Rx for success Featured

8:00pm EDT October 26, 2008

After nearly 27 years at Saddleback Memorial Medical Center, Steve Geidt knows a thing or two about stability. But the organization’s CEO also knows when and how to make a change.

In 2005, Geidt completely changed the way Saddleback was run. The hospital’s parent organization, Memorial Care Medical Centers, wanted to go paperless and invested $60 million into the endeavor.

It was a big investment, but the benefits were expected to easily outweigh the cost. Before investing in an electronic medical record system, Geidt’s organization used to copy 3 million pages of paper in a month.

“It was ridiculous,” he says. “Now, it’s down somewhere below 2 million, which is still a lot, but think of the savings in not just paper but trees and the amount of energy people spend running around looking for paper or copying paper or pushing paper around.”

Still, that wasn’t the most compelling reason the organization needed to make this change. Recent studies have revealed that misplaced decimal points and undecipherable abbreviations on prescriptions for medications are legitimate threats to patient safety. Geidt and his staff reasoned that taking the pen out of the doctors’ hands would greatly reduce the risk of transcription errors from hospital staff tasked with decoding a doctor’s handwriting.

“You’ve heard the stories, but many of them were indeed true,” he says. “That’s not to say that errors were rampant, but the potential was there.”

By relying less on handwritten scribbles of a hurried physician, Geidt’s goal was to eliminate that potential. But change is never easy — especially when it involves getting2,700 employees to fundamentally change the way they do their jobs every day.

Show them the goal

Geidt knew that the switch to electronic medical records would not be easy. After years of using pen and paper, the hospital’s staff members had become comfortable and set in their ways. Implementing a change of this magnitude could have been a disaster if it wasn’t properly planned and executed.

The first step is to make sure your team understands the goal and the reasons behind it. Geidt had to convince his employees that there was more to using electronic medical records than saving a few trees. His first step was showing them the bigger picture.

First, he outlined the benefits electronic records would have for patient safety. Then, he showed them how using electronic records would make their entire staff more efficient. Geidt says a typical clinical staff spends 40 to 50 percent of its time documenting medical records — time that could be spent taking care of patients.

“It’s ridiculous, really,” he says. “To go through that level of training and have that important of a job and then spend half of your day writing things down — that was the old ‘paper world.’ The idea here was to invest in not necessarily reducing employees, but on reallocating their time on things that make more sense.”

That was a goal the physicians could get behind. Geidt showed them how investing in paperless technology was a means to an end and how their staff would be able to spend more time on patient care and less time writing things down and poring through massive medical files.

“It required physicians to be engaged in why we were doing it — we weren’t doing it to turn them into clerks,” he says. “Although at the time, it must have seemed that way.”

Getting the buy-in of the physicians was critical to the initiative’s success. If they didn’t believe that the change would benefit the organization, it could have been a spectacular failure. Geidt met with them many times during the planning process to ensure the change had their support.

“They were very, very involved — they had to be or it wouldn’t have worked,” he says. “That’s what made that project work, and that’s what makes the place in general work. It’s not guided by me, per se, it’s not my goal — it’s the organization’s.”

During the planning process for a major change, it’s easy to get bogged down with tactics and input. However, Geidt says you must remember to never lose sight of the goal.

“When you articulate a vision that talks about what we’re trying to accomplish and not just the tasks at hand, which is to move from paper to computers, it is the vision of improving care that’s at the core,” he says.

“That is what we try to do. Explain the goal — which is to make life better for everyone and most especially for our patients — not just the immediate tactics to achieve that. When you do that, it’s amazing how much buy-in you can get.”

Don’t look back

Once you’ve developed a vision of where your organization needs to go, you need to overarticulate every step of that vision to your employees.

“We spent so much time in the development and communication of what we were trying to accomplish that honestly, by the time we turned it on, the physicians and other stakeholders were sort of sick of hearing about it,” Geidt says. “They were saying, ‘Let’s just go with this thing.’”

Geidt relentlessly hammered every nuance of the plan into every member of the organization. The communications came from every angle, in forums of every type: meetings, newsletters, e-mail, and conference calls.

“There was no doubt we were committed to this thing,” he says. “Everyone clearly knew that it was coming; they knew why.”

