Making Culture Your Ally in Clinical Information System Implementation

An organizations culture can make or break any Clinical Information System (CIS) implementation. Ask Joy Keeler, Chief Architect of Nicholas E. Davies Award-winning CIS initiative for University of Illinois Medical Center.We knew from the beginning one of our greatest challenges was overcoming a prevalent attitude of doubt within the organization as we moved to a paperless clinical information system. Once we showed quick wins and provided proof that we could make things better, we built a following among all the stakeholders at UIMC. By creating a passion for our mission, we transformed the way we deliver care, improving patient outcomes, reducing waste and variances, even improving our retention rate among physicians and nurses. And while everyone has embraced the new system, the principal beneficiaries are our patients, said UIMC’s current Associate Vice Chancellor of Heath Affairs.The case history described by Joy provides instructive insights into achieving success with CIS and tackling arguably the most challenging barrier of all, organizational culture. Instead of something to be feared, a renewed and revitalized culture can be your most important ally, as Joy discovered. Of all the approaches we have practiced and observed over the last 25 years as consultants to the health care industry, we believe the following ten are the most powerful and most likely to lead to making organizational culture your ally vs. your worst nightmare.1. Create Passion for the Vision, Mission, Values and Strategies
Whatever reason your organization has for embarking on a CIS initiative, make sure that all key stakeholders know, understand, and embrace the objectives and can articulate what we are doing and why we are doing it. Success for this huge undertaking will require a ubiquitous commitment to quality care, and many specific goals such as eliminating medical errors, waste, delays, unnecessary variance as well as improving patient satisfaction and your strategic positioning.2. Measure Readiness Early and Conduct Periodic Check-ups
A formal assessment of readiness for CIS will help you understand the major barriers you have to overcome. Assessing readiness and undertaking a readiness improvement effort is as vital for this type of initiative as physical training is for a marathon runner. Readiness can be measured in many ways, including: Technical Readiness, Workflow Readiness, Culture Readiness, Financial Readiness, and Project Management Readiness. We know this is a lot of readiness, but it’s a critical part of successful implementation.3. Deal with Cultural Challenges Proactively
Two very common cultural challenges (courtesy Dr. Jeffrey Rose, CMO, Cerner Corporation) include Infobia, or the fear of appearing incompetent using technology, and Archetypal Medical Tradition, which drives resistance to standards, guidelines, and outside scrutiny. Simply hoping that these challenges will go away by themselves is naïve. Intervention in the form of education and skill-based training is required, which will only be possible if all key stakeholders are on board.4. Establish Value as the Foundation for CIS
Our belief is that it is important to quantify and clearly articulate the Financial ROI and the Strategic ROI of the initiative. Value-based initiatives are the most successful because there is a clear understanding of all of the costs (financial and otherwise) and all of the benefits of the initiative. Continuous quality improvement is a fundamental value of any CIS implementation, and the return on the investment in quality should be well understood throughout the organization5. Communicate and Train Early and Often
We believe it is important for all stakeholders to understand (and articulate!) what they are doing, why they are doing it, and what are the costs and benefits of the undertaking. We also understand that most stakeholders will require new skills and capabilities to succeed in a new CIS environment, so it is important to provide substantial training so people can learn the new mechanics of CIS. Best results are achieved if the CIS initiative is treated like a major construction program; all the way down to the Pardon Our Dust posters that beg patience for current problems while providing hope for a much better future.6. Identify and Satisfy the Needs of Individual Stakeholders
You must identify the key stakeholder groups and the opinion leaders within each. Once you understand what their major needs are, work with them to ensure that the CIS project can meet those needs as much as possible. It is our experience that adoption happens more quickly and thoroughly if everyone gets as much of what they want as possible.7. Pick Champions Carefully at all Levels
Every major cause needs a legion of champions. We believe these champions can be identified, encouraged, and given roles that create leverage throughout the organization. You don’t need Superman or Superwoman, just opinion leaders who are respected by their peers, have the ability to perform, a positive attitude, thick skins and have high endurance. After all, this type of initiative is a marathon, not a sprint!8. Excitement Overcomes Fear of Change
We have learned many fundamental truths over the years, one of which is: A clear vision of the destination creates enthusiasm for the journey. It’s also very important to be truthful about how long and arduous the journey will be. Champions will be able to lead the organization through The Valley of Despair if everyone believes that the end result will be better. We also know that there will be people who try mightily but are unable to complete the journey; carry them, and give them new and more appropriate roles.9. Use Speed to Your Advantage
As evidenced by the UIMC example above, the faster you get to benefits, the faster the organization will embrace the initiative, and the quicker you can make organizational culture your ally. We encourage using three different and powerful mechanisms: Speed to High Performing Teams, Speed to Implementation, and Speed to Value.10. Engage Professional Management and Chose the Right Guide
Recognize that the selection and implementation of a CIS is a major undertaking, and most likely the one and only time most people in your organization will experience this in their entire careers. The cost of mistakes is very high and the probability of success is increased substantially with full-time professional program management. There is no reason to undertake this transformation alone, and the right professional guide can make all the difference in the world. Pick a consultant or expert who has a proven track record, understands your unique circumstances, acts like a guide and not a dictator, and will work with your organization.Most health care executives state that their most vivid nightmare about a CIS implementation is the fear of CIS-rejection by the organizations culture. Newton asserts that a body at rest will tend to stay at rest, and a body in motion will tend to stay in motion. We assert that if you apply the key points in this article, you will avoid the nightmare, avoid being stuck at rest, and be able to keep your organizational body in motion as you confidently charge ahead along your positive journey of progress.

