimate responsibility of implementing and adopting electronic health records (EHRs) and other health information technology (HIT) because the build and installation fall within their responsibility. While their technical skills and experience are necessary to select, install and maintain the HIT system, clinician leadership should ultimately own the use of the system.

Ownership of the system requires commitment to establish best practice workflows and system parameters that clinicians follow and evolve over time. The risk is that the technology won’t be used to its fullest potential and could even pose potential harm when used incorrectly or without knowledge of how information is entered, accessed, and used by other providers. In a recent alert from the Joint Commission, 23 percent of all reported HIT-related events were due to poor design and data associated with clinical content. Ensuring nurses, physicians, pharmacists, and other clinical staff are involved in decisions about how the system will be used will help alleviate these issues and ensure proper system use.

Over the years, The Breakaway Group’s research has shown that clinician leadership must be highly engaged to effectively adopt new EHRs and HIT systems. In fact, it is the most important predictor of successful EHR adoption. While clinician leader engagement may appear straightforward, competing priorities make it difficult to maintain the degree of engagement required after a new EHR system goes live.

For example, clinician leadership may see fewer patients or put certain responsibilities on hold until the system is implemented. In reality, responsibilities associated with the HIT system must shift and evolve among all stakeholders throughout the adoption journey. After go-live, clinician leadership involvement shifts from decisions around clinical applications and best practice workflows to decisions around upgrades, optimization of the system, and identifying workarounds. Both pre- and post-go-live responsibilities take time and need to align with the overall responsibilities for each role within the healthcare organization.

Involvement of clinician leadership early on in the adoption journey helps create a culture that embraces change and instills a sense of ownership to all levels in the organization. This cultural shift is not easy and requires the right mix of calculated planning and visionary leadership that must resonate with clinicians. A recent article published by The New York Times, describes the paradox of clinicians resisting new EHRs and creating “technology that physicians suddenly can’t live without.” On one hand this technology is causing resistance among clinicians to the point of reverting to paper, while on the other, this technology is helping mitigate countless medical errors and waste. Clinician leadership must engage to address both sentiments and create a culture conducive to change. With the rate of technological advances, a cultural status quo will not suffice.

Naturally clinicians are data scientists and lifelong learners. Show them data and provide them a comfortable learning environment to get up to speed quickly. Then they can help review the data and identify areas for improvement. For example, clinicians can query orders associated with quality outcomes such as electronic orders for flu vaccinations and determine if the rate ordered aligns with internal quality metrics. If the rate is below the agreed upon threshold, clinician leaders can focus efforts on systematically improving the rate ordered.

The longer clinician leadership involvement is delayed, the more likely resistance will fester and organizational culture will be at risk. Adopting technology, especially technology associated with government requirements, is painful and simply takes time. The difference is whether clinician leadership is involved early in the decision making process. If you do not want your clinician reverting to paper charts and/or throwing laptops and mobile devices out of sheer frustration, give clinicians the time and resources to fully engage in the adoption journey.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

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  • I don’t disagree with anything Ms. Paykos says, but would add this. Successful system implementation requires concentrated and concerned involvement of the full clinical team. All too often only practitioners and administrators have a full say. Nurses, technicians, schedulers, etc., etc., often play lesser roles to everyone’s determent.

    I also believe those managing implementations should guard against burnout among those who have both clinical, design and implementation duties. Nothing worse that having your best folks lose the very qualities that make them your best.

  • Carrie – Great article.

    I believe that you’re addressing an important chink in the armor of many hospital-wide practices that involves the disconnect between those making the policies and those carrying them out. In this case, the “policy” is the adoption of an EMR/EHR system that isn’t based upon the needs and input of those utilizing the system.

    This “disconnect” is endemic on a number of levels of policy and decision making throughout the healthcare system. It’s why we’re still struggling with reforms that fail to take into account the increasing acuity of our patients, and the increased workload of our staff.

    Failures in staffing policies continue to result in:
    • more injured nurses and care-staff
    • more frequent medication errors
    • increased worker burnout
    • the highest attrition of first year nurses in the history of modern healthcare,

    and heavier case-loads for hospitalists result in reporting such as:

    • 22% said they delayed admitting or discharging a patient until a subsequent shift;
    • 22% said they ordered potentially unnecessary tests, procedures, or consultations;
    • 12% said that their overall quality of care was negatively affected; and
    • 10% said that they failed to note or act on critical lab results.

    It seems that root-cause analysis of most EMR/EHR mishaps would indicate that the input from clinicians before the implementation of the system is paramount to positive outcomes.

    Any ideas on why this isn’t happening?

    Thanks for the great topic.


    Jerome Stone, RN

  • Carl great point. All too often change leadership and planning for EHR adoption is focused on the initial implementation. And the key members involved in deciding how clinical workflow are performed in the new applications are often too removed from the process. Pulling in critical members of all clinical areas to help develop and sustain the application is key. And those members must have the support and staffing accommodations otherwise burnout is inevitable.

  • Jeremy, thanks for the comment!

    Well said about staffing policies and case loads for hospitalists. In the midst of these challenges, electronic health records are helping prevent medical errors. But the systems and policies are not perfect. As healthcare shifts from a fee-for-service to a value-based model, safety and satisfaction for both clinician and patients will likely improve. But this transition similar to adoption of technology requires the direct input and leadership of clinicians to make significant and lasting impact.

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