The implementation of an electronic health record (EHR) is one of the most significant cultural changes a health system can experience because it fundamentally alters the work processes and habits of nearly every individual in the organization. Historically, health systems have focused their efforts and resources on the technical aspects of the implementation, giving minimal attention to strategically managing the cultural transformation. Oftentimes, this leads to dissatisfied end users and organizations failing to realize the full benefits of their EHR.
A successful EHR implementation can no longer be defined as the installation of the technology on time and on budget. Organizations are increasingly recognizing that adoption is a better initial measure of implementation success, as it is a foundational requirement for long-term success in EHR value realization. It is only when the technology is embraced by end users, embedded into the culture and integrated with streamlined operational processes that the groundwork is laid for organizations to leverage their EHRs to achieve the next level of efficiency, cost management, quality and experience. And, the best way to secure adoption is by approaching it with the same rigor applied to other aspects of the EHR implementation - through an effective change management plan that engages clinicians and wins their support.
For PeaceHealth, a large not-for-profit healthcare system, the implementation of a single enterprise-wide EHR was the catalyst for transforming organizational culture and laying the foundation to transition to a clinically integrated network. To ensure success, PeaceHealth employed a structured and deliberate approach to lead and manage the system’s transition based on proven change management principles and methodologies.
PeaceHealth: A Case Study
PeaceHealth is a not-for-profit healthcare system comprised of medical centers, critical access hospitals, medical clinics and laboratories in Alaska, Oregon and Washington. PeaceHealth Medical Group is comprised of more than 900 physicians and healthcare providers caring for patients in PeaceHealth’s clinics and hospitals. Like many not-for-profit healthcare systems, during its initial formation, the system’s facilities were loosely affiliated with PeaceHealth as the holding company. In 2014, the organization began transitioning to an integrated network, strengthening the relationships between its facilities and standardizing medication formularies, care processes and policies. Administrative operations were centralized in Vancouver, WA, and the decision was made to transition all ambulatory, inpatient and business office functions to a single EHR.
PeaceHealth’s clinical operations are organized into three geographic networks: Columbia, Oregon and Northwest. The EHR implementation plan called for a three-phase rollout for the hospitals and critical access hospitals, starting with the Columbia network, which went live on August 1, 2015. In parallel, PeaceHealth Medical Group’s clinics were placed on a rolling implementation schedule between May 2013 and March 2014.
PeaceHealth’s Columbia network is comprised of PeaceHealth Southwest Medical Center, a 450-bed community hospital located in Vancouver, Wash. and PeaceHealth St. John Medical Center, a 346-bed community hospital located in Longview, Wash. Both facilities provide a full range of acute care services, including emergency services, surgical and medical specialties and subspecialties, and women’s and children’s services. PeaceHealth Southwest Medical Center also serves as the region’s trauma center. Combined, there are over 1000 physicians, nurse practitioners and physician assistants on staff. Thirty-four percent are employees of PeaceHealth Medical Group, with the remainder in private practice.
PeaceHealth Southwest Medical Center had an existing EHR, and its physicians were accustomed to electronic ordering and documentation. Over the years, there was extensive customization of the legacy product; physicians were concerned that functionality would be lost with the new system and that it would not be as easy to use. In contrast, PeaceHealth St. John Medical Center did not have an electronic clinical record, so for their physicians, it meant transitioning from paper to electronic ordering and documentation.
To effectively navigate change, PeaceHealth invested in the development of a new Change and Adoption Team. The 10-member team is dispersed across all locations, and its members are seasoned, experienced change management practitioners. The Change and Adoption Team is part of the operation and system service group, which also includes the Project Management Office, Process Improvement and Enterprise Intelligence. The team’s focus is to develop change leadership capabilities and help the organization achieve measurable value from large, strategic initiatives that impact culture such as the implementation of the new EHR.
Principles and Key Components of a Proactive Change Management Strategy
Change management is the discipline that guides how individuals are prepared, equipped and supported to successfully adopt change in order to drive organizational success and outcomes. For more than 60 years, change management practitioners have designed strategies, plans, tools and activities to support stakeholders through the change process and minimize the adverse effects of changing behavior to a business (e.g., attrition, productivity loss, shareholder doubt, etc.).
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