Healthcare Technology Implementation: How Can We Hit the Ground Running?
By Karen Larimer PhD, ACNP-BC, FAHA
I love a good manual. Give me a manual and let me follow it step by step. When I first start a project, I want the directions, preferably with images. Map it out for me! This feeling probably comes from my days as trialist. If only every endeavor on which we embarked had a manual, and this could not be truer than when deploying innovations in healthcare.
So naturally with my latest challenge of implementing a new patient monitoring solution in a skilled nursing facility, I looked for that manual. Shocker…there wasn’t one. Fair enough, I move on to plan B: hello internet searches. And what I found was an excellent, if nonspecific, set of tenants to guide my execution. The “Top 10 Steps to IT Implementation and Long-term Success” written by Murray A. Reicher, MD FACR, Chief Medical Officer, Merge, an IBM Company, that was published in Healthcare IT News that provided me an excellent framework.
The following is a recap of Reicher’s 10 Steps, with a dash of my own experience for consideration.
1. Create a culture of collaboration and partnership
Develop, in partnership with the customer, a culture of cooperation and shared priorities. The vendor helps the customer reach the highest level of success, and the customer helps the vendor earn the highest reputation for the work they do.
I recommend starting this EARLY in the process.In other words, be sure your Business Development team has this philosophical approach too because that’s where this relationship begins.
2. Clearly identify key leaders
Reicher writes that the customer team members must include (at the very least) an administrative champion, physician champion, and technical champion.
While I do agree with this, it is also critical to know your product’s audience.In our case, it will be nurses using it mostly, so we will need a nurse leader/champion in that group.Also, don’t ignore the potential of informal leaders.These are the high performers on the customer team that may not be C-suite or V.P. but will be critical to the success of the implementation and any practice change.On the flip side of this, inspect for any potential saboteurs.Try to determine their agenda and work with them or involve leadership to resolve any dissent.
3. Select and empower a physician champion
Formally select a qualified physician champion based on his/her excellent communication/teaching skills, commitment to the mission, and leadership capability.
I agree with this; HOWEVER, it does not have to be a physician. For example, Advanced Practice Nurses and nurses in leadership positions are just as effective as a good physician leader.
4. Document team mission, vision, and values
Have all team members contribute to and sign-off on foundational documents that establishes the direction, priorities, and guiding principles that will keep everyone on the same page.
I have never seen this done BEFORE an implementation, but I love the idea.I have done it only when we have run into barriers, and by then it’s usually too late.Doing this early in the relationship is a phenomenal idea, in my opinion.
5. Establish rules for communication and decision-making
Set a rule that all communications are shared among key stakeholders. Document each implementation task, assign a responsible owner, and create a due date to ensure that each person is accountable and appreciates that an incomplete task means a project delay.
You know what this means to me? Get a PROJECT MANAGER.That’s worth saying again, GET A PROJECT MANAGER.A skilled project manager can support a cost-effective process while lowering the anxiety of both the customer and the vendor.
6. Establish clear objectives, success measures, and timelines
Success often requires changes in technology, processes, and personnel. Start by identifying important benchmarks and metrics that best match your values and project domain.
I agree whole heartedly here, but I do recommend carefully considering the priorities of your customer.In other words, has the customer just recovered from another roll-out and they are exhausted?Has the customer had a lot of recent turn-over and the new team is just getting their feet on the ground?Know their current environment and be prepared to address proactively.
A training team should be established at the start of the project, including a lead trainer from the vendor and other appropriate customer personnel. And remember, training is an ongoing process. It doesn’t end upon implementation.
Over the years, I have learned this the hard way. I had a site that once the training started, leadership evaporated.What message does that send to the rest of the customer team? The question to myself was, how could I have engaged them more?
8. Standardize implementation to boost quality and efficiency
Strongly consider creating a master file of procedures and training material rather than just adopting what was used in the past. You can improve on this and add as you go.
Aiming for a standardized training curriculum is important.That said, it is critical for the vendor to understand the customer’s culture and workflow. Tailoring the training to the customer is one of the biggest steps to success.This is not only important for the customer’s typical delivery of training, but also for the customization of content to match existing and future workflows. It is unlikely it will ever be one size fits all.
9. Agree on white-glove inspection requirements
Clearly delineate the system and personnel tests that must be completed before you go live and before you complete on-site training.
Don’t get so excited that you have a new customer that you assume all of this will play out “as planned.”It won’t.It never does. Do a dry run and get the validation complete before you execute. By not doing this, you risk lag times and the appearance of disorganization.
10. Measure, compare to benchmarks, and market the benefits
Use technology and the patient visit to communicate with your patient population and continuously solicit their feedback. Let your referring staff and contracted payers understand and appreciate your achievements. Don’t be afraid to make bold claims now that you have the data to back them up.
So often we are obsessed with the customer (payer) that we miss the patient.That’s a non-starter and we must improve this, because the patient is the bottom line. Consider your customer in improving your technology and your business.While it starts as a transactional relationship, it can become a trusted partnership.
Reicher’s 10 steps really helped me get my head around best practices for an implementation. It is consistent with good process, i.e. assessment, planning, execution and evaluation. I think it is also key to not to get caught up in the race to completion and focus heavily on the process without skipping any of these critical steps. And remember, philosophically treating this as a partnership between customer and vendor will go a long way to successful and mutually beneficial relationship.
My plan is to road test these steps with my next customer. I plan to report back on what has been working and what has not. My hope is that you can learn through my experience as we build this manual for deploying new technology implementation in healthcare.