Healthcare Talent Transformation

Are we really using the "BEST" to Improve our Healthcare?

Jonena Relth, TBD Consulting

About 18 years ago, my company was working with an international organization that adopted an IT project management methodology so complicated and cumbersome that it required everyone who was impacted by the process to attend a "college-level" course to understand and implement it. Ultimately, the project was a serious money-maker for:

• The consulting company that sold their methodology that had to be seriously customized
• Training vendors who wrote the curriculum 
• Printers that copied tens of thousands of copies of the curriculum
• Shipping companies that delivered the materials all around the globeI 

I was not privy to the financials for the project, but our clients couldn't possibly have seen a positive ROI for the millions of dollars and thousands of man hours they spent customizing the methodology, marketing it internally to the masses and ultimately implementing and managing the process. The methodology was just too complicated to be sustainable. Being a bottom-line kinda gal, even back then, I asked our clients the same question that I would ask the Washington bureaucrats changing our healthcare system today,

"Why would you put a system in place to manage a process that is far more complicated that the process you're trying to manage?"

My client's answer was, "This methodology was developed by the one of the most respected IT consulting companies in the world and we want to align ourselves with the best.  If things don't go as well as we would like, we will be able to tell our CEO and Board that if XYZ Company's methodology didn't work, no one's would."   In other words, my clients thought they were protecting their jobs and their company by going with who was considered to be the best.

I need to be careful here, because that "best" consulting company's practices damaged so many of their customers' organizations that they finally sued their parent company and changed their name.  You know the drill - - New name, but same people...  Just because a company or government agency hosts a high-end golf tournament or outspends its competition to keep their name "top of mind" doesn't make them the best.   A "Best" designation should only be given to a company or agency that has a proven track record of consistently providing results that improve processes while improving the bottom line.   

So now I ask, are we making the same mistake with our healthcare system? Someone in Washington DC has determined who the "best" are to determine the future of our citizens' care delivery and how it will be managed.  What I see is that many of the "best people" aren't even medical professionals.  They are politicians who ultimately won't even be covered by the new government healthcare plan. They have their own health insurance plan.  I don't know if that resonates with you, but it speaks volumes to me.  Why would the citizens of the US agree to be covered by a healthcare system that our politicians say is good for us, but not for them?  After all, our politicians are paid by our tax dollars and work for us.  Shouldn't we decide which healthcare system we want and which healthcare system our civil servants should have?  And shouldn't we be allowed to help keep the system simple enough to administer that it will be sustainable in the future?

Just asking...  Jonena

EMR Blueprint: Steps 5, 6 & 7: Future State Workflow; Design, Build and Validate; User Testing

Andrea Morgan, AndreaKnowsEMR.com

Most providers will agree that they want to care for patients, document appropriately, bill confidently and have a smooth transition from paper to electronic medical records. Having a plan in mind, such as the one outlined here, will go along way toward meeting your objectives.

1. Practice overview
2. Role definition
3. Current state workflow defined
4. Validation
5. Future state workflow
6. Design, build, validate
7. User acceptance testing
8. Training
9. Build for production
10. Go-live support
11. Post go-live support can be provided by:
    ○ Phone
    ○ Email
    ○ Newsletter/tips and tricks
12. Refresher training
13. On-going needs for training:
    ○ Optimization
    ○ New hire training
    ○ Software updates

In an ongoing series, each of these steps will be discussed in turn. Let's take a look at Steps 5, 6 and 7, Future State Workflow; Design, Build and Validate; and User Acceptance Testing.

After determining the current practices it is necessary to map those to the functionality and/or limitations of the EMR that you’ll be implementing. This process is the documentation of future state workflows - how patient care will transpire and be documented after implementation. Once this work is complete, the system design can be started and built to the specifications outlined in the future state workflows. When this build has been completed, it is necessary to validate that tasks can be accomplished as designed. It is very important to complete this step as well as to have end users (not technical people) test to confirm.

Quick story to illustrate how one word, misunderstood and untested, can lead to tremendous challenges:
In a specialty practice, providers dictated their notes. They were assured that post-implementation, they would still be able to dictate. This made the providers happy. After go-live, providers dictated their notes as they always had, into portable tape recorders, and dropped the tapes off to be transcribed with the front desk assistant.

Providers grew very frustrated when, after a few days, their transcribed notes were not appearing in patients’ charts. After multiple help desk calls, visits from IT staff, some yelling and a few threats to unplug every machine here (that is a quote!)...still no resolution. The IT staff came to test the providers' computers and make sure that audio was working, sound files could be heard. Since they could, it was determined that it wasn’t an IT problem. Help desk ticket closed...those spoiled doctors...insert eyeroll here.

