When Stakes Are High

What to Use When: Selecting the Right

Methodologies When Stakes

Are High

201

Jane Dowd, NorthShore University HealthSystem

March 11 - 13, 2009Orlando, FL

Page 1Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem

What to Use When:Selecting the Right Methodologies

When Stakes are HigheLearning Guild Conference | March 2009

Executive Insights

Jane DowdChief Learning Officer

Agenda• Factors to consider when selecting the right learning

methodology

• When to “e” and when not to “e”

• Creative strategies to consider when implementing large scale change/IT initiatives

• Managing expectations for e-solutions

Our Organization• 4 Hospitals• 60,000 Hospital

Cases/Year• Teaching Affiliate for

University of Chicago Medical School

• Research Institute• Foundation• More than 75 sites of

care

Integrated Delivery Network

Hospital Inpatient Care

Home Care Hospital Outpatient Care

Physician Offices

Let’s take a little journey… back to 2002

Snapshot: 2002• Paper-based patient charts

go missing

• Unknown history of patients on arrival to Office, Hospital or Emergency Room

– Complicating conditions– Allergies

• Prescription Errors– Handwriting

• Complex Billing to unravel

• Little system-wide control



Our Goal100% adoption of a completely electronic medical record (EMR) system across 3 hospitals and 65 physician practices in 2 years.

No more paper charts!

Big Risks• 1st in country• High investment cost• Risk to infrastructure,

healthcare delivery, andreputation

• Behavioral change of – 7000 employees– 1100 independent

physicians• Physician “splitters”• Stress on staff• Significant time for training

Big RewardsMajor steps forward in:• Patient safety• Quality of clinical care• Internal system improvement• Financial performance

…and it is coming as a government mandate!

This is a major system-wide change. The business case is clear. We are going to move and move quickly.

I am confident that you can get our people trained by go-live. Good luck!

How should you proceed?How should you proceed?

NorthShore CEO:

Your Challenge

Factors to Consider

What needs to be learnedTarget AudienceOrganizational ReadinessTraining ResourcesTechnology ResourcesTime

What needs to be learned?EMR System• Complex solution • Constantly evolving

New & Improved Workflows

Imagine your whole job has changed!



Emergency Dept.

What needs to be learned?

For our Hospitals:

Patient ChartsEpicCare Inpatient

SchedulingEpic Cadence

EpicCare InpatientEmergency Dept.

PharmacyEpic Pharmacy Rx

For our Doctors Offices:

Patient ChartsEpicCare Ambulatory

SchedulingEpic Cadence

BillingEpic Resolute

RegistrationEpic PreludePatient

Data

EMR System

Who are the Stakeholders?

… and more

IS Medical Informatics

Physicians

Nursing

Hospital Leadership

Physician Leadership

Medical Group

12 Clinical Depts.

HR/ Learning &

Dev.

Billing

Vendors

Other Depts.

Community

Medical School

EMR

Sample Target Audience

PhysiciansNursesStudents…and more


PhysiciansNumber: 1600• 500 Employed• 1100 Independent - Can choose to take

their business elsewhereAge Range: 30 – 70Computer Skill: Minimal to Proficient


Physicians – Their Perception• Time in training is money out of their

pocket• Not familiar with EMRs; perceived as a

potential obstacle to patient care• Big change to daily workflow• Low to no ownership – this is all new!• Covert Fear


NursesNumber: 2000 – in 3 hospitalsAge Range: 20 - 65Average Tenure: 12 yearsComputer Skill: Minimal to Proficient




Nurses – Their Perception• Not familiar with EMRs; perceived as a

potential obstacle to patient care• Big change to daily workflow• Overt fear


Students (Medical, Nursing, etc.)Number: 650+• 450 Medical Students• 200 Nursing Students• In and out of organizationAge Range: 20 - 30Computer Skill: Moderate to Strong


Students – Their Perception• “I get it, so let’s move on!”• “You are all old.”

