Clinical Decision SupportDigital HealthOperating Room

Innovation on the Front Lines: Change Management for Successful Digital Health Implementation 

By Evan D. Collins MD, MBA, Orthopaedic Surgeon and Chief of the Hand & Upper Extremity Center, Houston Methodist

As the population ages, the imbalance between the demand for care and providers of care will continue to fuel the need for innovative solutions in our healthcare system. Digital technologies continue to be developed and applying these solutions across the continuum of care is increasingly popular. Surgeons, such as myself, who are directly involved in patient care have witnessed firsthand the evolution of technology from an electronic health record (EHR) to today’s AI-based clinical decision support (CDS) tools. However, their success is not solely determined by technological advancements and unique problem-solving; rather, effective change management plays a pivotal role in ensuring seamless integration into clinical practice. I will discuss the significance of change management in driving the adoption and success of digital health solutions.

The Promise of Digital Health

Digital health technologies impact patient care, offering unprecedented opportunities for enhanced diagnosis, treatment, and patient engagement. From EHRs to telemedicine platforms and CDS systems, these innovations have the potential to streamline workflows, expand access and improve outcomes.

Nevertheless, none of the current digital health and CDS tools we use today would be successful in health care practice if they had not been solutions to pressing challenges facing clinicians and hospital teams. At Houston Methodist, as with other healthcare systems, we had been using telemedicine programs prior to the COVID-19 pandemic.  Nonetheless, when COVID cases first hit our hospital system, our ability to scale our virtual platform and learn its most effective role was our first encounter using many digitally based innovations in direct patient care. This would not have been successful without aligning and synchronously engaging our formal change management strategy and the telemedicine integration.

The successful implementation of digital health tools requires more than just technological prowess; they demand a strategic approach to change management.

Change Management

The successful implementation of digital health tools requires more than just technological prowess; they demand a strategic approach to change management. Digital technologies are not commodities; they look to enhance real-time decision-making based on historical data. In other words, the digital tool tells you something, but it is up to the user to execute the information. The successful adoption of technologies tends to follow these three critical steps:

1) How big is the problem that the technology attempts to solve,

2) Ease in the first step of the change process, and

3) Positive feedback after the first step. 

If any of these steps faces significant challenges, then the likelihood of adoption tends to be less successful. This strategy encompasses a series of structured processes aimed at training and supporting clinical teams, administrative staff, and hospital operations personnel to navigate change successfully. Effective change management ensures that these individuals are capable of using new technologies and embracing them as integral components of their practice.

Resistance to change, workflow disruptions, and concerns about data security are just a few of the hurdles that must be addressed. Moreover, the fast-paced nature of health care delivery leaves little room for extensive training or experimentation with unfamiliar technologies. An analogy for implementing change in health care is like trying to change a tire on a moving car.  Thus, it becomes imperative to implement change management strategies that minimize disruptions while maximizing user acceptance and proficiency.

At Houston Methodist, we begin with a small pilot program to determine quickly whether an innovation can expand throughout our hospital system, building upon our “succeed fast, fail fast” agile model. With a recent pilot project, we co-developed an innovation to use ambient technology in the operating room (OR) to improve accuracy in our OR data analytics and reduce the reliance on nurse-driven data entry into the EHR. The objective was to focus on maximizing case duration accuracy to improve scheduling and staffing and reduce the data entry demands of the clinical staff. Educating clinical teams about the new ambient intelligence cameras in their ORs was and continues to be a delicate process for change management within our organization. Strategies around its application and engagement are iteratively evolving and are integral to evaluating the success of an executed technology.   

Disruptive Innovation

Startups that challenge the status quo and introduce groundbreaking solutions often find success in reshaping the health care landscape, but the iterative process is essential for new technologies to develop and integrate in an impactful manner in health care. Without this collaboration, the technology would still be unrealized because just creating great technology is not enough. Startups which are amenable and flexible to co-develop their products with industry partners will be more successful in the long run.

The concept of disruptive innovation is no stranger to the health care sector. It is typically touted as a key component to innovation. However, at this institution, we recognize all change; therefore, all change management is disruptive. Therefore, our goal is to create strategies for adopting these digital innovations that are as small a disruption as possible to the end user in regards to their daily activities. Disruption is not our goal; technological adoption, execution of new workflows, and improved alignment with digital technologies are the focus. Developing an effective process in this regard is as critical as our innovation.

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