After you’ve over articulated the vision, the second step you need to take is to eliminate any doubt about the organization’s new direction. Geidt says if your employees know that they have an opportunity to step back into the safety of their old ways, the success of your project is in serious jeopardy.

“We’ve offered that crutch many times historically, and we realized that was a mistake,” he says. “There is no place to run from technology, especially information technology. We’re all going to get there eventually; we just thought we’d rather be there earlier than later.”

Through his communications, Geidt made it absolutely clear that once the organization made the switch, no one would be going back. Saddleback was going all in, and the change was either going to be a complete success or a total failure — there would be no in between.

“People had to be clear that this was not something we were iffy about,” he says. “We were fairly rigid when it came to not taking a step backwards. We basically got rid of the paper; we got rid of the forms. We would not let them write things down.”

Although it may seem drastic, Geidt’s all-in approach convinced his staff that returning to the days of pen and paper was not an option — they would have to adapt to survive.

Provide support

There was still one important factor to consider: Even if everyone at Saddleback made the switch to using computers for documenting records and never looked back, the switch would be a disaster if the people weren’t trained to use those computers.

“We stuck to our guns and said, ‘We’re very, very certain this is the right thing to do, and we promise to help you through it. We promise that we will not leave any physician behind,’” he says. “At the same time, we are not going to let you g o back to paper. That would have been the worst thing we could have done.”

So Geidt had to make sure he provided the tools to help his physicians and staff adapt. Training was provided to 100 percent of Saddleback’s physicians and staff. The key was to get everyone comfortable with the technology, because each employee would be using it every day. However, the training process created a new challenge. Where do you start when your employees are all at different levels of technology aptitude?

“Frankly, physicians are people just like our staff,” he says. “They don’t want to necessarily look unprofessional or stupid in front of their peers. These are people at the top of their profession. ... These people saves lives every day. Then you stick them in front of a computer in front of a large class of their peers? It’s just not a comfortable thing.”

Geidt’s strategy was to give the physicians personal attention. He created a team of helpful individuals who already had a good grasp of the system and made them the support system for the physicians or any staff member who needed help.

“These folks would do anything for these physicians, day or night — come to their office, come to their home, set up some of the subsystems, teach them, train them and help them.”

The support team brought a positive attitude to the project for the entire lead-up period to the launch of the electronic system and smoothed the transition by continuing to provide help for about six months after the launch.

“Once we did go live and made this change in this big-bang fashion, we were at their elbow constantly, for months and months until they got completely comfortable with it,” Geidt says. “We never let up on providing the support. We’ll help them through it — we will not let you fail.

“When the physicians saw that, over the course of years, they realized if we are going to invest that kind of resource into this system, the least they could do is suffer through the learning curve and make it work.”

Once your employees get past the challenge of learning a completely new system, then all of a sudden the benefits that accrue from the electronic system make more sense.

“Some of that is fuzzy when the dust is being stirred up during that whole learning curve process,” Geidt says.

Many organizations that attempted a major change and ended in failure simply never made it through the learning curve. Geidt says there are several reasons for that, including poor articulation of the vision, a lack of preparation for the change or insufficient employee training.

From day one of the planning process, Geidt knew those issues were going to make or break the change. So he focused on communicating every facet of the plan, getting everyone on board, making sure each person was properly trained, creating the support team and investing resources to make sure the plan didn’t fail.

“It was a big investment, but there was potential for a big return on that investment if we did it right,” he says. “Doing it right involved everyone being engaged in the outcome. It worked so well that we began to reap the benefits literally the day we turned it on.”

In retrospect, Geidt says the switch was one of the most successful things he’s ever done at Saddleback. It improved safety by reducing the potential for errors, improved clinical outcomes, saved the organization money on paper costs, helped the environment and allowed hospital personnel to spend more time caring for patients.

“This is our new way of doing business,” he says. “It’s not about plugging it in and getting comfortable and then backing off. We can’t back off on this one. We’ve reinvested in this level of support to ensure that everyone gets it. It’s made our lives better in so many ways, but it wasn’t easy.”

HOW TO REACH: Saddleback Memorial Medical Center, (949) 837-4500 orwww.memorialcare.org/Saddleback