McKesson - Performance Strategies

Culture and Leadership are Prerequisites to
CPOE Success

By Stephen R. Mayfield, DHA, MBA, MBB
Senior Vice President for Quality and Performance Improvement
American Hospital Association

Chasing Excellence
The American Hospital Association supports a strategic platform called "Hospitals in Pursuit of Excellence." The goal of the initiative is to help the nation's hospitals implement performance improvements to improve outcomes, operational performance, safety and satisfaction.

Information technology (IT) is specifically cited as one of the tools that will help to realize these goals. Solutions such as computerized physician order entry (CPOE) systems can play a key role in helping organizations improve care delivery.

There's a caveat, though. IT will have an impact only if it is delivered in an organization that has leaders and a culture that breeds success. As Jim Collins, famed author of Good to Great: Why Some Companies Make the Leap... and Others Don't, might point out: You can take two organizations with the same staff, resources and technology and set them side by side and get levels of performance that are poles apart. The difference is the leadership and culture.

For example, two healthcare organizations can have the same CPOE system in place. The one that views the technology as a "silver bullet" will more than likely fall short in its quality improvement efforts. But the organization that knows how to leverage the CPOE solution as part of a more comprehensive quality improvement effort can produce stellar results.

Strategies for Success
Following are some examples of how successful organizations go beyond a plug-and-play mentality to make IT a key component of successful quality improvement initiatives:

Reengineer first. Figure out how to "standardize, stabilize and improve" care delivery processes before turning to IT to hardwire the effort. To effectively do so, it's important to involve the entire care team – specifically physicians, nurses and ancillary support – in reengineering care delivery.

Make collaborative decisions. Leaders or "system decision-makers" – physician executives, trustees and C-suite executives – should start quality improvement efforts in a collaborative fashion. They should discuss strategic direction together, set the stage for change by defining common values, and put the structure in place to implement technology.

To make the best decisions about specific technologies, however, leaders need to rely on input from the "content" experts — the front-line nurses, physicians and other staff members. With this feedback, leaders can make fully informed decisions about various technologies such as bar-coding systems, clinical decision support and CPOE.

Dream and do. To ensure healthcare IT implementations are successful, both thought leaders and effective managers must be in place. Leadership must charismatically set the performance improvement and IT vision for the hospital. Such leaders can successfully "evoke" change.

To make vision a reality, organizations also need leaders who can manage the effort and make things happen. These managers must control the policies, procedures and budgets to make it possible to achieve real results.

Measure. Use balanced measurement systems to validate IT-infused performance improvement efforts. For example, if a provider sets "improving community health" as an organizational goal, it needs to establish exactly what success will look like in terms of lower mortality, shorter length of stay, fewer readmissions, fewer returns to the operating room or reduced infections.

Adopting these strategies and others can help healthcare providers go beyond merely implementing technologies such as CPOE to experiencing the promise of such systems. By strategically leveraging the power of IT, healthcare providers can go far beyond adoption and accomplish quality-of-care and bottom-line results.

Stephen R. Mayfield, DHA, MBA, MBB, serves as senior vice president for Quality and Performance Improvement for the American Hospital Association and Director of the AHA Quality Center. Mayfield is an active researcher, lecturer and speaker, and is published in the areas of leadership, performance optimization and patient safety.


	Without strong executive leadership, particularly from physician executives, you're likely to fall short of your organization's CPOE objectives. Following are examples of how executive leadership and governance can help you succeed. A Fresh Approach At Lutheran Health Network in northeastern Indiana, the secret to gaining universal adoption is a combination of leadership, a patient-centered vision and a metric-driven culture of quality. Lutheran Health Network has a laser focus on eliminating unnecessary variation in care processes. "Through our unwavering executive leadership and clinical governance, our team, led by Dr. Matt Sprunger and Shari Schneider, has been able to achieve universal adoption of CPOE at Dupont Hospital," says Steven Orlow, MD, chief medical informatics officer. "In doing so, we have demonstrated improved care efficiencies and patient outcomes. Our success has enabled us to leverage best practices in a replicable model we are exporting across the network." Governance For Wheaton Franciscan Healthcare, an eight-hospital system with 70 physician offices across Illinois and Wisconsin, CPOE implementation has been a key component of a much larger enterprisewide EHR initiative. To oversee a staged approach to implementing the EHR, two teams were formed: one to provide governance and the other to operationalize decisions. "A major key to success was engaging physician and clinical leadership in the design, testing and adoption of the applications," says Rita Hanson, MD, FACP, chief clinical information officer. "Setting expectations clearly and reinforcing them with end users is critical. 'Thou shalt not use paper anymore' is not necessarily intuitive. You need to state it explicitly."


	Peninsula Regional Medical Center leverages quantifiable patient safety results to develop a compelling argument for adoption that stifles CPOE objections.

	Concord leverages CPOE to improve inpatient diabetes care with increased usage of insulin bundles to reduce complications and standardize best practices.

	Allegiance Health is eliminating "alert noise" in its CPOE system in an effort to maintain physician adoption while providing an optimal level of clinical decision support.

	Methodist Medical Center has maintained enthusiasm for its CPOE initiative by demonstrating that it is possible to reduce telemetry costs while maintaining quality.

	The transition from manual to electronic orders is huge for physicians. To ensure a successful conversion, organizations need to sustain governance initiatives.
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