Change and adoption has become an important topic of conversation in healthcare, as the assumption that staff will easily adapt to significant changes in their clinical processes has consistently proven to be untrue. An off the shelf/one size fits all approach is not working,  adoption is an area that is often overlooked in planning and is significantly under budgeted in most projects. 

The reasons for poor change and adoption are complex and diverse across multiple disciplines. Poor communication, staffing issues, budgets, time, education and IT literacy will always put a strain on successful change and adoption. But there are some key actions which can ensure smooth adoption in the future, and some key holes we need to stop falling into:

1. A system which reflects the way in which clinicians work

More often than not systems are designed to suit the majority of the market rather than to meet the needs of a specific users. Rather than the system adapting to their needs, clinicians are forced to adapt to how the system was designed; sounds easy, however in most cases this can cause significant disruption to the everyday activities of most clinical staff. It’s not realistic to have a system that caters for every user, instead we need to ensure flexibility in design to allow staff to use the system in a way that reflects their current practice. 

2. The system needs to have the input of staff in a realistic manner

Getting feedback from every staff member would ensure that not a single project would ever be delivered on time. However this does not mean that staff feedback & input should not exist. Good governance, consistent communication, steering committees & providing staff with an appropriate forum through which to share their opinions, can ensure that the correct system is delivered and most importantly that staff have some ownership of the system which they will eventually use. 

In terms of content; almost all hospital staff (myself included) have at one point or another been part of a forms committee or given some feedback to a form or process design,  I have had experience of forms that are version 10 and upwards being use in multiple hospital’s. If a hospital has 150 forms, that can account to hundreds if not thousands of clinician hours in consultation & feedback. To simply ignore these forms rather than use them as a framework upon which to build a clinical system, is one of the key issues related to change and adoption. If recent figures related to adoption of PCEHR are anything to go by; members of the medical community feel disengaged from changes to health IT on a national level; to introduce systems which are unfamiliar and a stark contrast to their current practice will do nothing to curb this issue at a local level. 

3. The system addresses the issues at hand and most importantly the issues it was introduced to fix (the clinical can of worms)

As with many projects within & outside of health; fixing a specific problem often raises a number of other issues which also need to be addressed, one step forward and twelve steps back. This has consistently been the issue with many large scale projects within health in Australia, where a small change to one area has resulted in an overhaul of another seemingly unrelated area. The equivalent of asking for a bike so you can cycle to the shops & three years later a 767 jet turns up on your front door, no question it’s very impressive, but it’s expensive to run & more than you really needed; the original problem still remains. This change of focus while often required to meet the ever changing needs in a clinical environment results in staff wary of IT projects & sceptical of plans for delivery. Keeping focused to what was originally requested & fixing the issues at the core of the project keeps staff engaged & ensures that early promises don’t become late apologies.  

Overcoming the obstacles

Engage staff where possible and utilise resources already in place to gain insight your current processes. Keep focused on the issues you were brought in to fix and don’t try and reinvent the wheel. Start with the needs of the end users & build the solution from there; ensuring that in two years you don’t wake up with a jet on your lawn & very unhappy staff.

Kim Gilbert - National Account Manager, Sláinte Healthcare Australia