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#WOODSHOLEBMI DAY #2: “YOUR BABY IS UGLY”

This is what we learned in class today, and I mean that in the nicest way possible.

One of the presenters today, by J. Starren, discussed unintended consequences of implementing technology. He discussed how implementing new technology can interrupt or cause issues with current processes. Yes this is true. The other issue, which we have not discussed is when you implement technology on-top of a bad process only muddies the waters even more. What do I mean?

Hypothetical Scenario: Let’s say you have a process of filling out paper slips for lab for every item that is sent to lab. On this slip you indicate the specimen, patient data, and tests that need to be ran. When you implement the new EMR, you do away with the paper slips. Now only patient data is put on the specimen, and all orders are entered into the computer system screen which was built off the paper lab slip. Nursing has access to the system, so lab should too and why do nurses need this information filled out again?

It is the first day of implementation and about an 30 minutes into it when issue calls start coming in. Physicians are asking where their stat lab results are for patients and why the information is not showing up in the system. Nurses are now spending their time rewriting orders, calling lab, and some are actually going to lab. Lab meanwhile, is standing there like deer in the headlights. They have no idea what has just happened. They are trying to process orders without the information they previously received. The only person with access to the new system in lab is on vacation.

There are multiple possible issues with this hypothetical situation (I am making assumptions based on the information above):

    1. No one walked the lab process to determine if it is in fact done this way.
    2. No one confirmed the labs on the paper slip are actually orderable labs in the system.
    3. Lab was not involved in the process and now is receiving specimens without the information they were use to and do not have access to the system to look up the information.
    4. If no one reviewed the labs on the paper slip, then no one bothered to see if they could prefill specific items on the screen. IE, urine always defaults in the specimen field for Pregnancy Urine Test.
    5. No one worked with lab to create a glossary of orderable labs and what is included in each lab test.
    6. Lab was not even informed of the change.

Within 15 minutes of the first call, everyone has reverted back to paper. No worries lab had extra copies stored away in a cabinet.

Maybe I am thinking of the worse possible situation, but it illustrates what can happen when you take a bad process (not just the paper slips process but the lack of a process for making changes) and add technology onto it.

So how does this relate back to your baby is ugly? Well we discussed today how testing a system with someone you know does you know good. They will not admit when there are issues. It is the same for testing a process. You need to find an outside resource that is not involved in the process, has no ties, or influences to evaluate the process, database, program, etc.
Sometimes the best way to do this is get someone who is very resistant to change or against the idea and evaluate the process. If you are the one that designed the process, program, or other item, you may not be pleased with what you hear, but just remember it is constructive feedback. It is a little different than your baby is ugly. It is hard to hear, but you can fix the process/program.
I have had this issue lately. As I developed a process for order set development people have made suggestions for changes. I know changes are needed. I developed a process with parts that are constantly under change. So change is part of it. The issue is how it is addressed.

A stranger walks by and says your baby is ugly is actually better than you finding out your Aunt has been saying your baby is ugly every time you left the room. Why did the Aunt not tell you up front? Its hard. Some people do not take it as well. Personally, I want to hear if there are issues with a process/program so that it can improve. If I do not know the issues, then I cannot fix them. But these can be communicated in a nicer way than saying “your baby is ugly.” Constructive criticism is how you help others improve.

The other item is offer feedback to people directly instead of just criticizing. Don’t just say this is bad, I don’t want to change. Offer suggestions. Or say I am not sure how to fix this but it would be nice if..”.

All of this to say that technology will turn your processes upside. It sometimes is a good unintended consequence since it provides you time to review your processes. It can be an issue that does not go well if you do not take the time to evaluate the process and walk it in advance.

 

This is just something I have taken away from Woods Hole so far. I am sure as I reflect on my the presentation and my tweets I will have other take away items that I will post later.

 

Here is something else I’m taking away, wonderful morning walks with great views:

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