ARRA: The Care Revolution (a guest article by Newton-Wellesley Hospital CIO Scott MacLean)

All of these business relationships require us to view ourselves differently — namely, that we need to collaborate and share rather than protect and keep secrets.

Change in Identity

What does all this mean and what will happen with the ARRA? We all know the hackneyed expressions about change. It’s hard and people don’t like it. As we’ve been through these recent implementations because of our corporate relationship and external business partners, we’ve realized that people have actually had to think of themselves differently. End users, IS staff and managers and private physicians have all had to align themselves under a different “master.” Some have said that this “psychological” change is the most difficult.

Example: The staff nurse who had worked in this community hospital for 30 years and seen administrations come and go, needed to get a new paycheck distributed from our parent corporation. She needed to adopt medication administration practices and policies that were optimized at a sister academic medical center. Despite union representation, pay practices were aligned with other hospitals in our system. She needed to think of herself as giving the very best care for our community setting, but being supported by fiscal and administrative processes that span the life of the patient.

Example: The private physician adopted a common electronic medical record that is viewable by clinicians across the network who have a need to know. Inputs to this record must conform to policies set for clinical care, quality monitoring and pay for performance contracts. Changes in policy or software need to be vetted by numerous people. The physician needed to think of himself as part of a care continuum with shared services rather than a small business independent of any other encounters. As you can imagine, this transformation remains in process for some.

Example: The IS manager who came to the hospital to run technology needed to collaborate with corporate groups engineering the computer network and running the Help Desk. Tools and processes changed and functions were “outsourced” to the parent company. Of course, this drove job activity changes, but even more, it forced the IS manager to consider whether she wanted to be part of an integrated delivery system providing the necessary information at the point of care. She needed to decide whether she wanted to help optimize, and in some cases lose control over administrative processes that are not the core competency of a community hospital. The alternative, which is becoming less available, was to move on to another independent hospital that doesn’t have to cooperate with other business units.

It’s challenging to have these conversations. In our market, it’s difficult to find healthcare IT talent, so in many cases, we have to wait for this transformation to take place in existing staff. During these times, leaders need to communicate the mission tirelessly and show patience as people consider their identity. We wait and listen to good employees as they make their way. In some cases, a crisis can be created to help people decide where they stand. In our case, we used budget cuts, moving the Help Desk to corporate and service metrics to improve processes.

Expect more of this with the ARRA. What we have been going through is small compared to an entire industry learning to collaborate. The new mandate is to share information rather than use information to differentiate and to compete. The principles are sound – collaborative care to deliver the best quality at the best price. Build an information systems infrastructure that will support those goals. Vendors, providers and payers will all have to make significant changes to bring that about. The change starts with individuals considering their identity and loyalties.