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Rethinking 'clinical transformation'

By Celwyn C. Evans
04:34 PM
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In healthcare IT, clinical transformation has been around for a while, traveled far, and, predictably, come to mean many different things. Is it a process one can follow? Is it an objective to shoot for? Yes and no.

Though clinical transformation is a worthy outcome, we typically refer to “clinical transformation” as a process. But it’s something more than that, too. As we will see, it’s a model or a framework for defining, executing and orchestrating all of the requirements, tasks and processes required to achieve a particular type of result.

Any definition of clinical transformation will no doubt prove so broad as to be useless or too specific to be useful. If put it in context, however, a sort of operational definition emerges.

Instead of starting with a definition, we start with associations. Clinical transformation may focus on strategic objectives, but one of the things that makes clinical transformation powerful - and so unwieldy as a concept - is that it brings together people and management, technology and processes, leadership and vision. Generally speaking, the stakes are high and the effort is large-scale.

In practical terms, clinical transformation typically springs from the adoption of one or more advanced clinical information systems: electronic medical record (EMR) or clinical documentation systems, computerized provider order entry systems, electronic medication administration record systems, or clinical decision support systems, for instance. By considering some of the core concepts step by step, we can assemble something like a definition of clinical transformation.

A vision-driven, widely accepted project

Clinical transformation starts not with a technology plan, but with a clearly articulated vision of the desired end-state. The vision may focus on patient safety, customer service, cost controls or any number of outcomes. Clarity, in terms of how the vision furthers the organization’s immediate mission while laying a foundation for future initiatives, is requisite.

Entering into an undertaking on this scale, it’s important to emphasize that clinical transformation should question the status quo. This will translate to a practical level, where the team will be encouraged to question established policies and procedures. Too often, an organization will redesign a process but fail to question a requirement such as getting two signatures on a particular form. A surprising number of practices are based on outdated compliance requirements or even urban legend.

Leadership and best practices in change management

To take the vision and run with it, an organization must have strong leadership capable of communicating — and demonstrating the need for change.

To create a shared vision, leaders must understand organizational dynamics, engage “change agents,” and aggressively apply change management principles.

Leaders appreciate, for example, that participation is essential. Seemingly little things, such as regular feedback on widely-distributed project status emails or attendance at training sessions, get people on board while helping future end-user adopters see the value beyond the “what’s in it for me” perspective.

Another benefit of leadership outreach is a byproduct of engaging other key colleagues and leaders. When it comes time to resolve problems that arise, project awareness and strong relationships will prove an asset.

Fully-leveraged expertise

Clinical transformation calls for a division of labor that positions each stakeholder to contribute to the fullest with becoming overburdened. The organization’s internal staff know the history, people, proprietary systems and so forth. Vendors bring their specific experience with a particular software package. A third party can use project management techniques to maintain progress, use resources efficiently and guarantee the business case.

Cross-discipline primary workgroups should place the impact on and experience of the affected clinicians or patients foremost among their consideration. But, as delineated here, representatives should separate and define roles and responsibilities carefully. Leveraging expertise helps make most appropriate use of domain knowledge, prevents conflicts, and avoids merely replicating a “current state” with simple automation.

A “value-maximized” outcome

The result of clinical transformation will be maximized value, which reaches far beyond simple software installation. With an installation, you make a new application operational with the focus only on its standard functionality. At the next level, with an implementation, hospitals see greater benefit through planning and coordinating of process change.

With true clinical transformation, software and process change are reinforced with end-user adoption measures and application of change management principles. The new technology is integrated for substantial impact, achieves widespread user adoption, lays a foundation for future initiatives, and advances the organization’s clinical objectives. This diagram charts this distinction in the context of ambulatory EMR.

Putting it all together, a working definition of clinical transformation might look like this:

A framework for implementing a 
vision-driven project or set of projects... 
in a way that leadership can promote adoption 
by leveraging best practices in change management... 
and by establishing a division of labor that leverages 
expertise and positions each stakeholder to be successful... 
to maximize value rather than merely installing software.

When people and management, technology and processes, leadership and vision all come together, clinical transformation is a powerful way to organize efforts to improve healthcare delivery.

Celwyn C. Evans is a Senior Partner at Greencastle Associates Consulting in Malvern, Pa. He can be reached at evansc@greencastleconsulting.com.