When it came time for Barry Arbuckle to get his staff at MemorialCare Medical Centers to implement a new electronic medical records system, he was reminded of a lesson learned from his predecessor.
“Be prepared for the thousand questions they’ll likely never ask you,” says Arbuckle, MemorialCare’s president and CEO. “Because if they ask you and you don’t know, you lose momentum and you lose credibility.”
So Arbuckle’s job was pretty simple when it came time to overhaul the entire medical records process for the health system: He needed every answer possible to sell each facet of the change to every employee all 10,000 of them. After all, when you’re fundamentally changing the way people do their jobs, the onus is on you to give them the answers on why they should buy in.
“All of the sudden, you’re saying, ‘Change, it’s a fundamental swap, and you have to trust me that it’s going to be better,’” Arbuckle says. “Well, quite honestly, in the first couple of weeks, it’s hard, and there’s that propensity to say, ‘I’m going back to what I’ve done for years, it’s worked for 15 to 20 years, by golly, I’m going back to it.’
“Many of these people have done it the old way their whole life. Now we’re going to require them to change, and we’re going to take away every other means they had, that’s a big change, and you have to sell them on that.”
Rather than make employees feel like they were forced into changing, Arbuckle wanted to build buy-in for the new system to make sure employees felt like the adaptation wouldn’t just be good for MemorialCare but would also be good for them. To do so, he used a three-step process. He started off by including employees in looking for the answers on how to adjust, then used that information to push a consistent message about the new direction, and finally, followed up to make sure his staff had the right resources to make the change. As a result, MemorialCare implemented the new system on time and on budget, putting the $1.4 billion health system ahead of the technology curve.
Involve your team
“If folks understand why you are making the decisions you are making, they are more willing to go along with you on your journey as opposed to jumping ship and going elsewhere,” Arbuckle says.
The first step to that is acknowledging that even though you need to have all the answers for employees, you probably don’t have them.
“You have to know what you don’t know and acknowledge it,” Arbuckle says. “Sometimes, when you get to a leadership position, it’s easy to forget that. I’m a leader because I know more about this than most other people, but, my God, there are so many things I just don’t know.”
So when Arbuckle started the process of overhauling the records systems, he began by involving front-line people in the process before he implemented anything new.
“It’s got to be a vision that they also share,” he says. “It can’t be, ‘I’m being asked to do this because the hospital thinks it’s a good idea,’ there has to be, ‘I’ve been part of deciding that this is what we’re going to do because it’s what we want to accomplish.’”
The talk of a new system actually wasn’t started by Arbuckle but by MemorialCare’s volunteer physician’s society. Because physicians can’t be employed by a hospital in the state of California, Arbuckle has formed the volunteer group because he knows they are passionate about making medical care better.
Once the idea had been kicked around by the physicians, Arbuckle took it to other members of the team. He made it a point to get a diverse group of people, grabbing people from each department and each portion of the hierarchy because it’s important to make sure that every demographic is represented. When that group was formed, they became the eyes and ears for the staff, hearing vendors pitch new systems and voting to eliminate systems they thought wouldn’t work. The group was even invited to go to other hospitals to see working systems in place so they could ask about the things that concerned them.
“We said, ‘Let’s go out to a hospital like ours and see really how the system works,’” Arbuckle says. “‘Let’s have some side conversations and ask them, ‘If you could do it all over again, what would you do differently, would you spend more time doing this or that?’ And they got some grand ideas. It really added to our intelligence in terms of what to do and what not to do.”
Not only did it make employees feel involved in the process, but it gave Arbuckle a cheat sheet for those thousand questions that may never be asked.
“That’s useful because then you are able to articulate their reasons for decisions to board members or to employees whose livelihood you are potentially impacting,” he says.
To continue to get his staff thinking about the best system, Arbuckle even hired a former chief information officer of a hospital that had failed putting together a new system. The idea was to really let everyone get a close look at what would work best and what wouldn’t so they could articulate which system was the best fit. The employees had to make the change, so their opinions mattered more than anything.
“It was millions of dollars, but they selected it, and then they helped us build buy-in with our colleagues,” Arbuckle says. “The fact that they helped convince people who weren’t necessarily computer-ready to jump on this, that’s all that really matters because I don’t use that system. It’s easy for me to say, ‘This one’s big, this one’s popular, our neighbors chose this one,’ but that does-n’t work, particularly when you are asking folks to fundamentally change.”
