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Embracing change: Healthcare technology in the 21st century

Eastman, Doug PhD; McCarthy, Claire MA

doi: 10.1097/01.NUMA.0000414860.23761.27
Department: Performance Potential

Doug Eastman is the executive director of Technology Adoption, Optimization, and Web Applications at Kaiser Permanente Information Technology in Pleasanton, Calif. Claire McCarthy is the system director of Organizational Readiness at Providence Health and Services in Seattle, Wash.

The authors have disclosed that they have no financial relationships related to this article.



Welcome, healthcare professionals, to the world of change! For those of you who haven't noticed, you've been working in this world for quite some time already. No matter how well we deal with change, it's continuous and shows no signs of abating any time soon; change is here to stay. In order to remain competitive in this ever-changing environment, healthcare organizations need to improve patient safety, revenue capture, operational efficiency, and clinical outcomes. Economic, market, and legislative pressures are relentless, and we see more and more initiatives surfacing at work. Things keep shifting and it can be extremely hard to manage. For nurses, all of this change can have a profound impact on day-to-day work.

One way healthcare organizations try to manage these challenges is to throw more technology at a situation. But, when the implementation focus is primarily on technology and not the end user, efforts often fail and nurses grow more uncomfortable with the change around them. Technology can help facilitate change, but it's only half of the battle. Convincing people to change so they can take advantage of new technology remains the biggest challenge in most healthcare organizations.

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Getting nurses involved

Technology is merely an enabler. The biggest mistake healthcare organizations make is installing information technology (IT) that doesn't support clinical workflows.1 Operational needs should drive technology, not the other way around, thus, it's imperative that nursing operations representatives are involved in the upfront planning of IT implementation. The objective is to ensure that IT system development decisions reflect clinical workflows and the needs of frontline clinical staff. Including nurses at the planning table ensures their interests are appropriately represented and helps increase overall nurse buy-in, which is incredibly important not only because nurses represent the largest group of people who'll use the system, but also because strong buy-in from key stakeholders is critical when trying to influence organizational change.

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Avoid project babble!

Ensuring that key representatives from nursing operations are involved in implementation planning is crucial to the success of the overall effort. To help ease nurses into change, make sure to avoid using project babble at the front line. IT project team members often acquire a completely different language from that of frontline nurses. Project members become comfortable with the names of different testing, training, and production environments, as well as a host of other project-related terms, that only confuse others. This IT language doesn't add value to the front line and can be intimidating rather than engaging. Be respectful when using project babble outside of implementation planning walls. Work closely with a communications partner to ensure your messages are effectively understood by the frontline audience.

For example, during a training session at our facility, a nurse was asked if she understood how to use hot keys to quickly navigate through the electronic medical record system to find the diagnosis for a fictional patient. The nurse didn't understand what was asked of her and wasn't sure how to respond. In this case, we found that asking the nurse if she understood how to use keyboard shortcuts was a more effective approach. In fact, this nurse was extremely proficient using hot keys, she just wasn't familiar with the term. Be very clear while communicating and ensure that your language is appropriate for the audience.

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Exposing the front line

Frontline nurses need to become comfortable with a system well before implementation. It's important to provide opportunities for nurses to experiment with new technology in a training environment, or “sandbox,” with fictional patient information. This allows them to gain a level of comfort and security when searching for the information they'll need to deliver patient care. Providing opportunities to see how workflows will be supported in a new system is also critical. It's recommended that nurses attend preimplementation readiness meetings to learn what will and won't change when the system is launched. The more exposure nurses get, the better acquainted they'll be with the system before go-live. This is especially important because nurses with more exposure to the system will be better prepared to ask sophisticated questions during training. Without exposure to the system, questions asked during training tend to be focused on where to click the mouse and how to survive in the new environment, not on how the technology will support workflows and enable better patient care. This is an important distinction to make when trying to enhance user readiness for an impending go-live.

