Change is never easy, but at a time when health systems face more requirements than ever before with quickly approaching deadlines, CIOs are finding that the ability to switch gears is a must. And the group that’s putting up the biggest fight, according to the May healthsystemCIO.com SnapSurvey, is independent physicians. In the survey, more than half (52 percent) of respondents identified non-employed physicians as the constituency most resistant to change, followed by staff physicians (22 percent) and nurses (17 percent). One CIO noted that although nurses are “crucial to the care process, they will opt out of change every chance they get.”
The toughest aspect of change management, according to nearly half (48 percent) of CIOs, is changing individual behaviors. However, respondents also emphasized the role of leadership in creating a culture that supports transformation, along with the ability to secure financial support. The projects that pose the biggest challenges in terms of change management — particularly from a workflow perspective — are CPOE and electronic physician documentation, and the environment most receptive to change is the emergency department, where it is a necessity “to be highly flexible and adaptable.”
Not surprisingly, the vast majority (74 percent) of CIOs polled believe that health systems are being pushed to the brink by having too much change forced on them at one time. Some respondents are concerned that patients will be lost in the shuffle, while others worry about the ability to align incentives to qualify for Meaningful Use and participate in ACOs. On the other hand, others feel that change can be conquered if leaders are willing to step up.
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
1. Which project poses the largest change-management challenge?
HIE-related workflow adjustments
- It’s unfair to make me chose. We have done CPOE and eMAR, so the others, for different reasons and from different perspectives, are a toss-up. I chose HIE because the need, technology, use case are still not well defined.
- This is tough to choose just one. All of the above are huge change-management challenges. HIE-related workflow adjustments seem to cover a broader spectrum.
- By far, CPOE is the winner here… not only for implementation but the ongoing support as well.
- Because of the changes it presents in terms of physician, nursing, and ancillary department work processes.
- The biggest challenge is that the scope is not just about orders. It touches everyone who touches the patient in ways we haven’t even fully defined yet.
Electronic physician documentation
- Total workflow change for physicians and cultural impact.
- Adoption and compliance.
- Gearing up for ICD-10 shines a light on physician documentation. They will be required to document in a way that will seem more tedious than the current process.
- A better choice for me would be: ‘New functionality that changes workflow for multiple departments.’
Discharge summaries/transitions of care (clinician facing)
Patient engagement-related activities (patient facing)
- The patient will push us to become more responsive.
- All have their challenges.
- Patients can eat all the Big Macs they want, smoke a pack a day, and sit on the couch and play games, letting their health deteriorate and getting nearly free care from the healthcare system. Engaging patients to take responsibility to change their behavior from unhealthy to healthy is the next big challenge for us all.
- Patients engage in care at the time of the interaction, but tend to be less engaged when out of the direct care setting.
2. In which area is change best absorbed:
- Our ED physicians have embraced changes better than all of our constituents.
- They deal with change on a minute-by-minute basis.
- Our ED seems to take changes and rapidly integrate them into their practice. I guess it is a necessity in their daily business to be highly flexible and adaptable.
- Due to control and accountability. Incentives help with physician-related issues in their practices.
Hospital-based ambulatory services
- They are the path of least resistance (although ‘none of the above’ would have been a better option).
Owned physician practices
- They are the masters of their own destiny and know that if they don’t absorb changes, they will fail.
3. The most difficult part of change management is:
Changing processes on an organizational level, battling bureaucracy (governance, organizational charts, etc.)
- It is all difficult. All of the choices are related as you won’t be successful without strong support for each of these.
- The organization is driven by its culture and changing a culture is difficult and time consuming.
Changing individual behaviors (getting Doctor A to electronically input his/her own orders)
Obtaining sufficient executive support
- Change starts at the top. Don’t get support there and forget about it!
- No one wants to be the hammer so everyone ends up being “the friend” with no executive push or firm directive.
Finding the human and financial resources to effect the transformation process
- Huge impact on resourcing both inside and outside the organization at a time when resources are scarce.
- Trying to manage to budgets and productivity targets while also forcing change is difficult.
4. The health system constituency most resistant to the change is:
Administration/non-clinical staff (medical records, billing, RCM)
- It’s not a group in this sense. It is more of an individual’s ability to deal with change. Sometimes that person is a nurse, sometimes a doctor, sometimes an administrator, maybe a clerk.
Physicians employed by the health system
Independent (non-employed) physicians who refer patients into the health system
- It might be equal in resistance among nursing and physicians.
- No problem picking this one.
- [With nurses] you mess with one, you mess with all of them. While they are crucial to the care process, they will opt out of change every chance they get. It is a leadership issue with accountability that I have seen time and time again.
- We have met the enemy, and he is us (with apologies to Pogo).
5. Current programs and trends pose an amount of change beyond the ability of health systems to absorb:
- It’s not the volume of IT-focused changes (MU, ICD-10, etc.) that worries me. It’s our ability to align incentives (and disincentives) to get our people to use the new technologies to provide truly collaborative care.
- So often I hear the phrase “Can you make them stop?” In this case, mandates, regulations, financial shakedowns and haircuts, quality pressures, MD affiliations, HCAP scores, the list goes on and on. Organizations need to do a better job at setting priorities as no outfit can do it all.
- Primarily because there are so many issues — not just IT.
- Too much mandated change coming too fast.
- Success in an ACO world requires a complete redesign in the way care is delivered. The speed of change will be the determining factor in whether an organization can absorb it.
- I’d like to think this isn’t true, but I am very concerned that it could be true. I am concerned that in the midst of all the change, the patient who is supposed to be safer, better cared for, and more satisfied will actually be lost in the shuffle.
- Perhaps beyond the willingness, rather than the ability to change.
- Good leadership will make change happen.
- We have the time to design, implement, and incorporate change.
- Too often the excuse is used that there is too much change and therefore, certain things do not get done. The truth is that there are not enough leaders who agree to take a stand and apply focus and resources on change management support.
- It is a matter of force. Force being the pressure applied by, in this case, the folks driving reimbursement.