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 smart phone 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.