Managing Change — Not Avoiding It — Is The Answer

I just returned from the Prada show in Milan. Not really — that was the opening line from a piece on NPR. Apparently the runaway hit on the runways a few years ago was high heels, with the emphasis on the notion of high.

The following passage comes from the UK Telegraph: The girls looked like rabbits trapped in the headlights; their faces taut and unsmiling, their eyes wide with fear and apprehension. Were they about to undertake a parachute jump? Abseil down a 1,000-foot mountain? None of the above. All they were doing was trying to negotiate the catwalk at Prada during this week’s Milan fashion shows in shoes that were virtually impossible to walk in. At least two models tripped and fell on to the concrete floor; others wobbled and stumbled, teetering and tottering, clearly in agony, and all the while their minds were fixated on just one thing: reaching the sanctuary and safety of the backstage area without suffering a similar fate.

According to the NPR reporter, the heels are so high that regular people — women — can’t seem to walk in them without falling. This problem has led to the creation of an entirely new micro-industry. In Los Angeles and New York, there are classes to teach ladies how to walk in very high heels without hurting themselves. These classes are being offered through dance schools that couldn’t fill their dance classes — they are now booked solid.

From a consultant’s perspective, what makes this story interesting is that those businesses saw a need and re-engineered a part of their operation to meet that need, sort of like we’ve been discussing regarding the impact EHR will have on your organization. With the implementation of EHR, many things will change. If they don’t require change, you probably wasted your money on the EHR. What’s important is having a plan to define the change and manage it. Rework work flows, remove duplicated processes and departments.

Is this true, or is it simply consultant-speak? You tell me. Rumor has it that at a hospital near Baltimore, some 4,000 clinicians signed a petition stating they are not going to use the hospital’s EHR. The doctors are saying they are not even going to try to walk in those heels; they are going to wear flats. Can you name the EHR against which they are revolting?

Two other large hospitals with whom I have spoken purchased the same EHR. They have substantially fewer problems. Why? Because, they only use the EHR as a $100-million-dollar scanner. Their users do not click, navigate screens, or surf drop-down menus. Instead, they handle their exam notes the same way they always have. They dictate.

How can a software program be that bad? Maybe that is the wrong question. From what I have seen, EHR software does exactly what it was written to do.

There are two causes of productivity loss: additional tasks, and poorly performed additional tasks. The impact on productivity due to additional tasks is smaller and one that will not go away. The impact on productivity of poorly performed additional tasks is significant and can be corrected.

Additional tasks. Turn your back on your patient, literally. Every mouse click, keyboard punch, and screen navigation you make are additional tasks. Each of these tasks takes time. That time can either be subtracted from time normally spent with the patient, thereby keeping the exam time the same, or those tasks can be added on to the exam, thereby causing it to take longer. If the exam takes longer, something has to give. That something is productivity. Your EHR vendor will tell you the productivity problem will be self-correcting within two to three months — that if you click the heels of your stilettoes together three times, the productivity loss will disappear.

Poorly performed additional tasks. The fact that the EHR invokes new tasks accounts for only a portion of the productivity loss. The fact that the EHR regulates clinicians to perform these tasks in an order that does not mimic the order of an exam adds additional ineffectiveness and inefficiency to the process and causes lost productivity. All of this lost productivity is attributable to how your EHR was configured. This loss can be recovered by reconfiguring the EHR to match how physicians and nurses actually perform their work. The reconfiguration cannot be done by IT and it cannot be done by your EHR vendor. The only way to do this successfully is by working with systems designers; people who are experts in how users interact with technology.

Now I’m going to go saw the heels off my wife’s shoes before she hurts herself.