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Taking the Big Bang Approach

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BigBangBold visions are difficult to attain in health care because they require long-term leadership, sustenance through setbacks and failures, as well as the courage to make and uphold difficult decisions. Not every health care system has the resources and leadership to make that happen. This is a story of one that did. Allina’s CEO, Dick Pettingill, talks about their journey to implement an electronic health record at 11 hospitals and more than 65 clinics in four years as a “bet the company” decision.

How many times does a health care system have to make those kinds of decisions, and how many times do they have the courage and wisdom to sustain them? In my experience, very few. How do you take a bold vision and put the perfect plan in place to accomplish it? There is no perfect plan. But when things don’t fall neatly into place, you must continue trying to accomplish the vision. You learn and keep going, keeping the goal in front of you.

Stepping Up

No one argues about the need for comprehensive, integrated systems to improve the safety and quality of patient care. But how many institutions actually step up to the plate?

Many pick at the problem–a lab system here, CPOE there. Allina chose to go big bang-replacing all ambulatory and inpatient systems-and learned a few things along the way.

Let’s start with what we did well. Everyone cites leadership as a key ingredient, but here’s what it meant at Allina. First, leadership showed backbone by allocating $250 million for the project. That’s a good first test, because leaders will need the same backbone when physicians can’t understand why they have to go to a four-hour computer class.

hospital maquet

When our flagship hospital failed in its initial efforts to adopt CPOE, leaders took steps to make sure everyone understood the goal for the new way of life, including discipline, replacing leaders who weren’t on board, or even (gasp!) taking away parking privileges. Without strong leadership, the project would have stopped 90 days after the first go-live, based on initial reactions.

Another success factor was forming a solid partnership with our vendor, Epic Systems Corp., and main consulting partner, First Consulting Group (now part of CSC), and streamlining our decision making. One party could not succeed unless it had the support of the other two, and the power was almost equally distributed, which was unique.

As a final example, we successfully carried the banner of standardization across the system, especially with order sets. Although this was one of the most difficult aspects, the payoff is worth it. We can now educate practitioners about best evidence for a particular condition, and it’s easy to put the evidence into practice. It’s fantastic to watch changes hit order sets, and then see the improvement needle for patient outcomes move. It works!

To-do List

That said, there are a few skeletons in the closet. We still don’t have a system-wide standardized formulary. We didn’t have a clear physician engagement strategy until our third hospital. And we’re just beginning to get a handle on our data warehouse strategy. We continuously learn and refine our methods. Our first implementations were challenging. Leadership endorsed the directive of, “Mistakes are OK, as long as we learn from them and they aren’t repeated.”

In November, Allina’s ninth hospital will go live on every application on the same day. I anticipate the implementation team will be on site less than a week. 

And yet, when we review our lessons learned, we’ll improve things for next time.

Are you in the business of providing excellent health care? How can you know that’s happening if you don’t have the data to show it? How can you make data-driven decisions about improving care without the data? Step up and take the plunge. But bring your “A” game. You’ll definitely need it! "

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Last Updated ( Friday, 04 July 2008 14:12 )  

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