Collective Action 12/5/12

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Engagement

I failed, and I mean big time. Like “I was surprised I kept my job” type failure. Fortunately there were circumstances around me that moved the attention off the failure, but it still happened.  

I was 31. It was my first director-level job. I was, in many ways, woefully unprepared. I walked into this IT director position at a 100-bed behavioral health hospital at a time where they were selecting a vendor for their EMR project.

Even before I officially started there, I had to fly out to sit through vendor demos. My second day on the job I was in a meeting with the CFO, CEO, controller, CMO, and a hired consultant and was asked which system I thought we should go with. I didn’t even know where the restrooms were and had hardly logged on to my computer. It was a real “drink from the fire hose” experience.  

We eventually made a decision and started to progress through the project. I leaned on the consultant a lot, as I was learning healthcare terminology and at the same time trying to implement an EMR. It was crazy.  

Ultimately, the project failed. We never got it off the ground. Right about the time it failed, the company was bought by another company and the focus shifted away.

As I reflect on that project, I realize that the biggest piece that was missing was what I now refer to as engagement. We set up meetings and the CMO would not show up. The nursing director was too busy to help document workflows and processes. None of the physicians or nurses ever thought it would really happen — they were all seemingly waiting for it to fail. The CEO was a verbal champion for it, but could not quite get the CMO and nursing leaders to engage appropriately.  

I learned a tremendous amount from that failure. I carry many of those lessons with me today.  

The greatest lesson I learned is the power of engagement. In this example, it was lack of clinical leadership engagement that was the primary reason for failure. That project and experiences since that project have collectively heightened my sensitivity to and awareness of engagement. I now understand that engagement encompasses much more than I originally thought.

I want to provide a few examples of how we at Flagler Hospital are trying to engage with leadership, staff, and physicians.

The first example relates specifically to the IS team. Within my first six months of employment here, I floated the idea of what we now call the Clinical Experience program to the newly formed IS leadership team. The idea is rooted in the fact that we are not here for IT purposes — we are all here to support and improve patient care. How can you sit in a cube and make decisions that impact patient care without understanding what it means to provide patient care?

We implemented a program with the assistance of clinical leadership where every member of the IS team is required to spend eight hours per quarter on a clinical unit or combination of units. This time is documented and included in the employee’s quarterly performance review.

Some people have responded very well to this and have become even more engaged in what they are doing. Some just go through the motions and don’t see the value. They may not see the value, but that does not mean there is no value. The real impact came in one of our team meetings when we reviewed a network incident that took the ED down hard. Everyone there had a clear understanding of what that meant because they had all spent time in the ED, at least briefly, witnessing its dependence on IT services.

The next example of engagement is at the organizational level. We are in the middle of an EMR implementation at our hospital, but of course we have not always been in the middle. There was a beginning! The beginning for us was January 2011, and it was launched with an organization-wide event planned mostly by the marketing team (who else should be planning these things?)

They did a great job of putting a theme together that tied our corporate theme of iCARE (Compassionate, Always listening, Responsive, and Empowered) with the project. This ended up with the project name of iCAREiConnect.

Before the event took place, the marketing department went around with a video camera to each department in the hospital and recorded departmental dance routines to Stereo MC’s song “Connected.” The video they put together kicked off the event.

There were Xbox iConnect stations as well as other game stations around the room. Our vendor, Allscripts, was there performing product demos and handing out marketing items. Overall, it was a very successful event that got the whole organization, including physicians, engaged. If you watch the video, you will see that we are all in. That level of engagement and buy-in has been evident throughout this implementation and is something that we rely on daily to progress forward.

The final example is also project related. We are mostly completed with the build of our Allscripts environment and are looking forward to testing and training phases of the project. As you can imagine, stress levels are high and people are getting worn down. We wanted to ceremoniously mark the completion of build and shift of focus to testing and training, so we decided to have a “Project Reboot” event. The theme of the event would be Finish Strong, based on the book Finish Strong by Dan Green.  

Again, marketing planned and coordinated the event. It included a photo shoot, video shoot, a few speakers, and a formal ceremony. The whole IS department was present, as well as clinical leadership and SMEs, vendor partners, and hospital administration. The CEO spoke, the CMIO spoke, and because Dan Green could not make it to talk about the principles associated with Finish Strong, I took his place and wrapped up the speaker portion of the event.  

The final portion involved two significant ceremonies. The first one was the book. We purchased copies of Finish Strong for everyone present. For four weeks prior to the event, I worked with nursing leadership (engaging nursing leadership) to get each book signed by a patient. When we distributed them at the event, we talked about how a patient signed each book and how we told the patients what we were up to (engaging the community.) People were really touched by this — it suddenly got personal.  

We ended the event by handing out Finish Strong bracelets to everyone and asked them all to wear them at all times until we go live with the new system. We’ve done bracelet checks periodically since the event and most are still wearing them. I sent a book and bracelet to the CEO of Allscripts and asked Glen to wear it, as he is as much a part of this process as we are.

There are so many more examples of engagement. Our CMIO is doing a fantastic job engaging the physicians with the PIT Crew. We are going through every single order set in the hospital and will have consolidated, evidence-based order sets when we go live.

This kind of stuff doesn’t just happen. It must be intentional. It must be authentic. You have to actually believe that without engagement from everyone, you will fail. You can believe it or not, but that does not make it any less true.  

As I wrap this up, I want to encourage you to see where you are engaging others in the organization. Ask other leaders if they feel involved in what you are doing. We have not done this perfectly and are receiving feedback about where we are lacking. We listen to that feedback and try to engage others in different ways. This is not an IT project. It is a clinical transformation that requires the engagement of all areas of the hospital.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.