How do you achieve what we might call “managed innovation”? How do we encourage innovation within a structure?
Part of the challenge must surely be about having your clinicians understanding the strategy. I’ve helped develop ICT strategies for a large number of hospital boards and agencies over the years, and have yet to meet many clinicians who had a clear sense of where the organisation was going with clinical systems and ICT more generally.
Of course, it’s not their job to know all that in too much detail, but they certainly need to know enough to have an understanding of what’s coming up over the next few years.
I remember going to a hospital many years ago in northern New South Wales where we had rolled out the baseline EMR, including the surgical module. I met with a group of anaesthetists whose basic message was that their workload had increased due to this new system, but at that point we had not purchased, let alone installed, the anaesthetics module. So they were pretty cranky.
What made it worse was that we could not at that point give them a timeline for when they would see that part of the system deployed.
I learned a big lesson from that experience – you have to be able to articulate the forward strategy.
Another part of the challenge is making sure the right governance structures are in place to facilitate plan-change, and to provide a platform for innovative ideas.
I worked with an organisation a few years ago that was sitting on a list of 643 improvement requests for its EMR. They seemed to have no rational basis for deciding which ones went forward and which did not, and, even worse, they totally failed to go back to clinicians on a regular basis and update them as to where their idea had gotten to.
So staff gave up. And then they started doing things on their own initiative, bypassing the ICT department altogether. And bypassing its policies and procedures and standard practices as well.
We started out by helping them develop some kind of rational prioritisation procedure with associated criteria. In a way, the criteria for this are less important than the simple fact of having a process. Obviously people still don’t like being told that their project is not going to move forward, but in my experience they react better to that than if it falls into a black hole and never hear anything at all.
That list of 643 requests was also a pretty strong signal of poor governance. An organisation with a strong and effective clinical leadership group overseeing ICT development would not have allowed such a situation to occur. In places where there is an effective chief medical information officer (CMIO) and an effective set of clinicians and various other disciplines reviewing proposed projects, this sort of problem would not arise.
Compliance with standards
Related to the innovation challenge is the problem of getting compliance with standards.
This used to be as simple as trying to stop staff buying and installing Apple computers in their department. Then it became about what kind of mobile phone staff could connect to the Wi-Fi in the hospital.
But those kinds of battles are pretty much over. Most CIOs now understand that they have to accommodate whatever phone comes in through the door, and, on the PC side of things, there is usually some process in procurement now to stop people from buying just whatever hardware they feel like.
The real battle now is at the application level. It’s about being able to articulate clearly why the system being proposed by a particular department does not fit with the organisation’s strategy and standards. A lot of this is connected to having a clear enterprise architecture in a format that clinicians can understand fairly simply.
There is a series of Dilbert cartoons about the ICT department being actually “The Department of IT Prevention”… And if we’re not careful, that’s how quite a bit of our user base will end up seeing us if we say no too often. So the other part of the conversation is the ability to propose rational alternatives.
It is also true that the new technologies are actually a lot harder to “prevent”. A smart group of clinicians who can build an app to work on a phone don’t actually need any input from the ICT department to make their solution work, so potentially they can bypass you altogether.
This all means you need to be on the front foot communicating your strategy with your key clinical groups. Plus you need to have a series of forums where they can learn about the strategies and express their ideas for innovation.