January 4, 2017

Carter Groome • Chief Executive Officer

The sociology of maximizing EHR performance

As healthcare providers begin to transition from a fee for service approach to a “shared risk” or fee for quality model, hospitals will find ways to adapt or they will cease to exist. Promoting evidence based best practice, efficient knowledge transfer, solid structural support and effective information flow are factors that can positively impact outcome change. However, with so many competing initiatives most organizations are so focused on project completion they often overlook or undervalue one of the largest and lasting outcome influencers, social change.

A major health system CIO recently told me that they have embarked on numerous strategic, optimization, and outcome enhancing initiatives with much ado, energy and executive buy in. Unfortunately the intentions, performance indicators and achievement goals fell flat not long after project leadership and outside subject matter expertise moved on to the next regulatory requirement or EHR deployment.

Knowledge transfer is, or should be, a large part of any EHR project where subject expertise and 3rd party support are common. Optimization, workflow, and value re-engineering engagements provide solid case studies and good examples of where shortcomings can occur. For example, Lean Six Sigma programs can absolutely lead to lower cost and improved quality measures, but lasting improvements and change must involve more personal learning and cultural collaboration as even minor project and change is initiated.

I refer to many of our engagements that address EHR optimization as “Dynamic Maximization” initiatives. As an advisor to our healthcare clients, we must enter all engagements with a strong understanding that the socio-cultural influencers are a major factor in project outcomes. That “Dynamic” part of healthcare is what really differentiates an organization and leaves their patients (or clients) more satisfied as a result. Our idea of “Maximization” occurs when those organizations meet key indicators of structural, human workflow, information flow, and in-house personnel optimization. In the early stages of fee for quality, such outcome improvements can and should be addressed in smaller, more controlled initiatives where cultural change does not overwhelm and the opportunity to succeed is greater.

I’ll discuss social change approaches and examples during EHR optimization in my next post.