Physician executives can bridge the clinical and operational domains. In that role, they can be approached by forward-thinking clinicians, startup companies looking for a foothold in the healthcare industry, or their medical center leadership peers to advocate for an innovation to improve clinician satisfaction, increase patient safety, reduce waste or some combination of these goals.
What often happens is the physician executive is asked approve a proposed change on behalf of a health system senior leader with a budget to manage. Once it is agreed that the proposed change has merit and the contract is signed, the physician executive is expected to increase clinician adoption of the proposed change to help the organization achieve improvements as promised by the vendor or observed in the pilot. If the proposed change is not adopted in a way to ensure improvements in the relevant organizational metrics, the physician executive may lose credibility for facilitating organizational change or be blamed for not achieving the expected outcomes.
The physician executive’s challenge is that most innovations are tested from a technical perspective without considering the clinical implications of the innovation. Based on how well the innovation is refined and framed for clinicians, physician users will either incorporate the innovation within their workflows or persist in their pre-innovation behaviors. If the innovation is proposed by a technology firm without an understanding of clinical workflows, the suggested change might induce more waste than it removes.
In clinical research, trials are divided into multiple phases. The NIH describes four clinical phases:
- Phase 1: Determine the intervention’s safety, dose range and side effect profile
- Phase 2: Determine the intervention’s effectiveness
- Phase 3: Test the intervention’s effectiveness in a larger group of subjects
- Phase 4: Measure the intervention’s effectiveness after the being approved
Could we apply the same principles to testing health IT innovations?
Pretest: Is the Innovation Worthwhile?
Most health systems will not consider an innovation unless the proposed change addresses an organizational need. The larger the “burning platform,” the more likely a health system’s senior leadership will encourage early adoption of an innovation. I believe the physician executive should be clear that estimating an innovation’s effectiveness and safety will take several weeks or months, but once that information is available, the organization should move swiftly to disseminate the innovation across its user community.
Phase 1: Is the Innovation Safe?
It may be helpful to think, “For whom is this innovation safe?” Important constituents include:
- Does the technology induce behaviors that are unsafe for patients or healthcare team members?
- Is the learning curve steeper than what might be expected for 75 percent of physicians who work at your healthcare facilities?
- Do users see an immediate benefit in their workflows due to the proposed innovation?
Technical team supporting the innovation (“backend”)
- Work to on-board and address most frequent innovation failures
- Ability to detect innovation difficulties before an end-user notices a problem
- Managing innovation upgrades
- Difficulty rolling out backup processes if the innovation fails
Team supporting physicians with the innovation (“frontend”)
- Initial training requirements
- Refresher training requirements
- Interaction of innovation with other technology (e.g., smartphone upgrades, EMR changes)
- Helpdesk calls
If the innovation is too cumbersome for any of the three groups listed above, the physician executive should consider modifying it, adding resources to the teams adversely affected by it, or abandoning it. For IT associates, giving up on an innovation at this stage can feel like a failure, as the technical issues have already been resolved and the capital dollars may have already been spent. To mitigate backlash, physician executives can work to frame the innovation’s success as contingent on achieving progressively more complex milestones.
If the innovation is safe, the physician executive should be looking for signals from end-users about how the innovation is being adopted in ways that support or detract from the organization’s operational objectives. Sometimes, the innovation may be effective, but end-users will not change their behavior without “forcing functions” (i.e., removing old processes or implementing organizational mandates). Most innovations improve one aspect of a process (e.g., improved patient satisfaction) at the expense of another (e.g., decreased physician satisfaction). Ideally, there is a method to adopt the innovation where the positive aspects of the change outweigh the negative aspects. Physician executives should be looking for that “sweet spot,” as it should be how the innovation is marketed in the next phase.
Part 2 of this piece will focus on how leaders can determine whether an innovation will be effective — both overall, and with a broader physician population, and how to measure its success once implemented.