T

he rate at which technology is being integrated into the home care and extended care industries is astounding. Clearly, there are advantages to using computers to perform some of the work currently handled by people. Those advantages, however, have associated costs—costs often overlooked by the people driving the technological change from a high level.

Overcoming Resistance to Technology

       The promise of technology is that it will make an organization more efficient and productive. If the staff do not see it that way, however, the difficulty of implementing new software or hardware can increase exponentially. Technology may not always meet the expectations of healthcare workers in the back office and in the field—the people providing care and equipment to patients, scheduling visits, updating care plans, and submitting claims. Technology can cause anxiety, frustration, and, in a worst-case scenario, negatively impact the care a patient receives.
       Nonetheless, almost every agency and facility is facing some level of technological change. So, the goal for many organizations is to minimize the negative impact on staff or, more ambitiously, to generate excitement and enthusiasm about the prospect. If staff do not think their jobs will be easier once the new technology is in place, it will be almost impossible to generate interest and enthusiasm.
       The following list highlights common techniques for overcoming resistance to technology in the work environment.
• Involve your staff in the selection of the technology: As products are evaluated, ask for feedback and input from the staff members who will ultimately use the system. They understand their requirements better than anyone else in the organization. Also, nothing spreads fear and mistrust faster than closed-door meetings and secretive conversations.
• Set up a pilot program to find glitches: If you are implementing a computer system that will impact multiple aspects of your business, consider setting up a pilot program with a few key users to test processes and iron out wrinkles before the system is rolled out to a wider group of users.
• Customize training to cater to different learning styles: Among your staff, there are people who learn by reading manuals or watching a training video. There are also people that need hands-on time with the system before they will really learn it. Both types of training are important, but often the hands-on training never happens. Staff is expected to be able to use the technology without having any supervised practice with it. That type of experience can be very frustrating to users.
• Provide pre-training for novice users: Training provided to a large group of users with varying levels of technical ability can be problematic. Novice users will hold up the class, and the added pressure that they feel because they are not “keeping up” contributes to their fear of and resistance to the new technology. Advanced users consider the training laborious and a waste of their time. Providing general computer training to novices before asking them to attend an advanced session on a specific computer program will help them feel more comfortable and avoid slowing down training with a larger group.
• Create cheat sheets and quick reference materials: While online help and printed user manuals are helpful tools when implementation begins, users are inevitably drawn to “cheat sheets”—short, concise, easily accessible bits of information relevant to each person’s role. For example, there can be a specially designed cheat sheet for a biller, an intake clerk, and a scheduler. Each would be a high-level overview of the specific procedures or keystrokes the user will commonly use. Do not make the cheat sheet too wordy; more than 2 pages is too long. Consider laminating the cheat sheet to make it easy to find on a crowded desktop or in a drawer.
• Introduce new tools within the context of current work processes: Change can be very disconcerting, especially for staff members that have been doing their jobs well for a long time without any technology. If the new system is presented in the context of something staff members are already familiar with, it can make the change seem less overwhelming.
• Do not promise ease of use: Although almost all of them claim it, very few systems are easy to use. Healthcare is a complex industry, and the software and hardware that support it are rarely simple. Promising an easy implementation can ultimately increase the staff’s skepticism.
• Use problem-solution statements as much as possible: Whenever possible, talk about the technology in terms of the specific problems it will solve. For example, if you are talking to a biller, instead of saying, “This technology will decrease our DSO [Days Service Outstanding] by 25%,” promote the system by saying, “You will not have to write in procedure codes on United Health claims anymore.” The CFO cares about DSO, but the biller is going to be much more excited about spending 2 less hours a week to get out the United Health claims.
• Partner the strong with the weak: Identify “early adopters” within your organization. These are the people that like computers and are relatively open to new technology. Have them act as mentors by pairing them with more reluctant users. They will be a good resource and add to the comfort level of the staff. Consider providing awards and bonuses to teams that achieve specific goals or show notable improvement as a result of learning and using the technology. As soon as your staff sees the technology working, they will be more open and comfortable with the changes.

Evaluating the Suitability of Technology at Your Organization

       Before convincing your staff that a specific technology is a good idea, it is important to ensure that it is. High-level managers often view the technology from a very broad perspective. They may not always consider the day-to-day, role-specific requirements of the tool.
       In selecting technologies and products that are right for your organization, it is critical to consider all the requirements across departments. One effective tool for analyzing requirements is a workflow-mapping diagram. Figure 1 shows a very simple workflow-mapping diagram for a typical intake department.

Figure 1

       The rectangles represent tasks that are handled by 1 or more staff members in the department. The diamonds are decision points that set the workflow in 1 direction or another. The rectangles with a curved top or bottom show start or end points in the workflow process.
       Although there are specialized software packages that allow users to create very sophisticated workflow mappings, most organizations can make this diagram with drawing tools that come as part of basic word-processing or drawing programs. This type of map is also just as effective when drawn by hand, without using a computer at all.
       By sketching workflow in this manner, users can easily identify the following requirements as a basis for evaluating the products being considered. Use this type of list of requirements to help rate products during sales demonstrations:
1. Handle written and verbal requirements
2. Record date and contact information for insurance verifications
3. Report on denials
4. Assign a staff person to a patient.
       The workflow map is also an excellent tool for identifying process changes and security issues, especially between departments. In some cases, you may not know the issues exist until workflow processes are mapped. The following areas should be addressed as part of the overall plan to implement the new technology.
• Process change: Is the paper admission form going away as a result of implementing the new technology? If so, how will the information be sent to scheduling?
• Security and Health Insurance Portability and Accountability Act of 1996 (HIPAA) concerns: If intake enters diagnosis information, will all case managers be able to see it in the system? Should they be able to? Can you restrict what the case managers can access?
• Patient-care risk: What checkpoints will be put in place to ensure referrals do not get lost?

Conclusion

       The trend among many healthcare businesses is to automate as many processes as possible and decrease the amount of paper. Computers have a very important role in that goal, but only if the systems adopted are well suited to your specific organization. Understanding the requirements of the system before starting an implementation is critical to the successful implementation of any new technology.
       While high-level managers see the value of integrating computers into the workflow process, it is not always as obvious to the staff in the field or in administrative positions. A successful implementation in the healthcare environment also depends heavily on persuading the people who will use the technology that it will help them be more productive in their jobs and ultimately provide better care for their patients.

Editor’s note: Executive Summary is a new department geared toward the “C” level extended care executive. If you have an idea or suggestion for a future topic, e-mail it to Ryan Dougherty, Senior Editor, at ryand@hmpcommunications.com, and it may appear in an upcoming issue of ECPN.