CIO Interview: What does it mean to be a change-fit organisation?

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Picture: Stuart Bloomfield, chief information officer, Waitematā District Health Board & Counties Manukau Health

Waitematā District Health Board & Counties Manukau Health CIO Stuart Bloomfield

Three key ingredients are needed to become a change-fit organisation and to ensure that clinicians feel the change is done by them, not to them.

Someone once said, “change is disturbing when it is done to us, exhilarating when it is done by us”.

It made me think about how we in health IT can make change a positive, even exciting, experience for the clinicians – rather than one to dread. Sometimes a change that should be positive for clinicians and patients is not greeted with open arms and then we victim blame, saying “they just don’t like change”.

So how do we build a change-fit culture in healthcare? I believe there are three key ingredients: trust, clinician leadership and continuous change.

Key ingredients

Clinicians need to trust that we will support them to adopt new technologies and respond to their feedback with rapid and continuous system improvement. Responding to feedback intelligently requires a thorough understanding of the clinicians’ workflows and competing demands.

That is why the second vital ingredient is clinician leadership of system design and implementation. But that leader needs to be no ordinary clinician – they need to be technologists who make system changes and can fix problems themselves.

Lastly, continuous, incremental change is acceptable in a clinical environment as long as it is well supported and makes delivery of healthcare easier. We need to be mindful of developing resiliency and preventing burnout in our clinical workforce when there is constant change.

By the way, I have come to this view through working with and observing these amazing people, not being one. My role is in supporting them as they lead the clinical change across the organisations.

Intelligent design builds trust

We have recently rolled out electronic clinical notes in the wards of North Shore and Waitakere Hospitals, which means that doctors, nurses and therapists no longer handwrite notes in patient charts.

Notes are typed on the ward round, pulling detail effortlessly from other sources, such as vital signs and lab results, largely removing the need to search for paper charts.

Building trust started with intelligent design – not by a committee but by a small number of clinician technologists who understand workflow on the wards and technical possibilities. Staff were pulled from other roles and projects to saturate support ‘at the elbow’ on wards in the early days of implementation.

A senior doctor has said, “The adoption of eNotes is a universal success. Anyone who can text or email can use this system”.

Waitematā and Counties Manukau DHBs went live with Clinical Portal 8 recently with a clinically led, continuous agile team model to upgrade and enhance user functionality.

Known as the Regional Operating Mode, the multi-organisational team (from healthAlliance, Orion and the DHBs) uses an agile prioritisation matrix to rank ideas and sprints to deliver enhancements quickly.

Small things can have big effect

Small changes can make a big difference to a clinician’s life. A couple of recent enhancements illustrate this: adding a link in the portal to patient reported outcome measures and combining physiotherapy service names into one, reducing the number of clicks and allowing related information to be viewable in one place.

Auckland and Northland DHBs have recently joined the ROM, contributing subject matter expertise to the team. You can see the model explained at the HiNZ conference in November.

This approach to change is scalable and transferable, and works across organisations. We can only sustain this model though, by investing in our dedicated, talented people. To that end, we are building a digital academy to grow our next generation of clinical technologists.

Trust, clinician leadership and continuous change are not unrelated factors. Trust is built from listening to our clinical users, understanding their problem and its context, and then committing to continuous improvement. That way, the clinicians can truly feel that the change is done by them, not to them, and that’s how we build a change-fit culture.

Stuart Bloomfield is the chief information officer for Waitematā District Health Board & Counties Manukau Health.

If you want to contact eHealthNews.nz regarding this View, please email the editor Rebecca McBeth.

Read more CIO Interviews:

Tony Carpinter A digital journey from vein to vein

Geoff King Delivering on diverse fronts