Last week my home town was host to an ultra run to benefit cancer research. I’m not a runner. None the less, as a physician the whole concept of an ultra run of 50K or 100 miles is fascinating to me. Even marathons are a bit of an enigma. Runners train for long periods of time to prepare for the race, often for 6 months or more. They push their bodies and minds to the limit and beyond. There is pain…a lot of pain. But there is also joy at finishing the race and pride for even taking on the challenge. There are certainly some that run a marathon once and never do it again. More often though, runners that take on this challenge do it more than once. Even if they don’t take on a marathon again, they are likely to continue running for years.
What does this have to do with benefits realization? As it turns out, implementing an EHR is a lot like running a marathon. But realizing benefits requires that you finish the race…and then keep going.
Implementing an EHR involves EHR or other technology tool build, testing and training of both new workflows and the technology itself. The most challenging component of this step is managing resistance as teams begin to feel threatened by significant, impending changes to their daily routines. I call this “hitting the wall” and it’s the time, even before go-live formally begins, that morale may be at its lowest. Couple this with the wall that the build team is hitting and you have a recipe for disaster. But with the careful planning you’ve done up until this point and the readiness strategy in place the EHR team and end users will push through to the finish line. (HINT: Chocolate helps)
The secret to success, however, is not to stop there. Sure you need to take time to rest and refuel, even to let mind and body heal. But after that short reprieve it is back to work. Examine the race stats. How was my time for each segment? Where can I improve? Did I hydrate well enough or take on enough carbs? These are all questions a runner can ask to prepare to improve for the next race.
Similarly, as you are going live with the EHR you’ll need to monitor a benefits dashboard and continue monitoring it the post-live period. What is our performance compared to baseline? What about compared to our targets? What do we need to do now to be able to reach our targets? Working with operations, you’ll now start to use plan-do-check-adjust cycles to make adjustments to current processes and build until expected targets are achieved. I can’t stress enough the need to have operations deeply involved in this process.
Ultimately when short term benefits have been realized and longer term benefits are well on their way, accountability for sustainment needs to be transitioned away from the benefits management team and to operations for long-term management. You’ll need to have a plan in place to continue to monitor benefits performance over time as well as well-defined process to address needs in order to ensure continued success. Perhaps most importantly, senior leadership needs to be unrelenting in overseeing progress rather than allowing benefits realization to fade into the background once the EHR implementation is complete and other new projects become front and center.
Ultra runners nearly always were marathon runners first. Most have several marathons under their belts and have learned a lot along the way. They’ve made tweaks to training routines and nutrition as well as footwear. Rarely did they get it right the first time. Switching to ultra running presented more new challenges and they had to keep working to prepare, often for years.
In my mind, EHR implementation is a lot like running a marathon. But realizing clinical benefits is more like running an ultra. Many benefits are not achieved in the few months surrounding go-live or even in the first year. Achieving all of the benefits you set out to achieve may take several years. The key to success is to know this ahead of time, plan for success, having unrelenting focus and keep going.