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What CMIOs Can Get Out of the Arch Collaborative

Last September, we engaged with the Arch Collaborative and surveyed our organization to determine our clinicians’ satisfaction. The results gave us an introspective look at where we are, where we want to be, and where we are going.

The timing of the survey was great; we took it right as we were announcing that we were going to be switching EHR vendors. I think that the results gave us a nice baseline to determine our current standing and to determine where we want to be in a few years after we switch over to our new EHR.

Don’t be fooled, though—the feedback from the survey showed that many of our clinicians were frustrated with the system, and that was discouraging to hear. But as I read their comments, I wasn’t surprised. Some of the comments may have been especially charged with emotion because the clinicians are just ready for a change.

We realized that we as executives hadn’t necessarily set up our physicians and advanced practice providers for success. So rather than taking the results personally, we took the feedback to heart, and now the results are our basis for how we are going to do things differently as we move forward.

Combating Physician Frustration

To combat the issue of physician stress and burnout, we are planning to implement the triumvirate of keys that contribute to users feeling successful. We’re encouraging people to personalize their system, but we are mostly focusing on keys of training and ownership.

Training. In the past, we haven’t done a good job of making sure that people get both comprehensive and specialty-specific initial training, and also ongoing training. So now, we are going to require everybody to be trained before they can use the system. Also, we are going to change our training program so that we can provide ongoing, more structured training. That will ensure that people use the system appropriately.

Ownership. On top of training, we are going to start a much more robust governance program so that each specialty is represented. We want every specialty to have their own physician/APP champion, which is someone who can communicate the concerns that their respective specialty may have. The idea is to have that physician champion communicate openly with the specialty’s designated informatics physician, and conversely the informaticist can communicate what changes may be taking place in the system. With that communication structure, hopefully people don’t suffer in silence.

In additional to those items, as we design our system, we want to intentionally question the things that users are asked to do while they are using the system. We are evaluating all the things that we have put in orders in the past to determine what is actually necessary to put in orders.

Another example of us intentionally questioning processes relates to in-basket management. We are asking ourselves what things really need to go to the in-basket and whether we can reduce alert fatigue. Overall, we are trying to comprehensively look at how people are using the EHR and how we can make those users’ lives better.

Customization: We Could versus We Should

We are trying to improve clinicians’ satisfaction by simplifying the system wherever possible. We have historically customized the system a lot, but now we are going to err on the side of not customizing.

In the 1993 movie Jurassic Park, Ian Malcolm—the character played by Jeff Goldblum—says to the owner of Jurassic Park that his scientists “were so preoccupied with whether or not they could [genetically engineer dinosaurs] that they didn’t stop to think if they should.” We are taking that same approach with customizations; just because something could be customized doesn’t necessarily mean that it should be customized.

We have to ask ourselves, “Should we build something that will affect 90% of the clinicians but that only 10% of the clinicians will actually use?” And many times, the answer is no. The world of medicine has become complicated enough without us making the EHR excessively complex.

So whenever someone asks for a very specific functionality that will ultimately help only a small number of people, we plan to be better about explaining how in the past, taking that very specific approach didn’t necessarily work well for us. Moving forward, we want to see what we can do with the standard solutions first, and then we can discuss down the road what we might need to customize and adjust.

What CMIOs Should Know about the Arch Collaborative

Based on my experience with using the Arch Collaborative survey and learning from the results, I think it is important for CMIOs who are looking into the Arch Collaborative to know that the survey isn’t perfect because the results can evolve.

For example, as I was talking to KLAS’ Taylor Davis a few weeks ago, I mentioned that I had been out on the road telling my organization about how we had scored below the 10th percentile for physicians and how there is really only one direction for us to go.

However, Taylor said that based on the most recent data, my organization was actually now above the 10th percentile due to recent additions to the data set. Despite that change in the results, the survey still proved to be really useful.

CMIOs should also know that the Arch Collaborative is a great way to help hospitals improve and move forward in the right direction. If the hospitals score low, they can use the survey to express how they are trying to help. And if your hospital scores high, the survey can be used to analyze what has been done well and how those successes can be expanded throughout your organization and community.

In my mind, the Arch Collaborative is really about creating a community where healthcare providers and executives can learn from each other. We can all use the survey’s results to improve our own site’s satisfaction and help other sites as well.

A Valuable Experience

Our experience with the Arch Collaborative has really been valuable. We are very excited about going live with our new system and then retaking the Arch Collaborative survey just to see what has changed between surveys. We are hopeful that we will see a big, positive effect on our providers’ satisfaction scores since we have started to change our approach.




     Photo cred: Shutterstock, Kaspars Grinvalds