0. Delivering Sustainable Clinical Transformation
Written by: André Snoxall (

1. Why clinical transformation?
Consumers report a poor experience of the services offered by healthcare providers
It is estimated that between 75 and 150,000 people die each year from the care they receive and through medical errors in the US healthcare system (iatrogenic events)
In the US, medical errors are the fifth leading cause of death today
In two major US teaching hospitals adverse events related to medicines, and that were preventable, resulted in increased costs of about $2.8 million per year
Adverse events occur in between 2.9 and 3.7 percent of hospitalizations;
many of these errors and events could be avoided through improved processes and more effective use of technology

2. Why clinical transformation?
If we are to get the most from new technology, processes must often change
The aspiration is transformation from:
people helping people to:
people, supported by technology, helping people supported by technology
This shift is transformational: it fundamentally changes the way care is delivered

3. Clinical transformation
Changing the way we provide care by making the best use of technology
Objectives:
Keep patients well
Help patients to heal
Make encounters as pleasant as possible
Support healthcare workers
Reduce waste and improve performance

4. Who then, needs to change?
Clinical Support Services
Clinical Personnel
Clerical Support
Management
Working together to
serve the patient…
…but only as strong as the weakest link.

5. X No Thanks Change Who then, needs to change?
Everyone involved with the healthcare “system”
There is no “Opt-Out” button X
No Thanks
Change

6. Meaningful Use
“By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives…” US Government Meaningful Use initiative
…a program set-up to measure, monitor and incentivize healthcare providers to achieve meaningful use following investment in electronic health records
The program provides a best-practice framework against which we can drive targeted change facilitated by a CIS. Key performance targets should include:
The use of a CIS in a meaningful manner
The use of a CIS for electronic exchange of health information to improve quality of health care
The use of a CIS to measure and improve clinical quality

7. Change will happen
“All meaningful and lasting change starts first in your imagination and then works its way out. Imagination is more important than knowledge.” Albert Einstein
Change can be imposed, however, imposing change from the outside will make it neither meaningful or lasting
To be lasting, change must start from within…
We are implementing technology and new-process mandates that will force change
Our aim is to use this implementation as a catalyst for stimulating client stakeholders to drive change forward
Training alone is not enough

8. Change will happen Change Time Improved care
Better outcomes (improved success rates)
Increase in patient satisfaction
More productive clinicians
More effective expenditure
Investor satisfaction
More adverse events
Very unhappy patients Dissatisfied clinicians
Heavily increased costs
Significant investor dis-satisfaction
Transformation
Change
Little change in adverse events or patient experience
Dissatisfied clinicians
Heavily increased costs
Investor dis-satisfaction
Technology “churn”
Training
Time

9. Change Stakeholders Administration and clerical support staff Nurses
Allied health-professionals
Hospital consultants
Non-consultant Hospital Doctors
General practitioners
Clinical support-providers
Non-clinical support-providers
Provider management team
Investors

10. The Tools Communication Collaboration Inclusion What’s in it for me?
When will it happen?
How will I be affected?
Collaboration
Observe and extrapolate;
Anticipate;
Share, and;
Work together to mitigate risks
Inclusion
No discussion about me, without me;
Involve groups of stakeholders in planning change.
To take the vision and run with it, an organization must have strong leadership capable of communicating — and demonstrating the need for change.
To create a shared vision, leaders must understand organizational dynamics, engage “change agents,” and aggressively apply change management principles.
Leaders appreciate, for example, that participation is essential. Seemingly little things, such as regular feedback on widely-distributed project status s or attendance at training sessions, get people on board while helping future end-user adopters see the value beyond the “what’s in it for me” perspective.
Another benefit of leadership outreach is a byproduct of engaging other key colleagues and leaders. When it comes time to resolve problems that arise, project awareness and strong relationships will prove an asset.

11. Working with Stakeholders
Provider Management Team
Senior sponsorship (CEO, CFO, COO, CIO)
Enterprise architecture documentation and sponsorship
Focused workshops and discussions (finance, operations, HR, performance management)
Program oversight
To take the vision and run with it, an organization must have strong leadership capable of communicating — and demonstrating the need for change.
To create a shared vision, leaders must understand organizational dynamics, engage “change agents,” and aggressively apply change management principles.
Leaders appreciate, for example, that participation is essential. Seemingly little things, such as regular feedback on widely-distributed project status s or attendance at training sessions, get people on board while helping future end-user adopters see the value beyond the “what’s in it for me” perspective.
Another benefit of leadership outreach is a byproduct of engaging other key colleagues and leaders. When it comes time to resolve problems that arise, project awareness and strong relationships will prove an asset.

