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Digital Health Transformation requires Clinical Leadership
By Michael Walsh, Director-General, Queensland Health
Digital transformation in healthcare is more about the people and process changes than the technical ICT aspects. Clinician leadership is the beating heart of a successful digital program, particularly in hospitals. It is not just about convincing clinicians, it is about empowering them to lead and seize the opportunity to create a system that delivers better outcomes and experiences for patients, even though the journey will be challenging for them.
In large, multiple hospital systems, the challenge is even greater as many clinical practices are unique to each site and agreeing a common approach takes time and a willingness to compromise historical arrangements. Engaging clinicians early and establishing system-wide structures for consultation and decision making are essential drivers of reaching agreement on how an electronic health record with operate.
Another challenge is the fact that digital transformation does not occur in a green field environment. Embarking on a large multiple hospital digital transformation that results in the use of a common set of applications means that some locations will be required to stop using home-grown applications or locally implemented solutions. These home-grown or locally implemented applications are usually highly regarded and strongly supported by the clinicians who use them. As no two applications are the same, there will be some functionality that clinicians will lose when moving from the locally implemented applications to a system wide application platform across multiple hospitals.
Digital transformation in healthcare is more about the people and process changes than the technical ICT aspects
It is essential that this is acknowledged and that there is an open discussion of the differences including the benefit of an integrated system wide view, the ability to do advanced analytics and the opportunity for improved clinician feedback.
Engaging clinicians in the digital transformation needs to take the same approach as the companies who are leading the digital transformation in our personal lives. Apple, Microsoft and Samsung don’t sell products, they sell lifestyles and experiences that will be better in a digital world. We need to think the same way about digital health transformation. To be successful, clinicians need to believe that their lives and the lives of their patients will be improved as a result of the digital transformation. We are in the early phases of the digital health transformation and the applications and systems are not as intuitive, seamless and personalised as those used in our personal lives. But we are getting closer and we are experiencing improvements increasingly quickly.
To ensure that clinicians are fully engaged and leading the transformation at each hospital, I meet with all the medical, nursing and allied health directors ahead of every major go-live. These meetings provide an opportunity to have an open discussion between the local clinical leadership and the Chief Executive of the health system. The discussion is wide ranging and covers any issues the clinicians wish to discuss. However, we bring the discussion to a conclusion by focusing on the following seven questions:
1. Are all the staff in your area trained and confident in using the electronic health record?
2. Have the work flows using the electronic health record been developed and practiced in your clinical area?
3. Are you confident that your staff have embraced the new way of working with the electronic health record and that you have strategies ready to address issues that may arise?
4. Are all the computers and devices in place, tested and working quickly and reliably?
5. Do you have arrangements in place to operate if the electronic health record is not available?
6. Are you ready to respond to internal or public criticism of the electronic health record?
7. Are you confident that the go-live in your area is clinically safe?
Clinicians have the authority at this meeting to delay the go-live if they think that any of the seven areas will cause problems during or post go-live. Providing this level of accountability and authority supports the full engagement of the clinical leadership and their involvement with their clinical colleagues. A whole-of-hospital commitment is key to a successful digital transformation, and that commitment must start with clinicians, not computers.