Organizational Readiness

• No experience w/ cross-functional transformational change

• Physician leaders picked the system• Organization leaders rallying behind

physician leaders• Organization willing to raise the bar to

avoid failure• High expectation for custom solutions

Training Resources

• No experience with large scale training implementation

• Limited number of trainers• Limited number of training rooms• minimal experience with eLearning

Technology Resources

• No consistent PC or email access across audience

• IT busy with build and system design



Time

• Tight, ambitious window for training; training while IT is still building

• Training requires staff time away from work

Factors to Consider

What needs to be learnedTarget AudienceOrganizational ReadinessTraining ResourcesTechnology ResourcesTime

• eLearning/CD - CBT- Simulation

• Web Conferencing

• Classes• One-on-Ones• Newsletters• Quick Reference

Guides

Instructor/Print

How should you proceed? (2002)

SelectSelect

Technology

SelectSelect

Blended

SelectSelect

?

Our Solution

Newsletters/Quick Reference Guides

Instructor-Led TrainingMet

hodo

logi

es

2002 2004 2006 2008 2010

Present

Creative Use of Resources

• Most faculty recruited from nursing• Created required trainer curriculum and

support infrastructure• Re-purposed existing billing facility for

training

When not to “e”

• EMR constantly changing• Limited time to develop, change and

deliver training• Lack of IT infrastructure/experience• Nervous audience; a lot already

changing• Needed to “sell” change as well as

teach new skills• Audience not self-motivated



Fast forward… to End of Year 2003

System is live!

Fast forward… to 2005

Snapshot: 2005• Finance reports we are

saving $10 million a year

• 55% of patients that come to our Emergency Departments have a complete record on line

• >2000 new users each year

• Regular upgrades to EMR and new modules

Your training strategies for go-live were very successful, but times have changed. Now we need “graduate school” training to optimize this EMR investment and you need to figure out how to do more with less.

How should you proceed?How should you proceed?

NorthShore CEO:

Your Challenge

New Factors to Consider

What needs to be learned• New content areas• Improved functionality

Target Audience• >2000 New users/year• Entering fully functional org.• A little experience; still prefer

hand holding

Organizational Readiness• EMR more stable• Seen positive rewards

Training Resources• Experienced trainers • Dedicated classrooms• Training infrastructure

Technology Resources• Greater IT infrastructure

Time• Speed continues• Smaller waves vs. tidal wave

• eLearning/CD- CBT- Simulation

• Web Casting

BlendedInstructor/Print• Classes• One-on-Ones• Newsletters• Quick Reference

Guides

How should you proceed? (2005)

SelectSelect

Technology

SelectSelectSelectSelect

?



Our Solution

Met

hodo

logi

es

2002 2004 2006 2008 2010

Present

2005

eLearning

Coaching


Instructor-Led Training

Creative Use of Resources

• Partnered with other hospitals to create HospitalU eLearning Collaborative: LMS and eLearning development

• Redesigned classes to be more role specific

• Leveraged “Hospital Based Trainers”

When to “e”

• Addressing high volume of students & their demands

• Needed faster on-boarding• Fewer updates• Greater IT infrastructure• Smaller changes• More experience with eLearning• Organizational growth; increasingly

disparate geographic locations

Let’s return to the present…

Snapshot: 2009• EMR is “how we do

business”

• Continued emphasis on workflow to improve quality and reduce costs

• 1000 “near misses” are saved each year due to bar coding for meds administration

• >2000 new users each year

• Yearly upgrades to EMR

Our Solution

Met

hodo

logi

es

2002 2004 2006 2008 2010

Now

2009


Instructor-Led Training

eLearning

Coaching

Web Casting

Chat



Key Messages• Learner and organizational readiness drives choices of

training methodology

• Blended approach addresses diverse audience needs:– Instructor-led classes provide desired guidance and hand-holding– Coaching follow up provides safety net– Chat, Webcasts and eLearning help us drive down cost of/time spent

in training and provide “graduate level” learning

• Leverage members of your audience to “sell” your solutions. Partner with others to lower the entry point on cost-prohibitive technologies

• Keep successful methodologies working for you even with high demand for “e” solutions

What questions can I answer?

Jane DowdChief Learning Officer

Documents

When Stakes Are High