Change Management: How to Drive Physician Adoption of New Healthcare Technology

Rhonda Collins, MSN, RN, Chief Nursing Officer, Vocera Communications, Inc.

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Rhonda Collins, MSN, RN, Chief Nursing Officer, Vocera Communications, Inc.

Hospital and health system CIOs across the country face a universal challenge when it comes to implementing new technology: Obtaining physician buy-in. It doesn’t matter how much potential the technology has to create better workflows, improve patient and staff satisfaction, and even improve patient outcomes—it’s all about managing the change that’s involved.

Take for example a hospital that is implementing a new communication technology that redesigns how nurses and physicians communicate via an enterprise-class smartphone application that enables HIPAA-compliant voice and secure texting. The idea of enabling two people to communicate directly might seem straightforward to an outside observer. But within a hospital, it can represent a shift in a communication paradigm that’s been in place for decades.

Savvy healthcare leaders realize that in order to successfully implement this new technology, they must take a strategic approach to change management that acknowledges and addresses the fact that they are going to be affecting deeply ingrained, cultural, automatic processes. Simply installing a software application on physicians’ smartphones will not change their behavior. Changing behavior requires strategic thinking and planning so that physicians and nurses will see benefits and value.

 Changing behavior requires strategic thinking and planning so that physicians and nurses will see benefits and value

The challenge: different priorities, different incentives

Nursing and physician executives want to find a more standardized way for everybody to communicate as part of improving workflow to improve patient care. The core of the challenge is that physicians and nurses are not always aligned on priorities or incentives.

At the core of everyone’s priorities are the patient, patient outcomes, and the patient experience. However, because of fundamental differences in how physicians and nurses work, communication sometimes breaks down. Anyone who has worked in a hospital is aware that physicians have always worked from a position of control regarding the ways in which they receive communication and respond to it. Typically, nurses send messages out to physicians, and they have autonomy about how and when they respond. The nurse traditionally has to wait for the response.

Even within one hospital, cultural protocols and methodologies may vary wildly when it comes to workflow communication. The emergency department might have a cultural protocol that says you call these numbers first, then you do this, then you do that. The surgical floors might have a different cultural protocol where they want you to do number three on the list first, and then do number two and number one.

Technology that improves communication and collaboration within a hospital or health system removes barriers and obstacles to having direct contact to the physician. By bringing nurses and physicians closer together through communication, you and your team may encounter resistance. But you will ultimately improve communication, which reduces errors and improves outcomes.

Start with a few persuasive hospitalists

Physicians in general are self-employed and choose to have privileges at a hospital. Consequently, when hospitals say, “I want you to do it this way,” they feel somewhat immune to that request. In contrast, hospitalists are employed by the hospital. Because they are paid by the hospital, they have an incentive to cooperate with any hospital initiatives and adopt protocols, technologies and policies.

So when you are looking for potential first embracers of new technology that you are implementing, start with hospitalists who can be persuasive and who have “physician authority” within the hospital. They typically can get a few more colleagues on board and then the “I tell two friends and they tell two friends” method starts gaining momentum.

When implementing a new communications technology, it’s a good idea to start by getting 25 percent of the physicians to use the solution, and then bring in another group of physicians and continue to expand. The physicians who originally planned to remain outliers soon find it difficult to communicate because their colleagues and the nursing staff are on the secure platform.

Six steps to get physicians on board

Here are six steps that hospitals and health systems can employ to ensure successful physician adoption of new communication and collaboration technologies. It’s important to work closely with the hospital’s clinical leaders to help drive the adoption of these activities.

1. Enlist nursing and physician executives. Nursing and physician executives must be involved with introducing the new solution and understand the impact it will have on staff, physicians and patients. Executives need to be more than just sponsors; they must be active participants and champions.

2. Identify physicians likely to be successful with the technology. Ideal candidates are influential with their peers, natural team players, and tech-savvy. Work with nursing management and physician leadership to identify these physicians.

3. Provide in-depth training for end users within the context of their workflow and develop supporting policies. End users need to understand how the solution works in the context of their workflow. This means that physicians and nurses need to meet together to discuss expectations and policy guidance such as:
• When it’s appropriate for a nurse to send a secure text message versus a voice call.
• How physicians will manage messages when they are not on call or available.
• What a nurse should do if he or she has sent a secure text message to a physician who hasn’t responded, and the nurse is going off shift.
• How a physician will be connected to the nurse taking over a patient for a nurse who’s gone off-shift after contacting the physician.
• How unanswered messages should be handled.

4. Follow up support and feedback. Physicians and nurses will need to be supported closely when they use a new technology solution for the first time. There should be onsite support for the technology and for the physicians including regular check-ins and retraining as needed. Processes, expectations and policies should be reinforced and refined through regular meetings with physicians and nurses.

5. Measure satisfaction and create internal marketing. Formally measure user satisfaction to aid in system wide awareness and to identify users who can be featured in a hospital’s internal marketing efforts. Additionally, nurse and physician executives should plan on sharing the experience with other CNOs and CMOs in the system.

6. Expand. Once success has been achieved, select another group of physicians and repeat the process.

Leading physicians to embrace new technology isn’t always easy—but it definitely pays off.