The problem? The IT understanding of dictation (speaking into a microphone attached to a PC so that a .wav file is created) and the providers understanding of dictation (speak into a separate recording device and have information transcribed) were very different. No one had validated the proposed workflow for dictation, agreed upon it and had it tested by those who would be using it. When IT tested it, it worked - for what they thought would happen. Providers were not given the opportunity to test, only placated and brushed aside.

It may sound obvious, but it is imperative to get users involved in the documentation of workflows and testing because they are the people who will be most impacted when misunderstandings arise. While it may be tempting to do whatever is necessary to make end users smile in the short term (or get them off your phone/out of your inbox) it is better for the organization in the long run to take the time to confirm and test the proposed workflows.

Simple Advice for Improving EMR Implementation and Use

Jonena Relth, TBD Consulting

Best-practice workflows should be at the center of all system implementations.

Unless your EMR workflows match those of your medical facility, your EMR will get resistance from users and be a huge waste of time, money and energy that will ultimately be replaced.  Do your homework and only consider purchasing an EMR that allows you to map out best-practice workflows. If the EMR you're implementing requires IT changes to make it more "user friendly and useful," consider hiring a documentation/training company that has the expertise needed to capture your current workflows as well as help you improve your workflows so you're using best practices which will help achieve positive ROI on your investment.

The most efficient and cost effective implementation plan should start with documentation specialists mapping out workflows and processes and provide those user-specific, detailed maps to IT to guide their system customization.  Unfortunately what we see happening is IT is well into the process making programming changes before they get the actual workflow maps that should be guiding the system use.  Workarounds increase the time to go-live which costs time and money and leads to many unnecessary, heated meetings.

For more reading, I'd like to suggest a great blog written by Karl Walter Kirstead, Healthcare Professionals, Repeat after me...   Karl often shares his expertise with the EMR / EHR Clinical Transformation Group in LinkedIn.

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the communication needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

EMR or EHR Implementation Success Requires Business Acumen

Jonena Relth, TBD Consulting

Equally important to providing well-designed training is making sure people are ready for the changes they will encounter with a major system implementation such as EHR or EMR.  And of course, whoever leading these initiatives should be trained and practicing effective business acumen.

I don't want to insult anyone reading this, but lately I've been amazed to learn that many healthcare leaders are not trained nor do they understand business acumen when it comes to running a medical facility.  Here's a definition:

"Business acumen development is a method used to show how actions and behavior can impact financial decisions and affect financial outcomes at the unit and corporate level. It stresses the links between behavior and financial outcomes and shows how training and development in this area can improve the performance of a manager and bottom-line results of a particular unit or the corporation."

So let's start off with ROI:

The adage of "Pay me now or pay me later" fits perfectly for the purchase, implementation and training of large systems. Running a medical practice or hospital with inadequately trained staff is simply a waste of money. And in medicine, of course, we've got the added security risks of patients' lives at stake! Additionally, if you deliver training without first getting your people's buy-in and acceptance of the changes broiling around them, you might as well not embark on the journey at all. Your efforts will be sabotaged by frustrated staff that purposely avoid getting trained and look for ways not to use the new system, thus negatively impacting the ROI of the initiative.

Applying basic business acumen principles as well as applying common logic should tell us to plan for all possible contingencies possible that can negatively and positively impact an implementation.  By doing so, we can prepare our staff to deal with and hopefully eliminate as many obstacles as possible, thus increasing our chances for a successful system implementation.

What's CHANGE got to do with it?

Adding a new computer system to the daily work of busy medical professionals is asking them to change the way they do their work! Many folks are familiar with what they are doing now and feel comfortable with the status quo - even if they have to do workarounds, etc. Remember, change is hard to swallow for many folks, so they'd prefer to stick with the existing paper system rather than have to learn a new electronic one.

There are a number of change adoption models to guide and instruct the implementation of major change in organizations. Three of the most well-known are Kotter's strategic 8-step model for transforming organizations, Jick's tactical 10-step model for implementing change, and General Electric's 7-step change acceleration process model. My advice is always to review a few models and choose the one that best suits your organization - or customize your own with the "best" strategies for your purposes.

Additionally, to guarantee success for major change initiatives that involve new processes, policies, etc., it is necessary to include all the right people from the beginning of the process who will stay involved throughout the entire project to ensure change adoption and implementation of the expected changes.

Organizational development (OD) and training professionals should be involved from the very beginning of the system search. It's these folks that, if they are worth their salt, will maximize the ROI of whatever system is purchased by ensuring that the system is first and foremost "user friendly" and that the system customization, implementation and training will have as its core efficient, new workflows that work for the different user groups. If you do this, your staff will be at much more likely to develop the necessary skills and desire to use the new system before go live to ensure the change is seamless to customers.

