10 tips to work with resistant staff while rolling out an EHR

Just as driving a car takes time and becomes second-nature with practice, so would learning a new system. Good systems aren’t usually designed with the first time user in mind but are designed for the second-time, repeat user. It’s best not to expect that you’ll simply get it when you start using a system – anything that’s worthwhile takes a bit of time and interest to learn. Assuming that the system is designed well, here are a few tips to keep in mind while working with staff during an EHR rollout:

1) Develop a 3×3 matrix based on skill and resistance. On one side, divide the rows into High, Medium, Low skill levels. On the other side, divide the columns into High, Medium and Low resistance levels. Plotting staff in such a matrix helps you identify high skilled-low resistance ones, high skilled-high resistance ones, low skilled-high resistance ones and so on. This knowledge will help you take the right actions when issues occur.

2) Rollout in modules, not phases. Don’t attempt rolling out the entire EHR platform at the same time. Don’t think linearly (one after the other), instead think in concentric circles where modules build upon each other. At the center are the core modules that help document a basic chart, then expanding outward are modules with greater functional depth. Do not go to the next set of modules until you and your team have nailed (score a 100%) the core ones. For example, when you start the rollout don’t worry about Clinical Quality Measures of Meaningful Use – focus on documenting a basic SOAP note in the quickest, consistent way possible. This is important for ongoing success.

3) Identify champions. Early on in the process, identify who really wants to make it happen. Go across the hierarchy and create an informal rollout team that would help you during the process. Provide additional training opportunities.

4) Communicate. Have daily (10min), weekly (1hr) and monthly meetings (1hr) to align everyone’s goals, remove issues as they occur rather than letting them pile up.

5) Shadow, observe and give feedback as it occurs. Feedback is most valuable when it comes in the form of assistance. Shadow doctors and staff and help them resolve a mistake as it occurs.

6) Have a pilot phase. It helps to iron out the kinks with the system and staff when there are no real patients around. There’s no need to rush through a rollout.

7) Make it a game. Score points (e.g. on knowledge, helpfulness, speed etc.) and put the chart up on a big monitor for everyone to review by the end of the day. Thinking of the rollout as a game, will make it easier. Competition amongst staff members will help everyone get better.

8) Make the EHR vendor part of the team. Just because something doesn’t look familiar, may not mean that something’s wrong with the software. Have the approach of including the vendor as part of the team versus treating them as someone external to your environment.

9) Fall-back option. Think through on all the ways that the rollout could go wrong during a live patient scenario. Prepare staff on what to do when something like that happens (e.g. Internet downtime).

10) Celebrate. It’s important to celebrate with staff on the small wins during the rollout. This could be even a simple cheer or an ice-cream for everyone. It helps keep the atmosphere positive and engage everyone in the right direction.