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Plastic Bags

September 10, 2010
by Bobbie Byrne
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What is the key to motivating physician EMR adoption?

I am preparing to do a series of education sessions for our private physicians on ARRA and Meaningful Use. I would like our docs, and more importantly, their office managers, to know what is available for them and how we can assist them with their plans. Since their time is valuable and their attention span is limited, I started to delve into what would really motivate them to adopt EMRs. If I could determine that, I could do a better presentation.

Motivation, of course, is a complicated thing. There are over 18,000 books on Amazon somehow related to motivation. (Of course, if you look for “motivation: teenagers,” the number falls to less than 50. Perhaps motivation and teenagers is an oxymoron.) But motivation under ARRA is pretty simple: carrots and sticks. I believe ARRA will have limited impact on adoption for the innovators and early adopters. They are just cashing a check for functions they implemented years ago. For the early majority adopters, ARRA just got them off the dime. They were intending to implement anyway and needed a shove.

Motivating the reluctant adopters (later majority and laggards on the adoption scale) is the more interesting to me. Prying the paper out of their clenched fists will be a challenge, and ARRA may or may not have an impact. They will be balancing between a very small carrot and a very small stick. I cannot predict which will be more powerful or whether either will work at all.

Without a crystal ball and without much published here, I was at a loss. However, two stores I frequent have their own stimulus efforts going on; they are trying to stimulate the elimination of the plastic bag. A recent bout of errands gave me some perspective on my conundrum that area.

Target credits the customer 5 cents for every reusable bag used. On my last trip, I saw shopping carts full of white and red plastic bags, but nary a reusable bag in sight. I even saw someone put a new tote bag into a plastic bag. The carrot was not working.

The next stop was Ikea. Ikea charges the customer 5 cents for every plastic bag used. Absolutely nobody was walking out with plastic bags. I saw people balancing candles, bags of frozen Swedish meatballs, and picture frames in their arms. One man bobbled, then dropped, a whole stack of plastic children’s cups, on the way out the door. The penalty, even a nickel, will cause grown men to look like juggling clowns. The stick was definitely working, but definitely ridiculous.

My highly scientific study was consistent with what all those Amazon books on motivation were saying. Sticks and carrots work well for the simple behavior choices. Even small penalties can have a bigger impact on behavior than larger incentives.

So if we fast forward to 2015, I believe that we will still have a whole lot of paper in physician offices and a whole lot of Target plastic bags in landfills.

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Comments

Bobbie,

Nice observational science there!

The beauty of your lessons from Target and Ikea, and mine from Starbucks and Sears is that they are visible, objective and pretty much non-tamperable (no one could fake the Ikea behavior, although it could be confounded by other factors, such as the availability of plastic bags.)

Speaking of motivation ... It should also be noted for our readers that some organizations, both large and small, have embedded ARRA/MU attainment into individual compensation plans. True for both physicians, office staff, and senior executives.

Sticks and Carrots are one in the same. Done well, with Homework First, this management approach can be fair, reasonable, and effective. Done poorly, it leads to abuse. Abuse looks like asking people to use systems that aren't known to be usable, because they are turned on before they are ready, tested, trained, support thoughtful and rapid workflows, etc. A story very familiar to readers of HCI.

Thanks for another fascinating post.

Hi Bobbie,

I liked your blog, very interesting points!

BTW, Better Health stores give 15 cents credit for your own bags and there is a fair sum of people that bring their own - is it for the 15 cents or because they are more health /eco conscience?

As for doctors and EMR adoption, is it the money? I don't think it is in most cases that they don't need more incentive, but they certainly are reluctant about the upfront expense of software licenses and implementation time/costs.

Is it the fact they're really not interested in practicing better medicine? For the most part I don't think, so but as long as there is some assurance that it will be the a positive outcome of EMR implementation and not just a movement of paper to electrons. Not all EMR implementations stress the health maintenance rules/protocols facets of EMR products.

They did become doctors to provide the best care they can for their patients, gain respect in their field for doing it and make a respectable living. EMRs and IT stuff is not what they went to school for and may not be interested in dealing with. An EMR implementation takes time away, causes changes and, if not done properly, leaves open or loose ends-like IT network stress analysis if not done well, and now the doctor is slowed down because entering the data and accessing the EMR ASP service has long lag times or strategically converting the old paper records was not part of the EMR implementation and creates mix/match chaos.

The saddest part is this last point should not have to be that painful or overly expensive for that matter if you partner with a good IT/EMR project management group that provide a complete range of IT and business services.

In my opinion the EMR devil is always in the plan/strategy details and not in the lack of interest of practicing better medicine or search for cost saving methods.

Bobbie Byrne

Vice President for Health Information Technology at Edward Hospital in Naperville, Ill

Bobbie Byrne M.D. writes about being a community hospital CIO all the while trying to figure out...