Rob Rice, VP Infrastructure & IT Operations, St. Joseph Health
I’m a career technologist, but I didn’t grow up in Healthcare IT. In my pre-healthcare career, the impact of a mistake could mean disruption to the enterprise operations, a delay in time to market, or it could materially affect our financials. These are significant pressures to contend with in and of themselves, but in joining Healthcare I’d be lying if I said that I wasn’t worried that I could now impact someone’s health, a life, or a family.
I’m old bedfellows with “Brand Impact”, “Operational Impact”, and “Financial Impact”, but “Patient Safety” was a new facet to the criticality matrix I was used to. I have also been a longtime stalwart of the largest ERP systems, financial mainframes and back-office applications in the industry, but an EMR was new technology. To me at least.
At St. Joseph Health we consolidated our 8 stand-alone EMR platforms for our 16 acute care facilities, spread across 3 geographical regions, to one single EMR instance serving our 20,000+ clinical users. A herculean effort by many great teams, and as you can imagine it was not without disruption to those that provide care.
Post-consolidation everything ultimately settled in, and as we stabilized our enterprise EMR from an “engineer’s eye”, we continued to receive a loud roar of dissatisfaction from our clinical communities. The steady drum beat of “it’s slow”, “this is not working”, and “just fix it!” were continually escalated from our first responders, but these aren’t translatable for engineer remediation, especially when all system performance data looked fine?
Queue to my first understanding of the plight of the caregiver. As a whole, doctors or nurses couldn’t care less when I regale them with the technical intricacies of all the layers and components that come together seamlessly, and how every performance metric shows that all is operating as expected. I’ve seen eyes glaze over when I use too much “geek speak” trying to explain system performance. But how do you treat the patient when the symptoms they complain about are vague, and contradict the lab results?
I thought it’d be prudent to hear from the providers themselves in their own facilities. I needed to understand what their normal interaction with the EMR was. What frustrations were they experiencing daily? Could we catch an issue real-time in the wild and correlate it to back-end metrics? With a small team we set out to meet with a statistically significant group of doctors, nurses and staff at each of our facilities to learn about their pains first hand.
We methodically interviewed over 200+ doctors, nurses and staff across each of our facilities in our three distinct regions. Each interview was intentionally unstructured to ensure the flow of passion, and each discussion started with a simple question: “How are things going?”
They let us have it! But don’t let me paint the wrong picture here. The oft repeated undertone in every discussion across the entirety of our interviews was a simple and noble truth. A genuine desire to serve our patients, immediately followed by the frustration that the EMR makes it harder to do so.
Now there are a lot of details behind this simplified statement, and as we transcribed our many discussions a pattern began to emerge that allowed us to aggregate into the following categories:
•Process & Communication: “How am I being supported by IT”
• Education & Training: “I don’t know how to do X”
• Technology & Infrastructure: “The underlying technologies” • General Performance: “The EMR’s performance and stability” • Application: “I don’t like how the EMR does X”
• Workflow: “Why does it do X this way”
After we completed our first region (5 hospitals, 90+ interviewees), the picture was somewhat different than the initial “it’s slow” complaints, and a tangible direction towards user satisfaction began to surface. It also wasn’t quite as technologically focused as initially thought.
• Overwhelmingly (62 percent total), there was unhappiness with the application itself (35 percent), and its workflows (27 percent)
• Complaints about the more technology centric areas were least voluminous (10 percent)
• The remaining complaints focused on the way we managed our user’s experience (28 percent)
The application and workflow complaints, while representing the largest percentage are areas that are not easily improved because we don’t develop the EMR, and workflow changes are understandably disruptive initially. The low volume of technology complaints was unexpected. Especially when you compare them to the roar of escalations we received prior to starting the interviews. However, the user management findings presented a prime opportunity to potentially improve user satisfaction.
Before we created a holistic action plan, we completed the interviews for the remaining regions. When we laid the analysis of all three regions side by side, not only were the categories identical, but the percentages for each category were eerily similar (+/- 5 percent deviation).
As a data person, I was suspicious of the statistically similar outcomes so I reached out to industry organizations to see if it was what others were seeing. I couldn’t find a similarly comprehensive analysis done from a user’s perspective that could be used as a comparative reference. However, I did find surveys that corroborated our findings.
We began to create a program to improve our caregiver’s experience. It focused on 3 key areas that we had the ability to improve:
1. Improve Processes & Solutions
Let’s evaluate our current processes, focus on reducing inefficiencies, and establish empirical measurements to target improvements.
2. Enhance Customer Service
Let’s focus on improving how our caregivers directly interact with us.
3. Improve Communication
Let’s provide better transparency to requests and status, better engage with them, and provide information in simpler language.
I guess the question you might ask if you’ve read this article to this point is, “Were we successful?” That truly depends on what you use to measure success. Yes, we improved our processes, increased our engagement, and reduced the initial complaints that we were facing. We never received songs of praise on how amazing things are, or heard how wonderful the EMR is now. But, the volume and passion of complaints evolved and slowed. We still have our challenges, but they’re wholly different than when we started.
I also take away from this a lesson I learned from the many caregivers I got to spend time with. A lesson in dedication that I will carry forward with me. We all contribute to our patient’s safety and we do what we do not because we desire recognition, but because it’s the right thing to do and our patients depend on us. I didn’t grow up in Healthcare IT, but I am honored to be working with the many teams that work together to passionately provide care to those that need it.