The bottom line:

To ensure a positive return on investment on an EMR or EHR system implementation takes all the right players from beginning to end and proven, well-implemented business acumen development and change management strategies. If you do it right, I'd wager to say that your clinical staff and physicians will be at least 80% more likely to develop the necessary skills and desire to use the new EMR/EHR quickly.

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Turn Tail and RUN if you hear: "I can Train the EMR/EHR System from Generic Screens."

Jonena Relth, TBD Consulting

EMR/EHR Systems purchased and implemented without the efficient workflows and training is a waste of money. 

 "We can save training expenses by..."

If a vendor or employee tells you that they can provide training that consists of generic screens that come with the system - - turn tail and RUN.  Medical professionals are intelligent and very busy folks - not to mention expensive.  First off, no one has the time or inclination to be trained on something they won't use or that doesn't fit into their "world."  To add to this, many medical professionals do not have a strong computer  background and thus many folks won't be able to tie the generic training to the customized system workflows and screens they will be required to use after the system goes live.  It should go without sayin', but once again I emphasize:  If you don't train the ACTUAL processes (screens included), people will not have the skills and knowledge needed to efficiently and accurately use the system for many months -- if ever.

Pay twice - why?

If you only provide generic training that doesn't mirror the actual work, you will need to retain the "slower learners" and provide superusers at the beck and call of all users for many months, if not forever.  Rework and retraining is very expensive and a waste of time, energy and money.  So, I guess the adage for this should really be: "Go cheap now and pay twice as much or more!"

Another puzzle piece to successful system use:  

To ensure buy-in from all users, be sure to involve clinicians and physicians in the whole process.  Not doing so will result in a costly change imitative that is not embraced by the users.  Medical professionals know how they do their jobs without the new system.  With guidance, medical staff can work with training professionals to build workflows to guide a system design that includes new, more efficient workflows intertwined with the system for each user group. 

The result will ultimately result in an excellent system, customized training and improved patient care. Those are our ultimate goals, are they not?

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Three Ways to Reduce Stress When "Cancer" Enters Your Life

Jonena Relth, TBD Consulting

Having been married to someone who had cancer, I know what it's like when your loved one is diagnosed with the "C" word. You feel like you've been hit in your gut with a sledgehammer and you have to tell your brain and lungs to breath! Once the initial shock wears off a bit, your mind goes a million miles an hour (24/7) weighing the options and trying to get a grip of what life has in store for your coming months and maybe years.

A dear friend of mind gave me some excellent advice:

1. Accompany your loved one to EVERY appointment and take detailed notes.
2. Get personal copies of EVERY medical test and keep them with you.

I am so glad that we got this advice early on as it proved to be a life saver (truly) on several occasions when we rushed to a hospital, lab or new physician. On many of those occasions, the providers were unable to get/find our test results in time for the appointment, so we used the ones we carried with us.

Yes, it was awkward at times as the labs, hospitals and physicians were less than "happy" with me when I insisted on keeping a duplicate copy of our records. Not liking confrontation, I didn't enjoy those conversations, but it led me to believe in electronic medical records and participatory medicine even before I learned of organizations such as the Society for Participatory Medicine.

We found that my going into the exam room with my husband and taking notes during each exam helped us to remember what was discussed and make more informed decisions. There were times that the providers were hesitant to have me in the room, but we insisted in my involvement in his care.

Sometimes providers forget that just using the "C" word somehow shuts down the patent's brain. And as a caregiver that was close to the patient, I too would sometimes forget the details of the encounter because of the emotions involved. Dr. David Scher, in his blog, Bringing the Horse to Water: Patient Engagement and mHealth, stated the following:

"Supporting educational materials written or viewed in an understandable manner are necessary, as most patients forget most of the conversation that took place in the office. A companion or caregiver at the visit is a big help in this regard, as more information is retained in this manner. The provider needs to engage the patient from the outset in helping to determine treatment based on options and certainly the recommendation of the provider. Many providers give the necessary information and options and then ask 'So what do you want to do, Mr. Smith?''' I believe the provider should also provide his/her recommendation as well, based on both objective evidence and experience."

As a training professional, I totally agree and will add that as Number (3) to my suggested things for patients to ask for from their providers. Well written and reviewed materials can reduced much of the confusion and stress relating to health issues, especially cancer and serious chronic diseases.

Please check out the Society for Participatory Medicine and consider joining: Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.

Jonena

So, Who is Easier to get On-board with EMR Training and Use?

Jonena Relth, TBD Consulting

Historically, we've found the younger docs more inclined to jump on the EMR bandwagon. It's been our experience that the younger docs are more computer literate and were exposed to computer-based training and research in school, making their transition to EMR easier.

However, we've also seen a trend of older docs as champions of EMR. When that happens, getting everyone trained is easier because their leadership presence adds credibility to the use of the tool. It's also more fun to sit back and watch this phenomena.

