Making Culture Your Ally in Clinical Information System Implementation

An organization's culture can make or break any Clinical Information System (CIS) implementation. Ask Joy Keeler, Chief Architect of Nicholas E. Davies Award-winning CIS initiative for University of Illinois Medical Center.

"We knew from the beginning one of our greatest challenges was overcoming a prevalent attitude of doubt within the organization as we moved to a paperless clinical information system. Once we showed quick wins and provided proof that we could make things better, we built a following among all the stakeholders at UIMC. By creating a passion for our mission, we transformed the way we deliver care, improving patient outcomes, reducing waste and variances, even improving our retention rate among physicians and nurses. And while everyone has embraced the new system, the principal beneficiaries are our patients," said UIMC's current Associate Vice Chancellor of Heath Affairs.

The case history described by Joy Keeler provides instructive insights into achieving success with CIS and tackling arguably the most challenging barrier of all – organizational culture.  Instead of something to be feared, a renewed and revitalized culture can be your most important ally, as Joy Keeler discovered.

Of all the approaches we have practiced and observed over the last 25 years as health care industry consultants, we believe the following ten are the most powerful and most likely to lead to making organizational culture your ally vs. your worst nightmare.

1. Create Passion for the Vision, Mission, Values and Strategies

Whatever your organization’s reasons for embarking on a CIS initiative, make sure that all key stakeholders know, understand, and embrace the objectives and can articulate “what we are doing and why we are doing it.”  Success for this huge undertaking will require a ubiquitous commitment to quality care…and many specific goals such as eliminating medical errors, waste, delays, unnecessary variance as well as improving patient satisfaction and your strategic positioning.

2. Measure Readiness Early …and Conduct Periodic Check-ups

A formal assessment of your organization’s readiness for CIS will help you understand the major barriers you have to overcome.  Assessing readiness and undertaking a readiness improvement effort is as vital for this type of initiative as physical training is for a marathon runner. Readiness can be measured in many ways, including: Technical Readiness, Workflow Readiness, Culture Readiness, Financial Readiness, and Project Management Readiness. We know this is a lot of "readiness," but it's a critical part of successful implementation.

3. Deal with Cultural Challenges Proactively

Two very common cultural challenges (courtesy Dr. Jeffrey Rose, CMO, Cerner Corporation) include Infobia, or the fear of appearing incompetent using technology, and  Archetypal Medical Tradition, which drives resistance to standards, guidelines, and outside scrutiny. Simply hoping that these challenges will go away by themselves is naïve – intervention in the form of education and skill-based training is required, which will only be possible if all key stakeholders are on board.

4. Establish Value as the Foundation for CIS

Our belief is that it is important to quantify and clearly articulate the “Financial ROI” and the “Strategic ROI” of the initiative. Value-based initiatives are the most successful because there is a clear understanding of all of the costs (financial and otherwise) and all of the benefits of the initiative.  A clear organizational understanding of the value of improved healthcare quality will build commitment to your CIS implementation.

5. Communicate and Train Early and Often

We believe it’s important for all stakeholders to understand (and articulate!) what they are doing, why they are doing it, and what are the costs and benefits of the undertaking.

We also understand that most stakeholders will require new skills and capabilities to succeed in a new CIS environment, so it’s important to provide substantial training so people can learn the new “mechanics” of CIS. Best results are achieved if the CIS initiative is treated like a major construction program – all the way down to the “Pardon Our Dust” posters that beg patience for current problems while providing hope for a much better future.

6. Identify and Satisfy the Needs of Individual Stakeholders

You must identify the key stakeholder groups and the opinion leaders within each.  Once you understand what their major needs are, work with them to ensure that the CIS project can meet those needs as much as possible. It is our experience that adoption happens more quickly and thoroughly if everyone gets as much of what they want as possible.

7. Pick Champions Carefully at all Levels

Every major cause needs a legion of champions – we believe these champions can be identified, encouraged, and given roles that create leverage throughout the organization.  You don't need Superman or Superwoman, just opinion leaders who are respected by their peers, have the ability to perform, a positive attitude, thick skins and have high endurance – after all, this type of initiative is a marathon, not a sprint!

8. Excitement Overcomes Fear of Change

We have learned many fundamental truths over the years, one of which is: “A clear vision of the destination creates enthusiasm for the journey.” It's also very important to be truthful about how long and arduous the journey will be…champions will be able to lead the organization through “The Valley of Despair” if everyone believes that the end result will be better. We also know that there will be people who try mightily but are unable to complete the journey – carry them, and give them new and more appropriate roles. 

9. Use “Speed” to Your Advantage

As evidenced by the UIMC example above, the faster you get to benefits, the faster the organization will embrace the initiative, and the quicker you can make organizational culture your ally.  We encourage using three different and powerful mechanisms: Speed to High Performing Teams, Speed to Implementation, and Speed to Value.

10. Engage Professional Management and Chose the “Right” Guide

Recognize that the selection and implementation of a CIS is a major undertaking, and most likely the one and only time most people in your organization will experience this in their entire careers.  The cost of mistakes is very high and the probability of success is increased substantially with full-time professional program management.  There’s no reason to undertake this transformation alone, and the right professional guide can make all the difference in the world.  Pick a consultant or expert who has a proven track record, understands your unique circumstances, acts like a guide and not a dictator, and will work with your organization.

Most health care executives state that their most vivid nightmare about a CIS implementation is the fear of CIS-rejection by the organization’s culture.  Newton asserts that a “body at rest will tend to stay at rest, and a body in motion will tend to stay in motion.”  We assert that if you apply the key points in this article, you will avoid the nightmare, avoid being stuck “at rest,” and be able to keep your organizational body in motion as you confidently charge ahead along your positive journey of progress.