Change Management – Health, Technology & Organisation (HTO)

Philips Future Health Index 2018 released

Last July, I was approached by someone from the Philips team in London that works on the Future Health Index program. Previously they launched the first part of the 2018 Future Health Index, which is the indicator of the value delivered by 16 national health systems from around the world. For the second part, they wanted to produce some tangible guidelines on how things can improve and drive change within the industry.

In order to develop these guidelines, they interviewed 12 key opinion leaders (KOLs) across the Netherlands, US, UK, Australia, Germany, China, Sweden and Estonia – and I was one of them.

The Interview Questions

The interviewer was so kind to send me the transcript of my interview, otherwise I probably would not have remember them. I really enjoyed talking to him, which is not surprising given that people’s experiences with and attitude toward eHealth services is my PhD topic.

We started with my PhD research and I gave a background on the Swedish patient portal through which Swedish citizens can access their electronic health records online. We talked about the initial reaction from healthcare professionals and the conflict between the project and the local medical association (you can read about it in this article), how patients receive it, and what I think about this situation compared to, for example, Germany. Research within the DOME consortium indicates that the initial concerns of physicians might not have become reality and that many patients value direct access to their records, increased their understanding of their medical issues as well as their sense of control. In relation to that, I was asked whether the lesson would be to impose the intended change even if it is against heavy criticism of particular stakeholders. This really is a tricky question, especially in a context like healthcare in which a power-imbalance between clinician and patient still exists. I think, if real change is supposed to happen, sometimes consensus is impossible if the people who are supposed to change are against it. But at the end of the day, all stakeholders (like patients, family, physicians, therapists, nurses, management, insurance etc.) are (or should be) “in the same boat” so to speak and work together.

One of my favorite quotes on this is from Greenhalgh et al. (2012) who called for more effective inter-stakeholder dialogue in relation to telehealth and telecare:

The different interest groups described in this paper are likely to continue to exist in an uncomfortable truce with one another, competing for dominance as they gain more or less public appeal, professional credibility, political power, resource and so on.

and with reference to Checkland & Holwell (1998) they add:

While consensus is not a realistic or even desirable goal, surfacing such things as assumptions and values, and inviting debate on their significance through intersectoral and interdisciplinary dialogue will help achieve what systems thinkers have called ‘accom- modation’ (acknowledgement of, and adaptation towards, other perspectives and practices).

Future Health Index: Key Recommendations

I recommend to read the full report, which you can download here: Part 1, Part 2. According to the Future Health Index research, ‘universal’ electronic health records plays an important role in the future, for example regarding integration of and more effective use of data. They identified five key concrete recommendations to overcome challenges and drive integrated care:

Get regulation right.Clearly defined polices and robust data privacy and security standards at the national level build confidence in all parts of the healthcare continuum and help healthcare institutions develop their own data codes of practice, as well as encouraging healthcare professionals and the general population to collect, share and analyze data with greater confidence.
Modernize education.Healthcare professionals won’t demand EHRs and AI tools at work if they don’t learn to rely on them during medical training. Increasing healthcare professionals’ adoption of these tools must start with their integration into medical school curriculums.
End top-down implementation.Healthcare professionals are unlikely to adopt new tools when they’re presented as a ‘fait accompli’ by technologists. Creating EHRs and AI solutions in collaboration with both healthcare professionals and the general population will have a significant impact on successful integration.
Prove and explain value.Both healthcare professionals and patients need to be able to easily understand how data collection and analytics tools make a difference. Constantly measuring and communicating outcomes will create a body of evidence that will help bridge the understanding gap.
Harmonize data standards.Companies, healthcare professionals and governments in each market must work together to reach a greater degree of consensus on data formats and protocols.

Parts of this post originally appeared in a slightly different form on the my personal blog.

A Seminar (in Swedish) on the Implementation of IT in Healthcare

Back in December I was invited to give a seminar in Swedish at the EPJ department of Region Uppsala, the department in charge of many of the health-related IT systems used at the hospitals and primary care facilities in the region. My seminar was on the the current state of research in relation to how to implement IT in healthcare. Out of all the perspectives one can use to approach this area of challenges for healthcare, I devoted most of the seminar to presenting barriers and enablers to change management projects as well as IT development projects, and discussing these with the participants. The seminar was recorded and is now available on YouTube, if you find the topic interesting (and are comfortable with the Swedish language).

The HTO group, and more generally the HCI group at the Department of Information Technology, Uppsala University, have an ongoing collaboration with the EPJ department at the region, and there will be more seminars on a variety of topics given by us during the spring.

Hooked on the J-curve

Anticipating exactly what will resonate with your audience is not always easy. During the last couple of weeks I have been presenting some results from a study on the healthy digital workplace, as a part of the SISU-project. The presentations were part of the studied organisations change effort and my presentation was one part, embedded in the information from the organisations project leaders. The overall message was thus one of progress. The study I presented created a baseline for measuring the effects of the coming changes. It also indicated some strategic areas to observe during the change.

The one thing that really seemed to catch everyones attention was not so much the results as one of the slides I used to frame my message. In this slide I contrasted the idea of a linear progression from the current state to the next with the classic J-curve or change curve as it might be called (originally the Kübler-Ross model describing grief). The J-curve in this context is mainly a rhetoric tool, it presents a generic path through change, the big difference to the simple linear progression is the understanding that things will get worse, before they get better. As basic as this concept might seem, it did however seem to catch the interest of both managers and employees. It did seem as if it created a common ground for discussing the upcoming challenges.

As time was limited I did not expand on the concept however. Taken at face value it might be misunderstood as support for the idea of simple linear progression (A->B), just with a more bumpy road. In practice there are at least two waypoints that should be noted. The first is that there is a worst case scenario where there is no recovery and the change not only fails but even fails miserably (C). The second is that if the organisation navigates the turmoil it might still end up in some kind of status quo or rather same same but different (D). The promise of actual progress still needs to be fulfilled. Taking a note from Festinger’s theory of cognitive dissonance one might suspect that we might be tempted to rationalize our new position as an improvement without this actually being the case. Thus, we need to be careful to measure the right aspects during a change effort.

Finally, I didn’t use my favorite take on the change curve, namely the hype curve (hype cycle) made famous by Gartner. The inclusion of the hype is interesting as it puts focus on the rhetoric behind the change. Getting the boards interest and approval might well include some mild exaggerations regarding the benefits of the change. As is obvious from the hype curve the discrepancy between these promises and the coming turmoil might turn out rather dramatic. Thus, it is–as we all should know–important to manage expectations during change so as to avoid a roller coaster experience of change.