Robert Laramie, VP & CIO, Northeast Hospital Corporation, Beverly, MA

Managing Teams

What kind of teams did you build for the Advanced Clinicals install? Did you develop new jobs or tweak anybody's responsibilities?

When I first came to Northeast Hospital Corporation, there was not a clinically focused team. But, in the health care industry over the next three to five years--and probably even longer than that--the whole point of technology is going to be on impacting the patient care process. Never in history has technology been at the bedside as much as it's going to be in the next five to ten years. So, I created a clinically focused team that's managed by an RN, who has LPNs and other RNs on staff. When they went to the floor to implement, they had a strong understanding of what happens from a workflow perspective and from a daily demand perspective, to impact the quality of care for our patients. 

So we did create a whole division that's a clinically focused IS team, in order to implement clinical technology at the bedside. We thought it was important to do that to build trust and understanding with our end users, because it's about successful technology adoption as much as it's about workflow.

Once you had the right people in place, what management approaches did you take?

Once we had the clinical team and the IS division organized, there was a strong senior management commitment to clinical technology, specifically for POM [Provider Order Management]. We really focused and made it a priority to implement POM the way that we wanted to, because we knew we were going to have an impact on the physicians, the nurses, and the patient care process. 

The real management process that we went through was to make I.T. a priority, and show strong management commitment to that priority with resources, time, and effort. That way, we were able to do our CPOE implementation appropriately, build trust among our end users, and make sure that we had the right training and support structure in place.

Let's talk about physician buy-in, specifically with those physicians who may be resistant to technology, or resistant to change, or both. How do you get them excited about an Advanced Clinical implementation? 

I think clinician buy-in for these types of applications is critical. When I got to Northeast Hospital Corporation, they had already implemented CPOE to a certain point. I found out who were the biggest and strongest critics of what was going on, and I made them our physician champions. We also created a nurse superuser structure, to include the nurses in the implementation process. 

From there, we took a two-month hiatus and reviewed our "lessons learned" from the parts of the implementations that we'd already done. By doing that, we were able to engage the appropriate physicians and nurses, and try to get them to help with solutions. They worked with us on the technology and workflow--you have to address both of those. If you leave one or the other out in your assessment, then you're going to get the nay-sayers or the technically challenged individuals who will be the ones that make your life a little bit difficult. 

We made sure we had the nurses involved in the workflow changes for the nurses, and we had two physician champions who worked with the physicians who had already done some of these Advanced Clinicals--so they could speak from the heart about what things were good and what things we had to work on. Then, we created a multi-disciplinary team that included two physicians, six nurses, and IS. That was the implementation team moving forward. We engaged everybody, and got everyone's input, so that made for a much stronger implementation team and a much stronger strategy.

Sounds great. So, tell me about your go-LIVE days. Where are you and what are you doing?

This is actually pretty funny because the go-LIVE days are really where all your efforts come together. We were committed as an organization to "at-the-elbow" support for 24 hours a day, two weeks in a row for our clinicians. And when we went LIVE on our Beverly Hospital campus with our first unit, within two hours the nurse managers were telling us to get off the floor, because they were comfortable with the nurse superusers model we had put in place, and the training we had given them. So we were nervous going into those days, but then again, we were happy when the nurse managers had to ask us to leave the floors. Because they were comfortable enough with the technology that they could support themselves.