Three learnings for EPR implementation: How to get the medical professionals on board?

Implementing Electronic Patient Record (EPR) platforms goes beyond just setting up a new system and training people to work with it. It involves changing work processes, too. And with that, people need to change their daily ways of working and behaviour. Despite the focus on the technical element, behaviour change is the toughest aspect of implementing EPR. People will not be changed  – and certainly not overnight. Here are three learnings that do make that happen. 

Hospitals are not the easiest of environments to implement change in, and introducing a new EPR is quite challenging. The primary processes in hospitals make everyone abide by specific ways of working, leaving no time and room to pay attention to anything else. Plus, hospitals house a truly diverse range of (medical) professionals who are fully convinced that their own way of working is best, usually.

On top of that, just assessing the technical set-up of an EPR platform and the ensuing work processes  is a massive job in itself, often wearing down program managers and project teams. For that reason, focusing on how people should adopt the new system and ways of working usually comes (too) late in the game. Often to the commiseration of those involved, as the process may not deliver the expected return on investment.

That is why we are motivated to share a few of our learnings about getting the technical implementation done and the professionals involved ready to embrace the changes in their daily work. We aim to share them specifically with CIO’s and program managers, who may well be all too familiar with how EPR implementations can trigger frustrations. And even more keen to share them with hospital directors and managers: they need to work on the change more than they may think.

1. Engage (medical) professionals at an early stage

It may take months or longer to design a new EPR and the ensuing work processes. In most cases, representatives of nurses and doctors are being involved in the program. Most colleagues, however, only to learn about the new system shortly before the go live. The program team may think it best not to involve the organization while they focus on the technical side of things, as they know that will take time. They do not want bother employees with the new ways of working out of good intentions. But it does not help smooth adoption of the new ways of working. On the contrary. Changing is difficult in the best of circumstances. Having to change with increasing urgency and the clock ticking ever louder towards a fixed deadline will have people firmly dig in their heels.
Discussing the whys and wherefores of the new EPR system with relevant colleagues at an early stage is a better route to enhance adoption. Try to motivate the decision for a new EPR as concretely as possible. If cost saving has been the driving force, be clear about the impact on everyday work. Employees will want to know the added value of the system too. Or what will happen if they do not adopt the new system and ways of working. Please be aware that it is not up to the program team or IT department to discuss the need for a new EPR. From top managers to team leaders, it is the organisation’s leaders who will need to take on that role. Program teams and support departments are simply not in the position to set priorities for other people.

Most people do not get the impact of changes, until they cannot dodge them any longer.

Please note that engaging the full organisation with a new EPR is not a panacea. Even though people will start to take action only when they can no longer avoid it. Inevitably, they will have lots of questions and feel uncomfortable or insecure. However, preparing carefully and extensively and managing expectations in the best way possible will improve organisations’ agility when the time comes.

2. Adapt strategies to every user group

Organisations are diverse and complex, and hospitals to the extreme. A reasonably nerve-racking operation will gather quite some different people in the operating theatre, each with their own specific role and position in the team, each working to their own specific roster, and each managed and paid in their own specific way.

At the same time, each one has their own specific ‘invisible’ position in the medical pecking order. It is important to understand this as a new EPR system will impact them all but considering this diverse team as a homogenous group – a.k.a. the work floor – is simply not feasible:  there is no one leader who is in a position to communicate with all of them equally.

So, for success, it is paramount to understand which stakeholder groups the hospital is composed of exactly, as well as how the change will affect them, to what extent they have a say, and who are best positioned to engage them. Knowing this helps in selecting a fitting change and communications  strategy for the process: who will need to talk to whom? Which routes are best to involve the self-employed medical specialists? How can the medical representative body be included so they too can spread the word? The content strategy needs to fit as well: at what stage is which information relevant for who? This is not to say that everyone needs to hear a different story, as consistency in content will deepen trust in the change. However, the story serving as source for all change communications needs to be adapted for each stakeholder group and their level of knowledge, at each stage of the implementation.

3. Allow people time and space for the change

Hospitals are notorious for lack of time, but the pros of allowing people space to embed changes such as a new EPR in their daily work cannot be overestimated. Allocating time for processing the change early on, allows employees to understand why a new EPR is necessary and what its workings will be,   to discuss it amongst colleagues, and above all to practice. This tactic enables employees to gradually get what it means for their work.

Managers are the key actors here. As mentioned before, they are best positioned to set the priorities for the organisation. They can stress the importance of the new EPR and its ensuing ways of working. They can underline the importance by making their teams feel there is time and space for them to internalize the change. Consequently, they will feel heard, engaged in the change, and connected to each other. In turn, the entire organisation will respond with greater agility to unexpected (technical) issues, when everyone’s flexibility and creativity is relied upon to solve issues together

In short: time and energy taken for the change itself should fully equate the time and energy for the technical aspect.

Implementing an EPR system is a large-scale undertaking in terms of technology and change. What we see happening is that the technical implementation require so much time and energy that hardly any is left for setting up effective change management, or properly budget for i. Whereas the actual USE of a new EPR obviously determines the implementation’s ultimate success, and thus fully justifies allocating equal time and energy to technology and to the targeted behaviour change.

Purposefully, we focus our three learnings fully on the latter:

• Involve people early on and not five minutes prior to the go-live.
• Enable managers to discuss the why and wherefores clearly and impactfully, right from the start.
• Tailor the change process to the complex dynamics of the various stakeholder groups working together. Reassert the importance of the new EPR by allowing teams to take time for discussing and understanding the effect of what happens and will happen.

Would you like to get more insight into managing IT-related changes? Please read this information, too.  In case you would like to talk to us about your (EPR) change, you are welcome to contact us. We would love to talk to you.  

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