Arch Collaborative Data on Culture - Cover

Arch Collaborative Data on Culture

This is an excerpt from a recent Arch Collaborative webinar featuring Adam Gale, President of KLAS Research and Taylor Davis, VP of Business Development and head of the Arch Collaborative. 

Together they discuss what the Arch Collaborative has discovered about the impact of organization culture on clinician satisfaction.

Adam Gale:                       

Let's go on to the third key, Taylor, and that's around culture. I think that ties to some of the trust and the mission of moving this forward, "So I can be a super doctor and provide great care." I'm a little skeptical because culture feels like a big paint brush you can paint with that just covers every single thing. And sometimes we talk about culture and it's hard to know, "what in the world does that mean? Like what is the data behind that?" Can you actually give us some meaningful things that I just sort of gloss over on around culture?

Taylor Davis:                    

Okay. So I'm going to ask everyone who's on the phone today, KLAS has spent 20 years working with vendors and talking to them about their culture. So there's probably not a vendor out there that we haven't had some discussion with about culture. Right? And and as we have discussions about culture, Adam, if you ask a provider, "Hey, do you see different cultures in the vendors that you work with?" There's probably not a provider who would not agree that they don't see different cultures, right?

Adam Gale:                       


Taylor Davis:                   

And so everyone sees different cultures and different organizations, right? We all agree that culture matters a lot. When we talk about culture, what we're really talking about is that you could replicate the practices of some organizations, but how you go about it will be different enough because of your intentions, and the framework of your organization: how you're structured and how you think about things. Such that you will not get the same outcomes. So we could spend all day talking about specific things to do, but if we don't ever talk about culture and how you need to probably think about things before you do things, we're worried that you're not actually going to be successful. So let me give you an example real quick and I gave this example on the first webinar. This is a monk in India. I thought this was a great picture. If this fellow moved in next door to me, I could assume a bit about who he is. These Indian monks tend to have a much longer lifespan than us Americans. Right? And I could assume at a pretty shallow level, "I think that's probably because of what they wear or what they eat or a number of different factors." If I am trying to replicate their results, I may copy them. So I might start wearing the same clothes they wear or maybe eating the same foods.

Adam Gale:                       

It could be the fact that they don't use IT.

Taylor Davis:                   

Or the fact that they don't not use IT or they don't have those cell phones causing cancer by your ears or whatever. Right. So you jump to some conclusions. There's a lot to say when talking about different groups and how long they live. It's a combination of a lot of different factors.

And a lot of it stems from how do they see the world. I don't know this, this fellow here, but I can guarantee you that he sees the world in a very different way than me. If I'm trying to emulate him and how he sees the world I'm going to need to copy some of his life pretty differently.

Statistically, if we're trying to predict across organizations the satisfaction of a single respondent, indicator that has the highest predictive value is just what organization you came from. And just yesterday I spoke to an organization and they're using an EHR that is literally sunset. There will not be anyone else using this EHR by the end of 2018. So they're using a sunset EHR and then they're also using a very leading EHR.

One that in our usability reports has been highlighted as one of the most usable EHR on the market. The net experience score between those two EHRs was within three points of each other. They looked at that and they were flabbergasted. They're said, "are you kidding me!? The dinosaur has the same experiences as this new EHR!?" Well, it turns out both struggle at training and so both have some similar challenges. It was a stark example of how the technology matters.

But if you don't put everything else in place, the technology doesn't matter. As we talk about culture, this is why we do these webinars. We've had Mike McNamara and David Graham join us. We're going to have Rachel Dunscombe and Jeff from Nationwide Children's join us. We have Greater Hudson Valley joining us in March.

This is why we're doing the conference in May because there's a lot of things that these organizations are doing that may or may not work for your organization. But what we want more than anything else, as we look at culture, we want you to be able to see how these organizations think about it. It feels pretty clear to us, and I'm going to be fairly judgmental in this, we've interviewed almost all of you.

It feels pretty clear to us that leading organizations think about their EHR in a different way than organizations who are not leading in satisfaction. I am personally very, very convinced about that. You could take a "Mike McNamara offsite two day training program" that gives CME credits and how he does everything, and it could fail for you. It might be how you approach this, and intention speak louder than words and almost every single case.

