Change management and leadership


In all of the hyperbole and, let’s face it, outright evangelism, that generally takes place when an organization sets of down the path to implement computer systems to improve healthcare processes there is a very real danger that those for whom it is most important that change is effectively managed are forgotten. I am referring to the administrative staff who are responsible for registering patients, booking appointments, arranging clinics and who, in some ways, have the power of life and death in their hands when it comes to ensuring that a patient comes to the notice of a qualified clinician.

Healthcare providers; doctors, nurses, and allied health-professionals; are, if they understand the opportunities offered by digitalization, usually driven by a degree of self-interest to make such changes work for them. They can understand the benefits of improved decision support, the positive impact that this will have on their own professional performance, and the benefits that flow to their patients.

When properly informed many of these professionals will also see the value that they can add to their own performance through effective use of data that is collected as they practice and the potential for changing and improving the way that care is delivered.

Contrast this with a clerk or receptionist confronted with the daily grind of processing referrals for treatment, checking patient demographic details for previous registrations, checking how long a patient has been waiting for treatment, booking/cancelling/rescheduling appointments and followups, and dealing with both clinicians and customers who need a degree of care, sensitivity and attention. Now add to this that the fact that our reception clerk has been using the same computer system for the last 20 years, and that the computer work was something could often be done later. Consider the reality that the registration and management of patients and schedules was more often than not an administrative task that , if done poorly, was limited in its impact; affecting billing and possibly arousing the ire of the clinician running a clinic and wanting a smoothly organized day.

A modern patient administration capability asks a lot more of our reception staff. Patients must be properly registered before they can receive treatment, that is before a doctor can even begin to work. Effective identification of the patient will be crucial to ensuring that clinical users are presented with the right information to support their decision-making; patient-history can make a world of difference to a clinical decision. And the effective management of patients of referral to treatment pathways will be simplified by staff having visibility of the time a patient has already been waiting, the time left before they miss a target, or alerts as to the urgency of the appointment.

The Importance of Managing Change

The implication for hospital and healthcare services is that change management, and support for staff who will impacted by changes, is critically important to the success of such initiatives.

I have long been an advocate of the school of thought that says that change management is the responsibility of those who are paid to deliver business outcomes. The managers who are already in-situ in an enterprise must take the lead in identifying the implications of change on themselves and the staff they manage.

Successful projects are those that are able to engage the business-as-usual resources in the project at an early stage. Shaping the delivery to support effective change management and bringing the stakeholders, at all levels, along for the ride.

So what does this mean if you are sponsoring or accountable for a project that relies on effective re-modelling, or even transformation, of existing operational processes? Hint: make sure the accountability for ensuring that change happens sits with the line manager responsible for those processes. Not the HR Director, not the CIO, and not any other well-meaning but ill-equipped executive who doesn’t directly manage or bear the immediate impact of failure of a service.

The links I have provided below are just a few that I found that provide some sobering reading. I anticipate that you will be able to see the link between the issues that have occurred, the profound knock-on effects, and the impact that more effective change management and end-user engagement might have had on the outcomes.

A tragic outcome for Cerner Millennium implementation at Bath?

Patient records go-live “success” – or a new NPfIT failure?

http://www.digitalhealth.net/clinical_software/46723/harlow-trust-challenges-ehr-related-fine

http://www.digitalhealth.net/clinical_software/47104/hull-and-east-yorkshire-faces-rtt-issues

http://www.digitalhealth.net/clinical_software/47217/epr-implementation-led-to-%27catastrophic-loss-of-confidence%27

http://www.digitalhealth.net/clinical_software/47103/hull-of-a-job:-hull-and-east-yorkshire-hospitals%E2%80%99-epr-deployment-six-months-on

http://www.adelaidenow.com.au/news/south-australia/epas-labelled-a-dud-by-south-australian-doctors-forced-to-use-it/news-story/a846bc7ce1242efbb9435f494180e098

Coroner raises red flag on “ridiculous” e-health system

http://www.pulseitmagazine.com.au/australian-ehealth/2962-sa-health-on-a-pr-offensive-as-rural-gps-warn-of-dangers-with-epas

http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=2536:contingency-plans-for-epas-and-esmi-at-new-royal-adelaide&catid=16:australian-ehealth&Itemid=328

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