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Pyramid of Change

Kaiser Permanente Northwest identified a root cause of EHR frustration and created a way for clinicians to feel empowered by their EHR.

Created in partnership with Kaiser Permanente Northwest

Publish Date: 05/06/2018

Cost to Implement:

0 - No Cost

Time to Implement:

0 - 6 Months

Program Goals

Identify a root cause of EHR frustration
Improve EHR enhancement management

Organizational Outcomes

99th percentile for overall provider EHR satisfaction
99th percentile for agreement that IT leadership has implemented and supported the EHR well

Collaborative-Verified Best Practices

Efficient Governance Structure

What Kaiser Permanente Northwest Did

<h2>Program Goals</h2><ul><li>Identify a root cause of EHR frustration</li><li>Improve EHR enhancement management</li></ul><h2>Organizational Outcomes</h2><ul><li>99th percentile for overall provider EHR satisfaction</li><li>99th percentile for agreement that IT leadership has implemented and supported the EHR well</li></ul><h2>Collaborative-Verified Best Practices</h2><p>Efficient Governance Structure</p><h2>Keys to Success</h2><ul><li>It is important for organization leadership to maintain communication with clinical end users of the EHR to learn their workflow needs and attempt to meet their requests.</li><li>Clinicians need to feel that the EHR is supported by people who understand that the EHR is a clinical aide, not a billing or IT tool.</li></ul><h2>What Kaiser Permanente Northwest Did</h2><p>One of the most common complaints that KLAS hears from end users is that too many clicks are needed to achieve simple tasks in the EHR. This constant complaint shows that clinicians do not feel empowered by their EHR and is evidence that there is a deeper issue at play. The root cause of frustration, more than just a lack of efficiency, is users feeling helpless that they cannot make changes that will improve their efficiency. Clinician empowerment comes from (first) understanding that the EHR is a clinical tool meant to improve healthcare and (second) establishing a way to make enhancements to the EHR that address clinician workflow needs. The EHR at Kaiser Permanente Northwest is a tool to facilitate treatment of patients, so when an EHR workflow issue is identified, timely EHR enhancement can be implemented to help the clinician overcome that issue and deliver high-quality patient care.</p><p>Kaiser Permanente Northwest recognized that as medicine evolves, EHR workflows must evolve as well. They created a Pyramid of Change to help frontline clinicians understand how change occurs in an EHR and how to empower clinicians to own changes that are within their purview. From top to bottom, there are 6 levels in the pyramid: end users, specialties, Regional HealthConnect configuration, National Kaiser HealthConnect configuration, the Epic system, and government/regulatory. A provider with an EHR need starts at the top of the change pyramid and work down through the levels until a solution can be found. Each level requires more time to affect change, meaning it is easier and quicker for a frontline clinician to leverage standard personalization tools than it is to change how Epic controls their platform. This structure allows Kaiser Permanente Northwest analysts to be nimble with solutions to provider EHR requests; a difficult request that would otherwise be answered with no can now be answered with "let's try option A while we push this request further down the pyramid."</p>

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These perspectives are shared to facilitate better collaboration and communication between members of the Arch Collaborative. We encourage organizations to thoughtfully adjust their current operations based on their own experience, the findings of this research, and other complementary sources of information.

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Unlock the potential of EMR solutions to revolutionize healthcare efficiency and care-quality improvements by facilitating collaboration, measurement, and shared learning.

The Arch Collaborative is committed to finding and sharing healthcare technology best practices that forward the efforts of the quadruple aim in healthcare. The engine of the Arch Collaborative is the insights and feedback of thousands of clinicians and caregivers around the world.

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About Arch Collaborative Case Studies

Arch Collaborative case studies are focused on highlighting success that Collaborative participants achieve with or through healthcare technology. They are meant to briefly advertise member success and act as starting points for ongoing communication and collaboration between member organizations.

Case studies are typically published when (1) a verified outcome is recorded (and often verified through the Collaborative survey) and (2) the approach or steps to achieving that outcome aren’t commonly known and would be helpful to other organizations.

All Collaborative members and participants are invited to submit case studies by working with their KLAS guide.

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