solving it adoption

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  • & Q U A L I T Y H E A LT H C A R E& Q U A L I T Y H E A LT H C A R E

    Patient SafetyPatient SafetyN E W S S C I E N C E R E S E A R C H O P I N I O NN E W S S C I E N C E R E S E A R C H O P I N I O N




    Article reprinted from Patient Safety & Quality Healthcare, July/August 2007 Volume 4, Issue 4 Pages 8 & 9


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  • T E C H N O L O G Y I M P L E M E N T AT I O N

    If you introduce information technolo-gy (IT) into your organization, expectresistance. We do not have time forthis!It costs too much!Were alreadydoing a great job! How many timeshave you heard statements like these?Perhaps, you have even said as muchyourself.

    It is often debatable whether a newsystem will help. But, once it is here, theone thing everyone seems to agree on isthat to get any benefit, it needs to beused. IT-enabled improvement projectshave an undeniable dependency onuser acceptance for success.

    Successful information technologyadoption occurs when your user popu-lation understands its value and uses itas it was intended to be used. This iseasier said than done. User adoption isa challenge for everyone. Traditionally,it has been thought of as an IT prob-lem: How can we get them to use thenew system? The truth is, however, asleaders of organizations that need touse the new IT, adoption is your prob-lem as well. For your organization tobenefit, your people need to use it. Youwill need to use it, too.

    As a principal consultant for one ofthe Big-4, I had the opportunity towork on, and lead, some of the mostcomplicated information technologyadoption programs outside of health-care. Common issues surfaced withthese implementations. Each one was awarning sign that end-user acceptancewould not go as planned:

    The reasons for change wereclear at the higher levels ofthe organization but not theend users.

    Commitment and leadershipwere inconsistent.

    Expectations for thetechnology varied greatly andwere often unrealistic.

    Time pressures resulted inmore emphasis on getting thesystem up and running thanon implementing trueperformance improvement.

    Changes in workflow werenot sufficiently integratedwith the new technology.

    The Main LessonI saw these issues time and again,worked through the resulting organiza-tional resistance, and learned this les-son: The way you implement affectsuser adoption. If you implement cor-rectlyfollow a methodology, have theright sponsor, involve the right people,communicatethe risk of low useradoption can be minimized.

    The good news is you have morecontrol over adoption than you think.The bad news is the vicissitudes of theimplementation remain. Whether youare a small organization or are dealingwith thousands of potential end users,implementations are complex. Whereshould you focus? The answer involvesmore than leadership, training, andcommunications. Those are, of course,important. But, to increase adoption,you need methods-based strategies.

    Five StrategiesThe following strategies are opportuni-ties to stay ahead of resistance and get anunderstanding of the issues that canimpede adoption. When and how youuse them depends on your situation.

    Build and use a realistic case for change.

    The change process begins when stake-holders first hear there might be aswitch to new IT. Regardless of industry,type of organization, or level of employ-ee, the first question you will have toanswer is: Whats in it for me? It maynever get asked aloud, but it is there.Even if the answer is nothing, it isimportant to answer the question. Thecase for change is your chance todescribe to your stakeholders why usingthe new IT is in their interestin a waythey will hear. A case for change that iswell-constructed and communicatedcan go a long way to overcome resist-ance and improve acceptance.

    Understand the impact on your organization.

    Define your adoption population toinclude end users and their con-stituents. What groups and people willthe system touch? Who is affected? It isimperative to take stock of all the play-ers, organizations, and legacy systems.Now, how will they be affected? Docu-ment your findings and revise them asyour initiative moves forward. Use thisinformation as a management tool toproactively set expectations and planfor key changes. Understanding theimpact of new IT on your organizationbefore go-live increases the likelihoodof user acceptance after go-live.

    Look at processes first.

    Enterprise-wide or cross-functional ITshould not be implemented withoutfirst taking a hard look at the way youwork. New IT ought to enable processand workflow, not the other wayaround. When IT compliments thework, it is more likely to get usedbecause it makes more sense. Askyourself whether your workflow pro-vides optimal benefit, then think abouthow IT will fit.

    Stick to a methodology thatincludes change.

    Methodologies are proven ways to solvecomplex problems like user adoption.Your IT vendor undoubtedly has a sys-tems implementation methodology.Does it take change management intoaccount? Training, although important,does not count. The most effectivemethodologies are the ones that makesense to you. Pick one and stick with it.Resist the temptation to cut corners. Ifyou skip a phase, or do not give itenough time to be done right, you risknot having the information you willneed later to build user acceptance. Forexample, if you skip the analysis of yourcurrent organization, it will be hard toplan for the people in the high-impact-ed jobs or departmentsthe peoplewho will use your system.

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  • negative consequences of not workingthrough the problem are far greaterthan the pain needed to solve it. PSQH

    As a top performing principal consultant forPwC, Howard Perlstein led organizationaland process improvement and technologyadoption efforts for Fortune 100 companiesincluding General Electric, Pratt & Whitneyand PwC. Today, Perlstein leads theconsulting firm . Among its clientsare The Risk Management Foundation ofthe Harvard Medical Institutions, NationalLeisure Group and Akamai Technologies.

    Perlstein earned a masters of businessadministration from Babson College and a bachelor of science in businessadministration from the University ofVermont. He is certified in the GeneralElectric Six Sigma total quality methodologyand is trained and experienced in multipleproblem-solving methods. He can bereached at

    Demand more from changemanagement.

    Change management work starts beforeyour system goes live and continues after-wards.You need a change function that iscapable of rolling up its sleeves, learningabout obstacles and enablers to adoption,and then working with you on imple-mentation. The very best change man-agers act as program managers. Theyanticipate issues, look for ways to squeezemore benefit out of an initiative, andengage stakeholders in candid conversa-tions to drive results and improve adop-tion. The problem is this is rarely asked,or expected from, people in this role.

    Your System Is Already InWhat can you do if youve alreadyimplemented and you are not gettingthe results you expected? Unfortunately,there are no easy answers. But, heres an

    approach that will get you moving inthe right direction. First, update yourcase for change. What benefits are notbeing realized because the system is notbeing used? How much money is beinglost? What are the data-driven reasons aresistor should start to use the system?Take this information back to your usersand work with them to identify theobstacles to using the system.Your find-ings will tell you what needs to be done.

    ConclusionUser adoption is a universal problemwithout a simple solution.Which strate-gy works will depend on your circum-stance. A definite plan should be fol-lowed if adoption is to improve. Thiswill take time and effort when it seemslike you have neither to spare. But, if theuse of new IT will save lives andimprove the overall quality of care, the


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