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Senior Management Commitment
The need for high-level support from Senior Managment.
As with most major change initiatives, support from all levels of the organization is critical for success. With the implementation of CPOE, this is no exception. Support is required from Senior Management, Physician Leadership and the Board of Trustees. The medical staff must understand that CPOE is a quality initiative supported by the Board, and will be how “business is done,” at the institution moving forward. The following example illustrates the need for support and how it was handled at one institution.
ABC hospital is a multisite tertiary care, academic community hospital with approximately 1000 beds. There is a limited resident coverage, and the majority of the letters are generated by community-based physicians. During the planning stages of CPOE, the physician champion attended various clinical department meetings to discuss the upcoming CPOE roll out, and to articulate the benefits of the system. He was upfront with the clinicians about the impact on efficiency and workflow, especially during the early phases. One of the major clinical departments expressed significant opposition to the idea, and voiced various realistic and unrealistic concerns regarding CPOE. “Forcing us to do the work of the Unit Clerk will slow us down and ultimately lead to more mistakes.” “I can’t believe that you (directing this at the physician champion) think that are going to do this; you are as stupid as the administrators of who came up with this idea.” The most surprising aspect of these responses was that they were made in front of the Chairman of the Department. After several of these episodes, the Physician Champion brought the issue to the Oversight Committee (comprised of senior management leadership and senior physician leadership). The Chief Medical Officer responded by meeting with the Chairman of the Department, and restructuring the Chairman’s incentive plan for the year. The revision included major emphasis on the successful implementation of CPOE. Subsequently, the Department Chairman was publicly supportive at the department meetings and individually with the physicians in his department.
This example illustrates not only the need for high level support, but also the importance of concrete actions that demonstrate organizational support for CPOE. Attaching financial incentives to the CPOE implementation certainly sent a strong message to that Chairman and to the rest of the leadership team.