Keep a consistent message
Though the inclusion process helped Arbuckle see the advantages of the new system, some of the staff still had to be sold on the fact that a change was going to be made. That takes a consistent communication process that ensures every employee sees the core vision.
“You have to articulate the end goal, ‘Here’s where we are today, here’s where we want to get, and does everybody agree that that’s going to require a change in between?’” Arbuckle says. “You kind of get everybody understanding that this is where we want to get to, there is a reason we are doing this, and the path that we’ve taken to today won’t get us there.”
Arbuckle could articulate the change well from what he’d learned by including his team in the process, but he still had to do it over and over and over again.
“It was communication, and that’s an overused term, but we probably overcommunicated,” Arbuckle says. “The number of Web casts that I did on this topic out in the field, the number of newsletters, meetings, social events and signs around the office, quite honestly, it felt like absolute overkill. But it turned out that it wasn’t, it was necessary because we had to just keep reinforcing why we’re doing what we’re doing.”
MemorialCare brought in a communications and education expert to design the communication plan because it’s tough to know how many times you have to tell 10,000 people something before it sticks.
“It was like, ‘My God, we’ve got to say this again. Aren’t people bored with this by now, I’m getting bored saying it,’” Arbuckle says. “But it turned out to be very useful. The more we did it, the more it became clear to them that this wasn’t just the project of the month or of the fiscal year, this was a marathon process where we were going to be steady and keep working toward the goal. That communication helped remind people that we were still out there, that they couldn’t forget about it. Just the consistency of the message is powerful.”
Not only does the consistency help the message resonate, but a consistent communication attack can also alleviate the negative virus brought about by the rumor mill. Arbuckle consistently spoke with his people about the change at meetings and spoke freely about the transition.
“I’ve learned over the years that people imagine and develop their own reasons for why leaders are doing what they’re doing, and many times, they are wrong, and many times, they can be disruptive,” Arbuckle says. “I always open myself up and say, ‘Ask anything you want.’ I bring the core message with me, and I’ll take that risk. Sometimes I’ll have to say, ‘That’s a good question, and I can’t answer it today, but I will answer it when I can.’ But I find that most of the time I can give people exactly what they want, reinforce the message, and we can move forward.”
Help employees adapt
Building buy-in doesn’t stop once the change is in effect, so MemorialCare continued to sell employees on the process even after the systems had been picked and implemented.
“Having them verbalize it is one thing, ‘Oh, yeah, I can make that change, it looks like a nice system,’” Arbuckle says. “Making sure they are actually understanding and willing to embrace and accept change is the powerful finishing piece of these projects.”
Understanding that some employees will take longer to change and some will have to make bigger changes than others is a big part of the last stages of getting employee buy-in. For MemorialCare, that meant understanding that even though the new systems got the thumbs up, extra time and resources had to be spent training those who couldn’t just jump into a technology upgrade. MemorialCare hired a clinical training specialist who was deployed to every physician’s office to see how each one handled computer systems.
“Part of that process was to assess where they were, where they were personally in terms of their own ability to use a computer would they need a side class on keyboarding and navigating a new menu,” Arbuckle says. “Most people don’t want to admit that they aren’t ready for a change, or they’ll exaggerate a tad, and that turned out to be very powerful in working with them privately to see what they needed to improve upon.”
Arbuckle was also concerned with the emotional aspect of making a change. During the switch to the electronic systems, MemorialCare employed a psychologist specializing in change management who worked with employees who were set in their ways. It might not be a realistic expense for every organization, but the main idea is to let people voice how the change affects them mentally.
“It really turned out to be valuable,” Arbuckle says. “This fellow led sessions on change management, and some people would say, ‘I thought I came in to talk about computers, and we haven’t said the word computer,’ but it was so valuable to let people discuss the problems they had with changing because people aren’t always ready for it.”
More than anything, Arbuckle focused on the fact that it was his job to do everything he could to sell his people on the change. Getting 10,000 people to move in a direction is never easy, so the goal is always taking the burden off them by making sure they see the benefit of the change and then being ready to sell them with the right answer to those 1,000 questions that may come up.
“We never treated physicians or staff as people who had to do this,” Arbuckle says. “We treated it like a sell, we had to pitch the actual value of it to them again and again, and our job was to help them get there.”
HOW TO REACH: MemorialCare Medical Centers, (562) 933-1800 or www.memorialcare.org