Years ago, we started out developing mostly instructor-led training (ILT) because that was the training culture in the hospital systems. We found it very difficult to get all the physicians through the training for various reasons: time, convenience, egos, etc.

More recently, we've found that by creating task-driven WBTs customized for the different user groups, our training is better "attended" and the users get up to speed on the EMRs much quicker. Each person is only required to take the modules that are applicable to their workflows, and they can take the training when it is convenient for them.

And honestly, the feedback on the training has been much better with the WBTs than ILTs, so why do so many organizations continue with training in the same instructor-led, death by PowerPoint?  It's time for learning officers to encourage 21st Century learning, and yep, that might also include social networking and mobile technologies, too!

Comments anyone?  What has been your experience?

Jonena

Redesign Your Workflows BEFORE Customizing and Implementing an EHR!

Jonena Relth, TBD Consulting

These questions of keep healthcare providers up at night, so I'd like to add my two cents:

 

 

• "Should we?"
•  "Can we?"
• "When should we?" and
• "Why the heck did we implement an EHR/EMR anyhow?"   

This is not brain surgery folks:  To improve our healthcare productivity issues, we must FIRST improve our workflows!

Much of what is wrong with EMR/EHRs, and why the questions continue to swirl in our brains, is that most EMR/EHRs are not designed with new/redesigned workflows in mind. Until we stop mimicking old workflows and trying to do "business as usual," we're wasting precious time and money on implementing electronic medical record systems.  Each practice needs to redesign their workflows to ensure process improvements in every "task" that makes sense.  Then design the EMR/EHR to enhance those new workflows.

And a shameless plug here:  Please consider partnering with a company whose expertise is performance improvement.  I wouldn't presume to know enough to diagnose a patient's illness.  Why do so many providers think they have the expertise to capture, map and document existing workflows and then design new ones without the assistance of people who do this for a living?  Just asking...

Jonena

Unintended Consequences of EHR Implementations

Posted by: Jonena Relth, TBD Consulting

On the EMR/EHR Clinical Transformation group in LinkedIn, we have a spirited dialog going on the Unintended Consequences of EHR Implementations.  I invite you to join the group and take part in the convo.

We touched on usability being the number one problem with EHR implementations to date.  As the trainer in the group, I couldn't help add:

Workflows must "belong" to the staff and docs that use the EMR/EHR.  We're asking people to change the way they have practiced medicine their whole career.  They know their best practices so they must to be involved in the process of developing workflows and training for the EMR/EHR.  One caveat:  medical professionals are not process improvement or training folks.  Be sure to partner organizational development, documentation and training professionals with the medical folks to ensure that the new workflows and training model best practice, are sustainable and will be adopted by the medical professionals who were not in the design process.

Jonena

Move Over Lecture! UMR/Mayo Teaching How to Learn through Understanding not Memorization

Posted by: Esther Groves, Sr. Consultant for TBD Consulting

I don’t dwell much on medical procedures unless someone close to me or I need one.  But, given my baby-boomer odds, I expect to need more of them as time goes on.  A friend in the medical field got my attention the other day by lamenting about the lack of hands-on, patient-facing training and experience for new medical students. 

Put those two thoughts together and it adds up to one thing for me: Scary.  

 For those of us in the training and development field, adult learning principles amount to a sort of religion - so imagine my excitement when I heard this piece on NPR: Don't Lecture Me that spotlights, among other things, a new school at University of Minnesota Rochester which is attached at the hip with the Mayo Clinic there.  Their bottom line?  Chancellor Stephen Lehmkuhle said, “What we decided here is that we're going to build an institution that's focused on learning. We want them to learn through understanding not to memorize to learn.”

UMR is also helping students make connections among fields of study.  Chancellor Lehmkuhle: 

“One of the most effective ways to get them motivated is to help them connect to what they're learning. And making connections isn't just about getting students motivated, it actually helps their brains learn, better.  When you read about learning and the neuroscience or cognitive science of learning, it's all about making connections. And so that was really the basis for everything that we did here is to help students make connections. “

Their approach? Less lecture, more hands-on and collaboration -- learn how to learn so when they leave school, students can keep up with the times which we know “are a-changin’” at an ever-accelerating pace.  And, foster collaboration among disciplines (chemistry, literature, biology) for a holistic approach.

So, back to my point... This is no longer a philosophical argument about how to best prepare students for the real world of patient care.  We already know that people learn and remember best when they actively participate, practice and connect the dots.  It’s time for lecture (which dates from the times before book publishing) to take a back seat to patient-centric, collaborative learning and teaching.

Thank you University of Minnesota Rochester and Mayo Clinic for leading the way!

FYI:  It’s no coincidence the best-selling book ever published by the American Society for Training and Development  (ASTD) is Telling Ain’t Training by Harold Stolovitch, a guy who know effective training when he sees it.