Technology as a Tool of Change Management

A Touch of Lime: Technology as a Tool of Change Management

By Albert Molas Barberá, CIO, Hospital d'Igualada

In Spanish we have a saying: dar una de cal y otra de arena, which translates literally as "to give one of lime and another one of sand." This refers to making mortar, where the proportion of lime to sand is critical for its strength. In English you talk about carrots and sticks instead, but they point to the same thing: the balance between promise and threat in motivating people. However, no matter what language you speak, every CIO knows that people tend to see change as threatening, which can put you on the wrong side of that balance right away. This is especially true if you are dealing with users who have good reason to be resistant to change, as is the case in medicine. I don't say that as a criticism, for the conservatism of doctors and nurses is fundamental to their profession; their primary precept is "first, do no harm" — which isn't a bad motto for a CIO, either! So they are naturally and rightly suspicious of any change unless you can demonstrate a benefit to their patients. That's the touch of lime that makes the mortar stronger and easier to work — or the carrot that entices. With the right approach, the very technology that users might otherwise see as a threat can be used instead to entice them into adapting to change. We tried hard to get this balance right when we built the new Hospital d'Igualada in Catalonia, Spain near Barcelona. It is a state-of-the-art facility incorporating a medical-grade network infrastructure. The new hospital will serve as a blueprint for transforming medical care in Catalonia through integrating digital technology and enhancing collaboration with other healthcare organizations. In the early stages we focused on parameters such as mobility, availability, performance, support for converged services, easy management, and security. In the beginning, we faced two fundamental challenges:

  • The conservative attitude of some of the medical staff. As you might expect, younger doctors and nurses were more open to the idea of digitizing and networking everything compared to the more veteran members on staff. But we could not afford to create division among the staff. We wanted to be sure to bring everyone with us on each step of the journey.
  • The old facilities, created by the merging of two hospitals a decade ago, did not have the infrastructure to support a full pilot of all the capabilities we wanted to implement in the new hospital, which was to be built from the ground up as a networked facility. This not only put more pressure on IT by limiting the amount of testing we could do, but also limited our ability to prepare doctors and nurses for the new way of doing things.

We began working on these challenges by first identifying the best practices used in similar healthcare transformation projects, and undertook an extensive program of workshops and interviews with department heads and critical staff to find out how doctors and nurses worked in each area of the hospital. These workshops identified four areas as critical:

  • Clinical services and patient care
  • Knowledge management and learning
  • Internal efficiency and administration
  • Technologies for asset tracking, such as RFID

The workshops also helped identify possible obstacles, and helped us size the project in terms of the number of computers, wireless access points, and so forth required to make sure each professional had access to medical information as quickly as they needed, and where mobility was critical. We decided not to install personal computers in the emergency rooms, because our emergency rooms have two beds, and the only place to install the computer was hanging on the wall or at the foot of each bed. We were concerned that this would cause security and privacy issues since friends, relatives, or other unauthorized personnel visiting the patient could view the electronic health record. We are currently considering laptops on a trolley as an alternative. To help develop the right processes for introducing new procedures and for training the staff to use them, without worrying about infrastructure issues, we implemented a simple pilot of a third-party medical prescription application in the old facility, in a single department: internal medicine. This pilot helped identify some fundamental cultural issues that could have taken us by surprise later had we not known about them. An example is that doctors tend to see data entry as an administrative task rather than a core part of their responsibilities — they were used to dictating their reports for transcription by an assistant. That obviously would have to change, but how? It turned out that the key was radiology. In the old hospital, radiology was all film, and doctors fretted at the delay and hassle this entailed. In the new hospital, from day one, all radiology was digitized, online, and very quickly available. That was the carrot. The stick, such as it was, was simply the requirement that a doctor or nurse log on to get access. Not a big deal, but a huge payoff in terms of convenience. Now practically the entire staff could see a benefit from the new system with very little effort on their part. From there, it wasn't as big a step for doctors to understand that, yes, they might spend a little more time writing up their reports on a computer, but they saved that time and more when they needed immediate data on a patient. With that as an example, doctors and nurses adapted rapidly to other systems in the new hospital. Within three months, everyone was up to speed on the new prescription system, which is helping to reduce medication errors. Overall, operation of the new hospital is far more efficient, and the staff is more able to concentrate on patient care without worrying about administrative paperwork. Our experience with the new hospital confirms what I suspect many CIOs already know, but is worth repeating: The real challenge in change management is not the technology but the people. Make sure of your objectives, set realistic horizons, both short and long term, and be sure to talk to as many people as you can — and then more! And always try to figure out where the technology balance of lime and sand are.

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