Middle East Healthcare Has Room for Lots of Improvement

A close look at the healthcare scenario in the Middle East would invariably indicate that the dice is heavily loaded against the region.And, facts speak for themselves.Nearly 60% of the adult population is obese, with cases of diabetes fast picking up momentum amongst the younger generation.According to the International Diabetes Foundation (IDF), in the United Arab Emirates (UAE) and Kuwait 38% of the population in the age group of 20-39 years is diabetic in some form or the other. Infact, given the dietary habits of residents in the region – liberal doses of fat and sugar, thanks to the growing volume of petro-dollars – coupled with the lack of exercise, IDF has recently labelled the scenario as “out of control”.”With temperature averaging 40 degrees Celsius [104 degrees Fahrenheit] over six months in a year, obesity, diabetes and lack of exercise are all in a way linked to the geo-physical parameters of the region,” commented Raouf Ghali, president of project management group for New Jersey-based Hill International. “Economic well-being, coupled with a tolerant tax system encourages car ownership; indeed, over 90% of the residents drive cars. Without a developed public transport system, walking as in Europe and the US is not common practice. Thus, there is not much physical activity, on a daily basis, and if an individual does not actively pursue to ‘move’, one can find himself practically motionless and that is inducing health issues in the young population.”Added to it, is yet another factor and probably more lethal: the low price of tobacco products in the Middle East that has helped in high smoking levels.”Cigarettes are still nearly 35-45% cheap compared with the US and Europe and lots of offices still allow smoking,” he hastened to add.Besides weather, dietary habits and tobacco, there are two other issues – rising cases of non-communicable diseases (NCD) and deaths due to traffic incidents that further add to the woes.According to a Persian Gulf-based industry executive: “In the past few years, there has been a major transition from infectious diseases to NCDs and this is mostly related to individual behaviors, such as what people eat and drink and how they spend their time.”(NCDs are non-infectious and include cancer, diabetes, cardio-vascular disease and obesity).World Health Organization (WHO) has recently predicted that 47% of the disease burden of the Middle East is caused by NCDs and by 2020 it will rise to 60%.It also stated that Saudi Arabia has the world’s highest number of deaths from road accidents, which currently makes up for the country’s principal cause of death in adult males aged 16 to 36. A study revealed that 6,485 people had died and more than 36,000 were injured in over 485,000 traffic accidents in 2008 and 2009.It is not all gloom and doom, however.Spending on healthcare across the region is set to increase. According to independent estimates some US$26 billion-30 billion is targeted for investment by end 2011. And, looking ahead WHO has projected that figure will rise to US$60 billion by 2025.Leading the pack will be Saudi Arabia, which is making the biggest commitment with a healthcare spend of 3.7% of its gross domestic product (GDP). This compares to 2.5% in Kuwait, 1.9% in Qatar and 0.3% in the UAE. Comparative to the developed countries of Europe, Asia and North America, these figures are low. Health expenditure is 15.3% of GDP in the US, 10.4% in Germany and 7.9% in Japan.While laws are being enacted to discourage smoking, some of the governments in the Gulf are also updating their existing public health legislations.Cases in point are Bahrain and the UAE that have banned smoking in restaurants, hospitals, schools and universities, while in Jordan similar orders have been issued for all government offices and public institution.Meanwhile, in late February Hill International announced it had received a contract expansion from SEHA Abu Dhabi Health Services Company to provide project management services during construction of multiple healthcare facilities located in Abu Dhabi and Al Ain in the UAE.The heathcare facilities include Al Wagan Hospital and the Al Mushreef, Khalifa B, Al Falah and Al Towaya Ambulatory Healthcare Centres. The five projects have an estimated total construction cost of US$73 million.