Making a change in information technology—whether it's a software upgrade, a new application, a new feature, or an entirely new enterprise system—can be cumbersome and disruptive for a clinical lab that's used to doing things a certain way. But with proper preparation, it can be an opportunity for across-the-board improvement, says Terry Carroll of the SPRING Network, an organization devoted to organizational change.
Carroll, a veteran CIO who has served several large healthcare organizations including Dartmouth-Hitchcock Medical Center, Fairview Health Services, Detroit Medical Center, and Baystate Health System, rejects the notion of “managing change," in favor of designing and leading it. “Disruption is generative," he says.
Carroll recommends the following approach:
Identify the desired outcomes. This requires posing questions like: What can a software upgrade or a new piece of information technology do for the lab's operations?
Increase productivity? Improve quality of care? Expand the lab's range of services? Create more accurate records or bills? Reduce costs?
Carroll suggests identifying four or five specific, measurable goals, and analyzing how the new technology will advance the lab toward those goals. For example, Carroll worked on an IT integration project that took information from multiple systems to create a complete episode-of-care record, providing a clear improvement in the quality of information available to clinicians. “Normally in upgrades there are all kinds of choices you need to make," he says. “Every choice should go back to the five things you need to impact."
Set expectations and accountability. “People always want to gravitate to what they're comfortable with, and you have to help individuals overcome the pull of the past," Carroll says. To that end, the staff must understand how a technology change can help achieve the outcomes mentioned above, and how they must adapt their workflows to reap the promised benefits. If they have participated in setting the goals, they will be more open to using the technology for its intended purpose, rather than working around it to keep doing things the way they always have. And if they are accountable for achieving specific productivity or quality improvements or cost reductions, they can more easily see the results of their extra effort.
However, to be as proactive as this approach implies, it's important for labs to know why they're making a change, and ideally to be seeking that change from within, Carroll notes. Often, a system change or upgrade is imposed by top management. Labs will have to analyze its benefit for them and push back if there is none. “A lot of organizations do upgrades to keep up, but if it's not going to fundamentally change outcome, then it ought to be behind the scenes and not disrupt the people doing the work of the lab."
Carroll particularly cautions against the almost yearly upgrades issued by some major EHR vendors, each of which can put the entire institution on hold while the IT department figures out what impact they will have on the overall integrity of the system. “We've gotten into this rat race of thinking we have to constantly upgrade, upgrade, upgrade," he says. “Many of these systems weren't engineered for incremental enhancements, the way digital applications are today. That's a challenge for the vendors, to create something that's less disruptive."
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