12. Working with Stakeholders
For Clinical Consultants
Chief Medical Information Officer (CMIO)
CIS Steering group
Medical records committee
Clinical governance committee
Specialist advocates (surgeons, anesthetists, physicians, intensivists, ER consultants, radiologists, hematologists)
Grand round presentations
Flexible learning which has emphasis towards time based benefits and access to information (including one-to-one hands-on, out of hours sessions)
White papers
Published performance metrics
Regular, targeted communication from colleagues

13. Working with Stakeholders
For Nurses, Junior Doctors & Allied health-professionals
Medical records committee
CIS Steering group
Nurse manager involvement (wards, theatres [OR], emergency department, pediatrics, maternity)
AHP management involvement
Nursing informatics meetings
Solution/scenario testing
Published performance metrics
Process documentation
Appropriate targeted training (mix of 1:1, classroom, and on-line)
Induction processes
Prequalification of casual/temporary staff
To take the vision and run with it, an organization must have strong leadership capable of communicating — and demonstrating the need for change.
To create a shared vision, leaders must understand organizational dynamics, engage “change agents,” and aggressively apply change management principles.
Leaders appreciate, for example, that participation is essential. Seemingly little things, such as regular feedback on widely-distributed project status s or attendance at training sessions, get people on board while helping future end-user adopters see the value beyond the “what’s in it for me” perspective.
Another benefit of leadership outreach is a byproduct of engaging other key colleagues and leaders. When it comes time to resolve problems that arise, project awareness and strong relationships will prove an asset.

14. Working with Stakeholders
For Administration and Clerical staff
Focused workshops and discussions
Manager involvement (outpatients, emergency department, theatres, wards, general practice, medical records)
Procedure documentation: as-is / to-be
Hands-on classroom based training with strong emphasis on context of CIS learning within individual job roles
1:1 go-live support and hand-holding
Solution/scenario testing
Performance-based pay
Induction processes
Prequalification of casual/temporary staff

15. Finis
Questions?

16. What does 75 to 100,000 people look like?
190 Airbus A380 aircraft. Each carrying 525 passengers

17. What is the comparison between USA and Qatar?
US Pop (Source: US Census Bureau)
284 million
Iatrogenic deaths as a percentage of pop. (US)
0.05%
Pop. Qatar 2012 (Source: CIA Factfile)
2 million
iatrogenic mortality in 2012 if US statistics are extrapolated to Qatar:
1031
Key assumption: That Qatar healthcare is at least as good as US healthcare in terms of mortality rates in hospitals as a result of iatrogenisis
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18. Admin/clerical support staff
Change stakeholders:
Admin/clerical support staff
People who:
book appointments;
register patients;
record details of activity and change of patient status; and
communicate with patients and clinicians.
These personnel probably have the biggest impact on “the patient journey”. If they get it wrong:
appointments are missed;
patients are inconvenienced;
information is not recorded accurately;
clinicians are misinformed; and
time and resources are wasted.
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19. Change stakeholders: Nursing & allied health-professionals
People who:
provide care and treatment to patients;
collect and record clinical information that supports decision making;
ensure that care is provided appropriately and when it is required;
operate and maintain specialist equipment; and
…did not chose this career so that they could operate computers!
These professionals are characterized by:
the immediacy of the impact if they don’t meet care obligations;
their importance as observers and recorders of appropriate data;
their role in “processes”; and
their dependence on developing and following consistent processes to ensure quality.
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20. Change stakeholders: Consultant clinicians
People who:
interpret information, perform diagnosis and recommend appropriate intervention within an area of expertise;
perform clinical procedures;
monitor activity and outcomes, measure efficacy, and define appropriate treatment protocols; and
represent the pinnacle of their specialty within a health care system.
Consultants are often characterized by:
a desire for continuous improvement;
the need for accurate, reliable, and appropriate information upon which to base immediate treatment decisions;
an obligation to support the learning of junior doctors; and
impatience with impediments to effective completion of their work.
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21. Change stakeholders: Non-consultant hospital doctors
People who:
perform, search for and manage documentation;
perform procedures, take bloods, request investigations, review results;
ensure continuity of care through handovers;
collect information from patients, diagnose problems; and
provide advice or assistance.
Non-consultant hospital doctors are generally:
overworked;
subject to the whims of the consultants who they work for;
on a steep and continuous learning curve; and
not in a good position to drive systemic change across their domain of experience and expertise.
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22. Change stakeholders: Clinical, and other, support services
Include enterprises such as:
pharmacies;
clinical laboratories;
diagnostic imaging providers;
IT service providers; and
other non-interventional service providers who support the delivery of care.
These enterprises are characterized by:
their cost to the healthcare provider;
their importance in enabling access to accurate, useful information upon which treatment decisions are based; and
their dependence on specialist domain expertise to operate effectively and efficiently.
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23. Change stakeholders: Provider Management Team
People who:
define enterprise strategy and tactics to meet local challenges;
measure and monitor enterprise performance;
measure and monitor internal activity;
Plan, manage and ensure access to resources; and
ensure the quality and consistency of resources to support enterprise activities.
These people are characterized by:
their ability to understand clinical imperatives and convert these to meaningful plans and actions;
The ability to work collaboratively to balance the needs of clinicians, patients and government; and
their ability to make decisions inclusively and to communicate effectively with stakeholders.
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