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Practice makes perfect

The importance of IT training can't be stressed enough because nurses will need to acquire the requisite level of system skills, as well as an understanding of revised workflows and their clinical content. The one intervention that optimally prepares nurses for go-live is the dress rehearsal. Don't overlook or ignore the power of conducting dress rehearsals before going live with new technology.

It's critical that nurses are given the opportunity to practice using the system in their real workplace with scripted scenarios that best reflect their specialty. This is also the best chance for nurses, physicians, and other team members to practice together in their own environment and test how things are going to flow before real patients enter the scene. Have someone from operations play the role of patient and let nurses practice using the system in front of the patient. Role playing like this gives nurses an opportunity to think about the following questions: What will you say? How will you position your body? Where's the printer? How do you engage the patient with the computer? What patient questions can you anticipate and how should you answer? What do you say if you can't remember what to do or need to get help?

Sponsors, trainers, supervisors, administrators, and even real patients are examples of people who can act as a patient during dress rehearsal. Actual patients are flattered to be included in dress rehearsals because they feel that they're influencing something that'll ultimately improve their care and that of others. Dress rehearsals provide unparalleled experience for nurses and shouldn't be dismissed during end user readiness planning. Be sure to push back if IT project team members want to cancel a dress rehearsal due to time and budget constraints. Dress rehearsals are one of the most important aspects of training. This is when everything starts to come together for users, giving them a chance to develop individual confidence and team coordination before show time.

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Don't forget nurse leaders

Frontline nurses receive most of the attention when it comes to training and support for a technical implementation. But despite good intentions and training, initial behavior changes aren't always sustainable. The reason for this is that nurse leaders typically aren't prepared for changes in their own roles as a result of IT implementation.

Supervisors, administrators, and nurse managers are impacted by change too. They need to learn to use the system and understand its impact on workflows and the resulting implications for patient care. But nurse leaders must also be prepared to lead their staff through the change, as well as learn how to manage effectively in the new world of healthcare technology.

Be mindful of the multiple roles nurse managers play because they'll need extra attention during the implementation readiness and post-live processes. Here are some suggestions:

  • Train nurse managers early (before their staff) because this prepares them to better support their teams. It also gives them time to think through policy and procedure changes that may need updating to best suit their needs while using the new system.
  • Have nurse managers attend staff training to answer questions about workflow, policies, and procedures. Trainers are typically unable to address these operational questions and receiving quick answers helps staff prepare for impending changes.
  • Help nurse managers get clarity on what's changing and what's not in their respective areas. Being able to communicate this to staff in simple, practical terms clarifies expectations and helps ease anxiety.
  • Prepare nurse managers to lead in the new world. Experience shows that training, support, and coaching on how to use new system-generated reports is required. The new reports can help managers in many ways, but only if the managers understand the reports and know what to do with the information. This important step is often overlooked—build it into your plan.

When nurse managers are optimally prepared, they're extremely effective in preparing and supporting their teams. Prepared managers are confident in their team's ability to succeed, and this helps everyone navigate triumphantly into the future.

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Take charge!

Whether you're a nurse leader or frontline staff member, technology changes will affect you. It can feel overwhelming, but there are some things you can do to prepare yourself and make the experience less stressful:

  • Learn more about the process people go through during facility-wide changes to develop a better understanding of your own feelings. The added benefit? Self-awareness will make you more effective in supporting others.
  • Learn or brush up on typing and computer skills.
  • Take full advantage of all learning opportunities: web-based training, classroom training, sandbox practice area, superusers, and dress rehearsal.
  • Practice with the new system to develop comfort and confidence.
  • Participate in workflow redesign or other aspects of the project.
  • Ask for help when needed.
  • Remember that “see one, do one, teach one” is a great way to learn something new.
  • Reinforce your learning by sharing it with others.
  • Keep a positive attitude.
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1. McCarthy C, Eastman D. Change Management Strategies for an Effective EMR Implementation. Chicago, IL: Healthcare Information and Management Systems Society; 2010.
© 2012 by Lippincott Williams & Wilkins, Inc.