DOTmed News recently spoke with Jon Roberts, Director of Rule 4 Consulting, a firm focused on organizational problem solving. They have been doing a lot of work lately helping client hospitals and health care facilities learn new health information systems.

DOTmed (DM): Tell us about your company and customers.

Jon Roberts (JR): We work for hospitals, often part of larger health systems, hospices, and clinics around the country. We generally teach and emphasize a transformation of care by applying [quality improvement] techniques and changing the way decisions are made within an organization. One of the most popular challenges is new IT systems consuming a great deal of time and money. It became a focus to gain insight into implementation of new, large-scale information systems that have become problematic in health care.
DM: What are the typical problems?

JR: We constantly see projects running over budget and time. Once the systems go live there are hidden costs of IT implementation. Productivity drops dramatically. People are working longer. Some bad patient outcomes have been attributed to it. Some seasoned staff will interpret an IT adoption as a signal they need to depart the organization.

It's discouraging because amidst all the chaos, organizations are losing some of their most experienced staff who [don't want to] to spend their last to two years in an incredibly hectic environment. These people got into health care to take care of patients not to navigate the troubles of a new system they don't understand. One health system we spoke to that had gone live with their new EMR found that the hospital took 12 months to return to the same productivity levels as before the go-live. They had a sense this was happening so they brought us in to teach a new approach based on our insights into how people learn and how to understand the work people do. And help people incorporate change into their work.

DM: So yours is mostly a training effort?

JR: Yes. To sum up the flaw we see, people are generally taught to use these [health IT tools] in the context of the functionality of the technology. [Instead], we start with, what are the tasks that each person has to do? Let's start and understand these and teach people how to use the system in that context. By doing that, what happens is -- what people don't understand becomes immediately clear and we just practice it over and over.

I was observing a classroom session that was set up by a major IT vendor. They had gone through a chapter and a nurse said, "I have no idea how to admit a patient." That question was a response to the instructor asking if anyone had any questions. Normally people don't know what they don't know. So this nurse was very helpful because it became the starting point to saying -- what are the things you need to do in the normal course of the day? Let's practice doing that. It also helped surface some kinks in the system to engage the vendor in making some changes. The real power of this was the extent to which they were able to surface those questions before go-live, not after. Discovering the problems after you start taking care of patients in real time is what causes productivity problems.

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