Proposal For Onboarding Team For Implementing EMR System At Thomason Health System

Discuss about the proposal to present before Thomason Health System’s board of directors related to establishment of an onboarding team for implementing a new information technology system.

We at Thomason Health System (THS) are planning to undergo a huge information technology infrastructure update with electronic medical records (EMR) system and policy under the experienced supervision and leadership of Maggie Tweedy (MD), the chief executive officer (CEO) of THS. THS’s mission is to practice medicine and care as an integrated team of compassionate, multi-disciplinary physicians, nurses, and health professionals who are focused on the complete health needs of the patients. Thus, developing an accountable integrated healthcare system will help this organization monitor patient needs and outcomes, use performance data and indicators for organizational and staff assessment, and implement new forms of reimbursement that result in improved quality while keeping costs checked, thereby complying with American Medical Association (AMA) standards. EMR will provide crucial information when treating individual patients throughout different points of care as well as provide data regarding the effectiveness of treatments and staff within the system.  However, there is resentment against this new project amongst some staff members. Thus, we have planned to form a team that will aid in implementing this new system in the organization.

For the attainment of this goal, as the chief operating officer (COO) of THS, it is my responsibility to create an onboarding team charged with the cultural adoption of EMRs by THS. Thus, after thorough review and checking the knowledge, skills, and attitudes (KSA) of the staff members, I have selected Marco Tortello (PhD), Virginia Pavini (MD), Christina Trevor (MD), John Lieberman (radiology technician), and Jennifer Kline (monitor technician) as the proposed members of this team. The reasons for choosing them and their roles are described below.

Team leader - Virginia Pavini is an anesthesiologist and the chief of staff. Over time she has set high standards for staffing as well as establishing performance evaluation procedures and professional development polices. She has exhibited strong leadership and many staff members look to her as a mentor. Her belief that majority of the staff will eventually adopt EMR, with training and follow-up, makes her a suitable member of this team.

Situation monitoring - Tortello being the chief information officer can be of great help in implementing EMR in the organization with his knowledge and experience of information technology (IT and public management. He has focused on innovation and technologies that are patient-centered while increasing the organization’s efficiency through technology, modernization and business process improvements. In fact, he has been the driving force behind THS’s acquisition of EMRs as he believes it will help minimize errors and inefficiencies.

Team Building

Mutual support and communication - Christina Trevor is a pediatrician and has worked at other organizations and facilities with EMRs. She fully supports EMRs and believes that EMRs streamline the process and allow doctors to spend more time with their patients. She has been a vocal supporter and has communicated her own experience with many other staff members.

Mutual support and communication - John Lieberman is a radiology technician and has been at THS for 17 years. He is a strong advocate for EMRs and believes that it will help increase productivity and care while decreasing errors for the radiology department. He has also maintained very good relationship with the other technicians and labs. Thus, he is an apt member for convincing the lab staff and technicians about the benefits of this technology.

Mutual support and communication - Jennifer Kline is a monitor technician and assists the nursing department by monitoring cardiac rhythms. She believes that EMRs will decrease mistakes and inefficiencies between departments. Her position requires Kline to work with other teams and specialists within THS and she has an exceptional rapport with staff and patients.

Something that's good for the organization and ultimately good for the patient population is the ultimate goal of the above five members. Thus, they are apt for being the team members in this project. As opposed to this, the other members have ideology of something being good for an individual, their career, a particular constituency. They are more self-focused and are thus not appropriate to be chosen as team members (Nancarrow et al., 2013).

Gene Rosario (MD) is a primary care physician and after so many years of experience is opposing EMRs because he feels that they are very burdensome and the doctors would lose autonomy. He also thinks that costs incurred for EMRs will limit community and charity services.

Todd Ramos (RN) is a nursing administrator for the hospice facility. He thinks that the staff will be stretched too thin with the necessary training for EMRs. Though he believes the shift is beneficial in the long run, conflict persists.

Frances Hays (RN) is a nursing administrator at the hospital. She does not want to use EMRs because she feels it is time-consuming and will cause her staff to lose interpersonal and communication skills. Thus, she needs to be convinced about the organizational benefits of EMRs.

Todd Birchman (MD) is a dermatologist who has privileges at the hospital but maintains a thriving private practice with several locations. He is an exception to the team list as his main target is his private practice and he will not be able to give full time support for the project. Though he uses a very similar system to the one THS is planning to acquire. Many staff members have talked to him about his experience when he is at the facility.

Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS)

In a team, role ambiguity is the commonest cause of conflict. When people don't understand exactly what their roles and responsibilities are, they start doing another's role or doing something differently than someone other's expectation is. This creates miscommunication and conflict. Sometimes, teams develop coalitions. So in a five-member team, three people may gang up on two people. And then the majority will win through competition or coercion as opposed to collaboration.  The team leader has important role here. The roles of the members of the team need to be clarified and all team members need to know enough about each member of that team, their aspirations, their skills, and their motivation(Mitchell et al., 2012).

The conflicts may arise because in health care we have different expertise on different teams and conflicts may arise due to limited knowledge in particular areas. Thus, an interdisciplinary team needs to learn from each other. There may be cultural or gender conflicts. In such cases the leader needs to make the members understand and respect diversity before we put them together on these teams so that they can respect people for what they bring to the table (Belinsky, Eddy, Lohmann, & George, 2014).

Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) is a methodical approach established by the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) to incorporate teamwork into practice (King et al., 2008). The first stage that a team goes through is called forming. In this stage, everyone is ought to be very enthusiastic as it is a new project and all are together for the first time. The leader needs to take charge and be very clear about the goals, timeline, responsibilities, and role clarity. After the group has been working together a little while the team members become comfortable with each other and demonstrate a bit more skill. As a team, they have collected data on the barriers of implementation, what their competitors are doing, what the organization and the physician needs would be for this specific new service. So the team has more data but is not sure about what to do with it, how to analyze it, and how to put it into a meaningful pattern. At this stage, a good leader moves the team through a series of questions called storming. This is necessary to invoke performance. It is at this stage that conflicts arise. Thus at this stage the leader needs to recognize the different styles that people have and try to match them in a complementary way, not a way that they're going to conflict. Teams are notorious for having people try to come to a consensus, yet there needs to be discussion. If the conflicts are resolved successfully by the leader, the team enters the third stage, developing. At this stage the team has enough knowledge and has overcome the political nuances and is a bit more comfortable working with each other. Now the leader plays a facilitator role that allows the team to come up with the answers. The team begin to decide what their next steps are, who else needs to be spoken to, what other data do they need, who in the facility needs to be included. The team members are now confident with each other's skills, they trust each other, encourage each other, are committed, resolve conflicts as a team, are accountable and result-focused. There are no role conflicts (Ćirić & Raković, 2010).

Once the team is built it needs to engage the organization in its processes. This can be done after identifying the key processes, analyzing the processes, identifying the measures to be taken, analyzing the customer feedback, developing scorecard, and monitoring the results.

The cause of resistance is usually the presence of certain blind spots and attitudes which the staff members have due to their preoccupation with the technical aspects of new ideas. This can be dealt with by presenting to them the facts and figures of the improvement in the performance of other organizations. Live talks related to the experiences of people using the technology can also be organized to enhance the knowledge of staff members about this technology(Lawrence, 1969).

The onboarding team needs prepare a monthly report about the effectiveness of the system and the adoption of THS staff’s engagement that will be assessed every three months, half yearly, and annually. With this plan we hope to implement this system successfully in the organization.

References

Belinsky, M., Eddy, M., Lohmann, J., & George, M. (2014). The application of social impact bonds to universal health-care initiatives in South-East Asia. WHO, 219.

Ćirić, Z., & Raković, L. (2010). Change Management in Information System Development and Implementation Projects. Management Information System, 5(1), 23–28.

King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., … Salisbury, M. (2008). TeamSTEPPS^TM: team strategies and tools to enhance performance and patient safety. Retrieved from https://www.ncbi.nlm.nih.gov/books/n/aps2v3/advances-king_1/?report=reader

Lawrence, P. R. (1969, January 1). How to Deal With Resistance to Change. Retrieved July 24, 2016, from https://hbr.org/1969/01/how-to-deal-with-resistance-to-change

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C. E., … Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Washington, DC: Institute of Medicine. Retrieved from https://micmrc.org/system/files/Core_Principles_%26_Values_of_Effective_Team-Based_Health_Care.pdf

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human Resources for Health, 11, 19. https://doi.org/10.1186/1478-4491-11-19