We live in a great time for the advancement of technology. It wasn't that long ago that we were asking, "Can we do this?" Now we are asking, "What can't we do?"
As the explosion of technology has invaded healthcare, the possibilities are limitless. While I acknowledge and embrace these opportunities, this paper is focused on the downsides of adopting healthcare technology without sufficient operational discipline — or proactive problem solving that takes human behavior into account — firmly in place.
Healthcare requires a high degree of routine. Consistent procedures must be established to ensure quality, patient safety and privacy. What's more, to provide high-quality care, organizations must achieve a high level of operational discipline. (In other words, they must create a culture in which all employees strive to adhere to best-practice procedures at all times.)
There is nothing magical about technology. Yes, in a disciplined environment, an information system (IS) can improve communication, aid decision-making, streamline workflows and produce better patient outcomes. But if operational discipline is weak, adding an IS to the mix will likely create more work than it enables.
The following are three common pitfalls that healthcare administrators should guard against when implementing healthcare information technology:
1. Ignoring the human element. A culture that believes automation will solve care problems is headed for trouble. For IS implementation to succeed, the key players must have in-depth knowledge of what happens when you combine human behavior with technology.
How often have we been in a meeting and heard the drumbeat: If we could automate this, it would make things so much better, save time, cut costs and improve patient safety? And yet, eighteen months later, those aspirations have turned into frustrations. While plenty of money has been spent, the return on investment is not realized and outcomes have not improved. In fact, the staff is now spending more time on the system than it is in providing direct care.
This outcome has been so dramatic in some healthcare systems that IS implementation had to be delayed for months while underlying processes were repaired.
Combining human behavior and technology to improve patient care is a complex undertaking. Unless clear, effective procedures are in place — and every user adheres to these — automation alone will not change the results.
2. Implementing in a climate of poor operational discipline. Adopting new technology requires planning, communication and consistency. In the hands of undisciplined users, an IS is unlikely to streamline workflows, cut costs or improve care. Instead, it takes on a life of its own.
Technology has provided the opportunity for customization, and often this is a major selling point for health systems. Administrators may authorize certain customizations to achieve buy in from participants.
But unplanned, uncoordinated customization is a recipe for disaster. The outcome is often a system that looks much like the undisciplined workflow it was intended to address.
Often, this lack of discipline is seen with the implementation of order sets. Where there are too many, we run into lack of integration among systems and inability to change them as a unit. Nurses may be asked to grapple with decision trees that require working beyond their scope.
Humans, by our nature, prefer to maintain current status. Adapting to new workflows doesn't come naturally. So unless leadership gains buy-in and sets expectations ahead of implementation, the system ends up looking like a spider-gram with lots of activity, but no unified purpose or goal.
3. Underestimating loss of time. As the healthcare industry navigates rapid changes in direction and conflicting interests, time has become a major commodity. While time lost is often not recognized in the cost calculation of IS systems, I think it is imperative that it be considered.
Concerns about cost and patient safety have resulted in increasing pressure to automate all processes with the assumption that an IS will improve timeframes for outcomes. However, IS implementation almost always results in loss of time in the form of training and decreased productivity.
Unrealistic expectations around time can lead to a vicious cycle. Weeks and months slip away, and patient and financial outcomes remain static. As time pressure mounts, so does the need for more cash on hand to fund ever-increasing automation. And still the outcomes do not keep pace with the system that was intended to drive them.
Users also feel this loss of time. Any organization is only as strong as its most engaged employees. If those employees are spending their time training in system isolation — and wondering if the IS doesn't work, what will — there isn't much time left for the real work of the day.
In today's challenging healthcare environment, time spent needs to be value added, not lost in meaningless activity.
As stated above, I am excited about the future of healthcare and the ability of information systems to help cut costs and improve care. What concerns me is the frequent application of those systems in workflows that lack discipline and clear goals and fail to take human behavior into account.
Time is running out to achieve meaningful use of technology before healthcare reform demands more fundamental change. Even the most successful IS adopters admit that they struggle to maintain discipline and productivity. It takes a great deal of planning and coordination — as well as buy-in from all participants — to keep the IS from becoming the work rather than enabling the work.