Transcript Dreams of Camelot… effective end user engagement

Field of Dreams?
or…
it could be just an empty ballpark!
COACH
May 2004
Agenda
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the proposition
why this matters
case studies
what the stakeholders
said
moving forward
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The proposition
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effective engagement
and support of the end
users is absolutely
critical to the goal of
getting information
technology used to
improve patient care,
quality of professional
life & health system
management
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Why this matters
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Standish Report findings (1999)
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investment in IT application development is HUGE
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failure rate unacceptable
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$250 billion US/year; 175,000 projects
31% of projects cancelled before they get completed
53% will cost 189% of their original estimates
Only 16.2% “on time, on budget”
three key overall success factors: end user
involvement, clear statement of requirements,
executive management support
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Why this matters (cont.)
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November 2001study* re: key factors in
forecasting EMR/EHR implementation
success
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over 150 factors identified
only 2 identified consistently associated with
successful implementations
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top management support
clinician involvement
*Sittig, D; The Importance of Leadership in the Clinical Information
System Implementation Process
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Why this matters (cont.)
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spending ~ 2% of healthcare budget on IM/IT
too low anyway
if we screw up over 50% of these we’re really
in trouble!
risk losing credibility with/support of senior
policy makers, funders and end users
disenchanted users (once we lose them,
they’re twice? 4X? harder to get back)
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Case studies
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Danish national system (MedCom)
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grew from modest clinician-driven project
key success factor: getting opinions and ideas from
general practitioners’ professional organization AND from
practising GPs
New Zealand
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extensive physician use of computers and EMRs in
improving health status through HealthLink
strives to be responsive to physicians as primary obligation;
many initiatives result from primary care physician
demands
replaced alternate product (after millions of $) which failed
when they tried to connect to GP computer systems
officials had little/no understanding of general practice
environment
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Case studies (cont.)
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Cedars-Sinai 2003
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Hospital believed it had sufficiently involved
physicians in design/implementation process by
working with 40-physician medical executive
committee
turned off CPOE after complaints from hundreds
of physicians – cumbersome, didn’t follow
physician workflow
underestimated impact on ancillary departments,
complexity of implementation and work involved in
transitioning to CPOE
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Case studies (cont.)
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Upstate New York Veterans Healthcare Network*
in < 5 years, went from poor performer to a leading
performer among VA 22 networks
conscious attempt to empower frontline employees
by:
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increasing patient outcomes focus
adopting a learning environment
increasing frontline autonomy
encouraging grass-roots innovation
developing esprit de corps among frontline workers
*Timothy J. Hoff/IBM
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Process used
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interviews:
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interviewees
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standardized interview
template
payers(i.e. CIOs),
physicians/physician
organizations, vendors, other
– over 35 key players in the
Canadian health infostructure
scene
coast-to-coast coverage
synthesis and analysis of
results
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What the stakeholders said…
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significant convergence among views of payers,
vendors, end-users, CIOs
end-user engagement seen as “absolutely
critical”, a “no brainer”, “essential”, “crucial”
agreement on critical success factors:
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commitment to process - trust is earned
all parties need to be prepared to change their “going
in” position – requires “active listening”
acknowledgement of interdependence
recognition and acceptance of different drivers
creating a climate of mutual respect
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Stakeholders (cont.)
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performance “spotty” across the country
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generally poor reviews at the national level
balancing province-wide system needs with one-on-one medical
care creates challenge
only two provinces have issued a strategic IT plan
vendors not generally involved/seen as the enemy
cultural differences (project managers vs end users) get in the way
of effective end-user engagement
 need to migrate from “create and direct” to “facilitate and
empower
AB generally perceived to be engaging stakeholders
 process slow and painful but making real progress
growing awareness, increased attention/$$
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Moving forward
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interest-based approach
start having the conversations, building the
relationships now
allow adequate time for engagement
jointly define clear statements of requirements
engage end-user organizations on strategic and
implementation issues;
work with informed end-users at the project
level
 at ALL stages of the process
engage skilled facilitators
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Moving forward
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the job’s not done with implementation
 build in a “feedback loop” after implementation
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ensure end-users aren’t “out of pocket” for
their time
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include those who are going to deliver the
product….e.g., the vendors (VCUR)
use consistent processes
we need to talk about this….nationally,
provincially and locally!
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Recap
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effective end-user engagement is critical if we
want IT used to improve health outcomes
we need to ensure what we’re
designing/building/implementing works for
those who use the IT systems to deliver care
we need to do a better job of involving endusers….now!
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Questions?
Bill Pascal P. Eng., CMA
CTO, Canadian Medical Association
[email protected]
Mary Gibson CA
Consultant
[email protected]
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