Adam Gale:                      

Taylor, I've been in a number of usability sessions that HIMSS or CHIME or different conferences. One of the hardest things to know is, "did that thing that they did move the needle?" And a lot of times that's really hard to know. So one of the things I love about hearing from Mike and David Graham and others is, "look, we know that what they did worked."

Figuring out why it worked or what the nuance was or how I apply it to myself is going to be a challenge. But at least I know this is something that moved the needle for this group of physicians, and that feels like a great place to start.

Taylor Davis:                   

There's so many organizations that we've come to and we've said, "hey, do you realize that your top 10%?" Consistently their feedback is, "What? Are you kidding me?" They're in the trenches day in and day out working to meet the needs of their clinicians. They see that there's so many areas where they could improve and it's a real surprise to them.

Then we start working with them to look at the best practices. I just sent an email to a member of the Collaborative a couple of weeks ago and asked, "Do you realize that your physicians are reporting the highest level of fulfillment of any physicians of any organization?" Because we had that question about what are you fulfilled as a clinician. There's a big delta between them and everyone else.

We sent that data over to them and they said, "no, we didn't realize that, but we have a few guesses as to why that is." And I get a jump on the phone with them next week to understand why they think that they're so high? This data creates the discussions where it's not "if" it's "why."

We think that that's a more helpful place to go. And Adam, I know that we walked through this, and maybe this is one where we're palm reading and maybe there's not actually something here; but we thought that this was really interesting.

Adam Gale:                      

I think this is one of those scenarios of saving the best for last because it's one of the most - I'm going to just say weird - findings. An aha moment kind of finding. And we're still trying to figure out why that is.

There may be other ideas from the people that are on the webinar today, but let us at least present to you what was so unique about what we found.

Taylor Davis:                   

We asked all users to rate themselves on the same scale, right? Rate themselves, their IT organization and administration and their vendor. Using that strongly disagree to strongly agree scale. And we talked about this before when we had the idea for these questions and we wondered if any group of users are going to on average rate themselves the lowest.

What's interesting is that we actually found five organizations out of about 50 who did this, the clinicians rated themselves the lowest! We looked at the profile of these organizations and they tended to be the most satisfied organizations in the Collaborative. Not quite, but it was almost true that these were the five most satisfied organizations in the Collaborative. It was really close.

Obviously that's pretty interesting, and it tells us - we think - a couple of things. One is that obviously everything else is working pretty well, right? But then as we go interview these organizations, asking, "Hey, what do you do?" They respond, "You know, one of the most important things that we do is we try to help our users feel empowered. And so when they come to us and ask to change x, y, or z, we don't just say no. We can't change that." They say, "Well, let's talk what we can change."

They'll help you be successful and they keep sending the message over and over to their clinicians: the success of your EHR is up to you. That it is largely up to you. There's a few things that are up to the EHR vendor but you own the steering wheel. You have your hands on the steering wheel, driving to be successful or not.

And then you think about the opposite of this: the largest group down where the vendor is the lowest rated. Think how often and how easy it is when somebody comes and says, "Hey, can we do this?" To say, "Oh my gosh, we can't do this and this is so frustrating for us." When you hear that your leadership can't actually make the change that you want to make, it just makes you feel like you want to go into a room, shut the door and scream, doesn't it? Just think about how maddening that is. So we think that this highlights the empowerment the clinicians have.

Obviously there's a lot in that group where there's real problems with their vendor or real problems with their IT organization and that's part of the reason why they're unhappy. But we also think that this data point is interesting because it highlights the profile of the organization; what does a culture look like?

Where folks tend to be really satisfied and they tend to be really empowered. We see that in their comments too.

Adam Gale:                       

Yeah. But the Aha moment for me: It that feels really natural to throw your EHR vendor under the bus and you read articles in the press about how EHR vendors are failing the physician community. There's a lot of negativity out there and it feels fairly natural to do. But it does not help your organization take the reins and say, "look, we still own this. Let's still work through and make ourselves successful."

To me, that was just a, "wow!" moment, because it feels like such a natural thing to do. And begs the question, "how do we train ourselves to not respond in that way as as an organization?"

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