The benefits of integrating a radiology information system/picture archiving and communications system (RIS/PACS) into a streamlined healthcare information system are clear to most healthcare executives. Order automation, improved billing accuracy, and efficiency of decision-making and diagnoses are just a few benefits that make a significant impact on the quality of patient care.
We often assume an organization will realize these benefits as soon as implementation is complete. The reality is a hard pill to swallow and many organizations never truly realize the benefits. Why? The fact is we are still focused on the technology installation. However, ensuring successful adoption means thinking about the process in an entirely new way from the start.
Navigating any significant organizational change requires strong leadership, starting at the top. And organizations that make change leadership a priority experience improved technician proficiency, workplace efficiency, and ultimately, a higher quality of patient care.
So what exactly is change leadership as it relates to RIS/PACS adoption? To define that, let's take a look at the traditional “train-the-trainer” model of technology implementation. Organizations rely heavily on trained system administrators to get systems up and running, and train users as well. Although a customary practice, this approach does not provide users with the knowledge and confidence they require to adopt new technology. These traditional training models fail because new users are overloaded with new information, have little or no time for hands-on practice, and lack the time required to attend training. Users often feel frustrated, unprepared and even unwilling to adopt new technology.
Leadership in action
The first step in true change leadership is to dedicate the necessary time and resources to the adoption process, rather than train-the-trainer and classroom instruction methods. HealthSouth (Birmingham, Ala.), one of the nation's largest healthcare providers, was a prime example of how to tackle change leadership during its recent RIS/PACS integration. HealthSouth understood that successful and rapid end-user adoption is a change leadership challenge, not a technology project. To that end, the organization first engaged in effective communication from the CEO to introduce the technology, explained how the advancements relate to the organization's mission, and made clear why the change is needed now. HealthSouth leaders knew communicating with users at all levels would help them understand their role in achieving larger organizational goals.
HealthSouth truly engaged those who led the end-users, and was relentless in the focus on adhering to new workflows and best-practices. This change leadership method proved extremely successful in helping the organization to certify 61 diagnostic imaging clinics and 874 providers in just eight months. As a result of the leadership model, 82 percent of site administrators could clearly state their responsibilities and the goals of system implementation. And providers adopted the new enterprise applications 116 days faster compared to the train-the-trainer model used during the pilot phase.
RIS/PACS adoption at HealthSouth is an ideal example of how to create an environment where technology change and rapid adoption are embraced.
First, let's explore how to achieve customized learning. For each end-user role, organizations should identify the primary tasks required to successfully fulfill that role using the new technology. For example, the technologist's role is defined by each specific task that is completed in the new technology. Next, the tasks must be sorted by frequency and complexity. The best model for teaching those tasks is dependent on their frequency and complexity. Scenario-based online simulators are an excellent model for many organizations because they offer relevant “just in time” practice. Job aides are another tool that can be customized to the needs of the users — online resources, desktop tents, and index cards are very effective.
To make the most of such customized learning, leaders must communicate the importance of everyone's participation. Users should clearly understand the process and the level of proficiency required for effective system use. The organization should establish specific criteria for user “certification.” This can be defined as the point when users are proficient and can perform their jobs without assistance in the new system.
To achieve this level of proficiency, super-users or champions should coach users, then observe them performing the required skills. At the end of the learning process, all users should have documented certification that they have acquired the skills necessary to perform their jobs.
When these methodologies are used in combination with strong leadership, they are extremely effective. At HealthSouth, 92 percent of providers rated their experience with the system launch as “good” or “excellent.” Given that today's healthcare professionals are wary and many times unwilling to sit down for traditional training, that figure is astounding.
The long haul
There is great value in the certification process, but before you pull the trigger on RIS/PACS implementation, don't forget sustainability. A well-designed plan for measuring and managing the proficiency of the workforce will mitigate millions of dollars in re-training and enable a change-weary employee time to provide excellent care to patients. If you plan well, the tools you develop for certification will serve you well for sustainability. Online simulators and job aides provide the consistency and relevancy for new and current employees to continue learning. Champions and super-users should continue in their role as “certifiers” to ensure long-term sustainability.
The time committed to developing a clearly defined change leadership strategy and customized learning model leads to higher end-user satisfaction, faster end-user adoption, and a clear understanding of the goals and objectives of the system by clinicians and leadership. This strategy allows the focus to be on achieving the most important return on investment — better patient care.
Heather Haugen, Ph.D., RD, is vice president of field operations and research for The Breakaway Group, Denver
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