Managing Change: Analysis of a Hypothetical Case

Mercer Medical Center has been successfully competing for business because of the strong visionary leadership of Chief Executive Officer (CEO), E. Joseph Burns. However, the pressure has been relentless to constantly update expensive systems and equipment. The latest lawsuit has brought this forcefully home yet again. The publicity will undoubtedly have a negative impact on the public's perception of Mercer and on critical negotiations with the area's largest employer, Syntel. Medical Director of Information Services Kathryn Reed has just left a meeting where she and Chief Information Officer (CIO) Barry Marks were informed that it is critical that the timeline for implementation of the new physician order entry (POE) system be moved up. They now only have nine months instead of two years to make this happen. And make it happen they must. Mercer Medical Center is a 450-bed community hospital in a large metropolitan area in the Pacific Northwest, with 650 medical staff and a residency program. It is part of an ever-growing health system that has been successful in competing with two other major health systems in the city. Managed care penetration is increasing, and Mercer has bought up small private clinics as well as having its own managed care insurance plan. To remain competitive in the marketplace, Mercer has gone after contracts with the high-technology firms in the “Silicon Forest,” as the area is known. These contracts are sought after because these companies tend to employ lots of young, relatively healthy people who, overall, use fewer health care dollars—a critical advantage in this area of high managed care penetration. One such company, Syntel, a leading manufacturer of processing chips for the computer industry, is currently in negotiation with Mercer for a managed care contract. Interestingly, Syntel has recently announced its plans to get more involved in the health care arena. The medical industry, top executives say, is due for a consumer-driven technologic revolution that will result in advances that have already changed the business world in retailing, banking, and investing. The prevailing sentiment is that the health industry is lagging behind the corporate world. Questions about the hospital's information system arose during negotiations. Mercer's information services are comparable with those of the other health systems in town, with the exception of its POE system. One of the competing medical centers has announced its plan to deploy a new POE system. Syntel was impressed by this innovation and queried Mercer about its plan for a POE system. Mercer's CEO, loathe to be upstaged by the other health system, told Syntel that they also plan to implement such a system in the not-too-distant future. Two years ago, the hospital attempted to implement a nursing documentation system called Physician-Manager, and it ended in a disaster of grand proportions. The medical staff had opposed this system from the time they previewed it. It was implemented without any consideration of physicians' opinions. After only two days of operation, it had to be abandoned because there were so many technical problems. A substantial amount of money was wasted, the CIO nearly lost his job, and the information services department's image was severely tarnished. More recently, another system, called CareReviewer, was deployed and the medical staff was challenged yet again by unwelcome technology. In general, information service systems are seen by the medical staff members as adding to their workload when these systems should be making jobs easier. Physicians are increasingly being pushed to see more patients in less time and with less compensation. Managed care is driving down their salaries. Professionals who had previously enjoyed a great degree of autonomy now are feeling like cogs in the health care machinery, working to make more money for the top executives. All these pressures are driving physicians to the breaking point. The corporation is under pressure as well. Negative publicity from a recent lawsuit could damage Mercer's position in the market and its managed care contracts. A 35-year-old woman, a promising new talent at Syntel, was admitted to Mercer, through the emergency department, for high spiking fever and rigors. Blood cultures, blood for a complete blood cell count, and appropriate samples were drawn in the emergency department. The doctors were about to administer antibiotics when the patient's blood pressure dropped, and she was rushed to the intensive care unit with a presumptive diagnosis of sepsis. The ordering systems in the emergency department and the intensive care unit were separate, so new orders had to be written. A sleep-deprived physician who had been up for 27 hours quickly scrawled a stat order for ampicillin/sulbactam (a potent antibacterial medication). The order was issued in triplicate, with one copy going to the pharmacy. The pharmacy read the medication as Acyclovir (an antiviral medication) and filled it as such. The registered nurse from the float pool quickly hung the intravenous medication, and it was administered. A seasoned intensive care unit nurse recognized the size IV medication bag as being the wrong size and caught the error, but two hours had elapsed. Unfortunately, the young woman's pressure continued to drop, and she suffered irreversible brain damage. After the PhysicianManager system failure and the resulting uproar from the physicians, the Board of Directors created the position of Medical Director of Information Services (MDIS). This person would be a medical information specialist who would work closely with the CIO and develop an alliance with the medical staff. Kathryn Reed, MD, was appointed because of her excellent informatics background. After receiving her MD and MBA, she earned her PhD in Medical Informatics from Stanford University. Under the guidance of Edward Shortliffe, one of the pioneers of medical informatics, Kathryn proved to be a formidable student. She was hired as the MDIS reporting directly to CIO Barry Marks. The goal was for these two people to work together, the CIO to bring management discipline to the complex organization, and the MDIS to work with the medical staff to both stimulate effective user input and build their support for technology improvements. It was hoped that these efforts would go a long way toward overcoming the organizational and political barriers in the organization. Reed eventually received enough funding to hire six people devoted to supporting physician computing. She created positions for two technical specialists, a network analyst, two support technicians, and a support person for her department. She focused all these resources on meeting the needs of the physicians and being their trustworthy ally in the organization. She established a 12-member Physician Computing Council earlier this year to create a venue for presenting new ideas, brainstorming, and having physicians “test drive” programs before they were introduced throughout the organization. She also hoped to gain their support and have this group champion ideas to other physicians. Reed is acutely aware of the dangers of imposing a system on unwilling users. She has worked hard to gain the respect and trust of the medical community by being straightforward and honest and having no hidden agendas. By keeping the users' needs foremost in her mind, she sets a high standard of customer service for everyone in her department. She has also had to overcome automatic distrust because she is seen as part of the hospital administration and because she did not advance from within the existing medical staff. Reed demonstrates her commitment to “walking the talk” by going the second mile herself. When introducing e-mail to the medical staff, she offered to help them get hooked up at home by personally visiting each one at home. By doing this, she was not only building trust but also making a first step toward getting physicians to use information technology on a personal level and seeing advantages to the system. She is further building relationships through the training program she has created. Nurses have been challenged to teach physicians one-to-one to use the current information system to look up patient data. For the nurse who manages to teach the most physicians, she offered the unorthodox incentive of an all-expenses-paid trip to Hawaii. Implementing a POE system has been identified as a future goal, and Reed is working toward that step by step. She knows that this will be a challenge at Mercer, given its previous history. She also knows that such a system will cause dramatic change in the organization and that such change will naturally be resisted. Her research has shown her that the whole organization to be by of POE implementation in established and The of by the computer the of the system to The of The of a in the physician community of the of the information services Reed is also with the of other in POE and she is to from She has seen change when new technology organizational get The by administration time to the of at all the the strong of the medical staff and members of that staff to and in it be to the to and to any pressures with Reed has been making in such The physicians on her Physician Computing Council to be They are to the of this technology and are to in support of a POE system. However, in their Reed knows that physicians a system to a of training help hours a on by a system patient care and needs be to implementation there is to be any that they will use the system. The to a patient's on is they that their time is being as they use a POE system, they will be to use it. The of physicians for information is a in them to use a information system. use would meeting their needs through and of would naturally be to any change that and of physicians, and Reed knows she from that group She to the change by leading the medical staff to of the new system. She plans to work on substantial physician and leadership in the of on and and a to user needs and them in the system. By having physicians on the Reed is to the physician who will the of the medical staff of the POE system. Reed now in a The is hard for a implementation of the POE system. negotiations and are on making it happen. 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