The Key to CPOE
By Linda Franks

CPOE is one of the most extensive process re-engineering projects a hospital will ever attempt. Changing how clinicians practice medicine is a project with inherent risks and issues. Managing this change requires an understanding of the hospital culture, a strong project manager, and a well thought out change management plan. The goal of managing this change is getting the acceptance of physicians to this new paradigm and to avoid the risk of failure from resistance to change.

“…nearly 75% of all organizational change projects fail…not because leadership didn’t adequately address infrastructure, process, or IT issues, but because they didn’t create the necessary groundswell of support among employees.” Price Waterhouse Coopers, “How to Build An Agile Foundation for Change,” 2008.

Support for succesful CPOE needs to come from the highest levels of management. The hospital organization needs to outline its need for change up front, including references to the mission and values of the hospital. In addition, the justification for CPOE needs to involve the hospital’s strategic direction and the potential for incentives from the government stimulus package. Once hospital leadership has outlined these, the project manager needs to concentrate on consensus and adoption. One process that has proven to be effective is to hold one-on-one conversations with physician leaders.

Before assembling the implementation team, before defining project scope, before outlining CPOE strategies or developing plans, the project manager needs to understand the hospital culture in order to understand what the human risks to the project will be. These risks can be discovered in conversations with physician leaders. The goal of these conversations is to increase confidence in the project, encourage participation, harvest ideas, increase buy-in, show the physician’s inclusion in the project, and introduce the project manager as part of the team. A process to communicate with physicians that has proven to be effective at a university hospital in the Midwest is outlined below:

The process approach:

• Identify formal and informal physician leaders within the organization
  • Include the physicians with the most adamant protest to CPOE
  • Include the physicians with the most visibility in the hospital
• Respect physician time by formally scheduling a one-on-one meetings with each of them

The meeting agenda:

• Structure it as a conversation
  • Introduce the change
  • Introduce the PM’s experience
  • Show willingness to discuss resistance
  • Listen to concerns, and ask for recommendations
  • Listen to their wish lists and ask for participation
  • Provide a high level overview of the plan, governance structure, and communication goals
  • Describe the intent of the change
  • Quickly give a high level overview of scope, strategy, time line, support structure, and change management plan

The tone:

• Emphasize the inevitability of change
• Be empathetic
• Be calm but enthusiastic
• Listen intently and take notes
• Emphasize your experience but flexibility

The goal:

• Increase confidence in success of project
• Decrease skepticism
• Open two way communication to show inclusion
• Encourage participation
• Harvest ideas
• Increase buy-in
• Introduce PM and gain confidence and enthusiasm about PM

The successful outcome:

• Get the physician to agree to some level of cooperation
• Leave with good ideas to incorporate into the plan

The follow-up:

• Communication from executive leadership to the entire organization should follow within a month
• Established formal lines of communication for progress reports and future input should be advertised immediately
• Revisit the most resistant physicians when appropriate

Even physicians that are not 100% on board are usually grateful to be included up front and most promise to keep an open mind as the project moves forward. The result is a high level of cooperation and participation in the project by physicians, and an increase in leadership responsibilities.

“People within an organization must be allowed an opportunity for intellectual, emotional, and psychological reaction to the desired change. Providing this opportunity enables people to become accustomed to the idea of change and to align their thinking in ways that will help both identify potential problem areas and contribute substantively to process improvement.” Jonathan B. Gilbert, “The Change Management Life Cycle: How to Involve Your People To Ensure Success At Every Stage.”

For more tips on CPOE acceptance please visit our website at www.getvitalized.com. You can also contact us at 610.444.1233 or vcs@getvitalized.com.