Process The Forgotten Continuum - An Ethnographic Research Study
-
Upload
j-bryan-bennett-mba-cpa-lssgb -
Category
Healthcare
-
view
46 -
download
0
Transcript of Process The Forgotten Continuum - An Ethnographic Research Study
Process –The Forgotten ContinuumAn Ethnographic Research Study
J. Bryan Bennett, LSSGB, MBA, CPA
Executive Director
Healthcare Center of Excellence
www.healthcarecoe.org
Copyright 2014, Healthcare Center of Excellence 2
The Problem
Many are solely focusing on data and technology for their transition to becoming a data-enabled healthcare organization (DEHO)
Missing key components that will significantly improve their chances for long-term success
Will put the organization at a risk of not providing the best patient care, be disadvantaged to their competitors and may present challenges to future revenues
Copyright 2014, Healthcare Center of Excellence 3
Investment
Organizations have put a lot of money and effort behind the technology and the training of the people Sometimes the process design,
redesign or workflow is slighted.
An ethnographic research study found that inefficient or poorly designed processes can be a contributing factor in many implementation failures In this case, physician engagement
Copyright 2014, Healthcare Center of Excellence 4
What is Ethnography? Ethnography is a qualitative research method
that tells a story from the perspective of those being researched
It is always conducted in the field and typically involves some sort of participant observation in which the researcher actually gets involved with the activities being studied Watching how people use products in their own
environments, talking to them, and asking them questions
In this case, the researchers were trained and embedded in the various hospital units as physician support personnel to help physicians learn how to enter computerized patient orders.
Copyright 2014, Healthcare Center of Excellence 5
Methodology
The study took place at a multi-hospital system in suburban Chicago
The system has about 1,000 physicians on staff and with privileges
The goal was to understand the challenges to physician engagements during implementation of a computerized physician order entry system
The EHR system was one of the top solutions but not the leading solution This minimized any ‘halo effect’ from physicians’
acceptance just because it was the leading solution
Copyright 2014, Healthcare Center of Excellence 6
Methodology (continued)
The study observed over 600 of the 1,000 physicians as they entered orders in almost all hospital units including: Intensive care, transitional care, telemetry,
cardiac care, catheter lab, day surgery and labor and delivery
Physicians observed were from a variety of specialties, including: Internal medicine, cardiology, oncology,
hematology, neurology and cardiovascular surgery
The study produced 125 representative comments and behaviors The same or similar comment or behavior may
have been observed by multiple physicians
Copyright 2014, Healthcare Center of Excellence 7
Observation Categories
Observations were classified into three categories:Process (how something is done)System (the EHR solution)Technology (the physical hardware
or solution access)All 3 continuums were addressed
People was represented by the physicians observed
Some observations were classified into multiple classifications
Copyright 2014, Healthcare Center of Excellence 8
Results
Process or process related comments and activities was a factor in 62% of the observations
The software solution was a factor in 54% of the observations
Technology was a factor in 8% of the observations
Observations could be categorized into multiple categories
Copyright 2014, Healthcare Center of Excellence 10
Results Summary
CategoryObservations & Comments
Process Only 41%
Process & Solution 19%
Process, Solution & Technology 2%
Total 62%
Copyright 2014, Healthcare Center of Excellence 11
Positive of Negative?
The observations were further categorized by positive and negative
Based on the tone, action or body language of the physicians. 23% of observations were considered
positive 69% of observations were considered
negative 8% of observations were considered neutral
The positive results were highly skewed toward younger physicians or those who were computer savvy from any age group
Copyright 2014, Healthcare Center of Excellence 13
Representative Comments “I don’t have time for this; I will call from
my phone to place orders.” “I did not know I went to medical school to
become a secretary.” “This is ridiculous!! All it does is take time
away from my patients. I am with the patient now 5 minutes and with the computer 15 – 20 minutes.”
“Something is going to get missed and someone is going to get hurt.”
“I have not put orders in the computer for over 20 years and I am not starting now. I will retire before I start with this crap.”
Copyright 2014, Healthcare Center of Excellence 14
Representative Observations Doctors would write orders on paper chart and
leave for nurses to enter in system Doctors were reluctant to ask for assistance
(even though it was obvious they were having difficulties)
A few doctors left the floor and then proceeded to call in the orders because they refused to place the orders themselves
A few doctors have slammed/pounded the keyboard in frustration
The nurses were getting very frustrated with doctors that didn't enter their own orders (because they knew they would have to enter them for them)
Copyright 2014, Healthcare Center of Excellence 15
Upon Further Review
An examination of the comments and behaviors, and many like them, reveals that the physicians’ comments and actions weren’t about the actual software solution But were about the process of
actually entering the orders into the system
Getting physicians to overcome this hurdle will be critical in the success of any enterprise-wide transformation
Copyright 2014, Healthcare Center of Excellence 16
Conclusions Organizations might be overemphasizing
technology to the detriment of good processes Continuum misalignment can be illustrated by an
inverted triangle with the technology receiving the most emphasis and process receiving the least
Improperly Aligned Continuums Properly Aligned Continuums
Technology
People
Process
Technology
People
Process
Copyright 2014, Healthcare Center of Excellence 17
Failure is Not an Option
The choice and deployment of technology is just as important as training personnel which is just as important as the workflow design or redesign
Any attempt to do otherwise will result in failure
This failure could come in the form Poor physician acceptance Missed diagnosis information Unrecorded diagnosis information Leading to incorrect or incomplete business
intelligence
Copyright 2014, Healthcare Center of Excellence 18
Processes Need Attention Too!
Automating or just adding technology to a bad process or not giving the process enough attention just results in a bad automated process. Personnel Buy-In
Delayed training
The same is true for not giving the process or workflow enough attention
This can be evident in challenges to personnel buy-in and occurs when the change is viewed as simply a software implementation as opposed to an organizational transformation
Copyright 2014, Healthcare Center of Excellence 19
Don’t Fail Before Getting Started
Organization transformation must start from the beginning with communication and personnel training throughout the process to increase acceptance and advocacy among the staff
If training and information on the software is offered just before the software ‘goes live’ you may have already failed
Copyright 2014, Healthcare Center of Excellence 20
Physician Engagement Challenge
Physician engagement is an especially difficult challenge, but it can be overcome
Keeping physicians involved in the process and workflow design will improve buy-in Avoid rescinding a software workflow after
it has been deployed because the process did not work or was inefficient for the physicians to utilize
Copyright 2014, Healthcare Center of Excellence 21
Questions & Answers
Contact Information: J. Bryan Bennett, “The Professor”
Websites / Blogs www.healthcarecoe.org
www.himssfuturecare/blog/1266
Twitter @healthcarecoe