when stakes are high
TRANSCRIPT
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
March 11 - 13, 2009Orlando, FL
Page 2Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
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!
March 11 - 13, 2009Orlando, FL
Page 3Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
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
Sample Target Audience
PhysiciansNumber: 1600• 500 Employed• 1100 Independent - Can choose to take
their business elsewhereAge Range: 30 – 70Computer Skill: Minimal to Proficient
Sample Target Audience
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
Sample Target Audience
NursesNumber: 2000 – in 3 hospitalsAge Range: 20 - 65Average Tenure: 12 yearsComputer Skill: Minimal to Proficient
March 11 - 13, 2009Orlando, FL
Page 4Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
Sample Target Audience
Nurses – Their Perception• Not familiar with EMRs; perceived as a
potential obstacle to patient care• Big change to daily workflow• Overt fear
Sample Target Audience
Students (Medical, Nursing, etc.)Number: 650+• 450 Medical Students• 200 Nursing Students• In and out of organizationAge Range: 20 - 30Computer Skill: Moderate to Strong
Sample Target Audience
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
March 11 - 13, 2009Orlando, FL
Page 5Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
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
March 11 - 13, 2009Orlando, FL
Page 6Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
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
?
March 11 - 13, 2009Orlando, FL
Page 7Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
Our Solution
Met
hodo
logi
es
2002 2004 2006 2008 2010
Present
2005
eLearning
Coaching
Newsletters/Quick Reference Guides
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
Newsletters/Quick Reference Guides
Instructor-Led Training
eLearning
Coaching
Web Casting
Chat
March 11 - 13, 2009Orlando, FL
Page 8Session 201 - Executive Insights: What to Use When: Selecting the Right Methodologies When Stakes Are High – Jane Dowd, NorthShore University HealthSystem
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