Rethinking 'clinical transformation'

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.