Dr Paul Eleftheriou, Chief Medical Officer, Western Health
I still remember the first time I was told I’d have to give up my typewriter for the revolutionary new ‘personal computer’. The typewriter was clunky, but only in retrospect. The typewriter is now a museum relic but it was our word processor for decades, and for me how I typed up professional documents for school and during those fleeting moments when I thought I was an author. Moving to a tool where I didn’t have clumsily use ‘liquid paper’ to make corrections was indeed revolutionary, but at the time it was scary, and I was uncertain.
Now we look back at these anecdotes and can’t help but laugh but with every technology revolution, we humans are expected to adapt without a sweat. The modern industrialists – technocrats – must scoff at the innate resistance people have to drastic change but they must realise that as inventors, they don’t have to anticipate as they’re writing the future. As the old adage goes ‘Who wants change? We all do. Who wants to change? Silence… People embrace change but only when you explain it in their terms and highlight the ‘What’s in it for me?’ test.
Even with something as simple as an Electronic Medical Record (EMR), never ever just assume that people will accept new tools without question. In the late 19th Century, scores of people thought the invention of the phone would breed social disconnection and workers protested on the streets in the 1950s with the advent of the personal computer as they thought it ‘would take over their jobs’. We may again laugh at these stories but they’re real and reminds us that we’re all wise in retrospect but fear of change is nearly always about the fear of loss.
As a hospital executive, many people call this engagement or change management but at the risk of getting too psychological or philosophical, I don’t think we need to over-academise this dilemma. People just want you to be honest with them, and therefore tell them the benefits and risks (I prefer to call this ‘areas for opportunity’) akin to when we as doctors explain to patients the benefits and risks of a procedure to a patient. Clinicians have a well-tuned authentico-meter so fluff doesn’t work and risks undermining your credibility.
Next, always listen to the naysayers, the black-hatters. They sometimes have the gold nugget of feedback that none of the polite types wanted to share. These could turn into red flags that are the linchpin of the system you’re selling. Take all feedback seriously and ensure you close the loop on all suggestions and concerns. What clinicians hate the most is when nobody responds to their grump email or takes them seriously. A key tip here is also to never rely just on emails when you’re communicating with the troops. Face-to-face is always best if the concerns are serious or the person is a key opinion leader, or at the very least a phone call.
I was always told that people engage as part of the ‘engagement pyramid’ (adapted from a concept that Dr Simon Woods developed) which has leaders at the top tip of the pyramid, followed by champions. They’re easy to get along for the ride when implementing new technology and the next layer (and largest chunk) are the co-operators who represent a large majority of staff who have the attitude of ‘just tell me what to do and I’ll do it’. Many of this group can be converted to champions so it is worth investing time here. The next group can be taxing, and they are the resisters. My experience is to spend a lot of early engagement time with this group as they usually hide the ‘informal influencers’ who are senior people who wield a lot of power but may not necessarily have formal leadership roles. They have incredible pull so early and effective relationship-building with them means you will not only hear how to best get through to their disciples, but also means there’s a great chance that they can become champions or even in some cases leaders. The last group that thankfully represents <1 percent of staff are the saboteurs. They’re the staff who are like a poison in the organization and will do everything to sabotage the project and start making their colleagues doubt the change. They need to be dealt with quickly and rigidly through your organization’s performance management processes. Otherwise, there’s a real risk that they can blemish your efforts.
Last but not least, lead by example and get in the trenches. If I had tried to sell the PC back in the 80s but still plodded along on my trusty typewriter, people wouldn’t be convinced. Get your hands dirty and lead by genuine example. With the EMR, never get in front of a group and be an evangelist if you’re not a true believer yourself. Use the system, find its flaws and understand them before you get asked about them. Love what you’re trying to sell, otherwise intelligent and sceptical staff will smell the fraudulence and your credibility will go down the gurgler.
As a leader, if you acknowledge that change is inevitable but very exciting. Build relationships with your staff and respect the fear. Engage and communicate genuinely and effectively, and manage sabotage early, not only will you succeed in implementing technology in any organization, your customers and patients will be far better off as the staff will use the tool with passion and to its maximum benefit.
Courtney Fisher-Lewis, Associate CIO, Saint Luke’s Health System & Ex-Sr. Director, IS Program Management, Children’s Mercy Hospital David Chou, SVP & CIO, Harris Health System & Ex-Chief Information & Digital Officer, Children’s Mercy Hospital