Habits – the double-edged sword of healthcare
Written by Jesper Bengtsson
Enterprises are increasingly becoming accustomed to a rapidly evolving marketplace where “cultivating dynamic capabilities” and “scanning for disruption” has become organisational necessities. Change is to be expected, it has even become a state of existence that must be embraced. However, while companies are changing, the lives of the people working in them remain the same: change for the individual is a different matter. Constantly having to “scan for disruption” isn’t something many of us would voluntarily introduce into our personal lives. People intuitively avoid unnecessary change – we’re quite happy to enjoy our habits, routines and settled way of life. Without a solid track to run the train that is our weekday, we’d be drained of willpower before lunchtime. Change is a cognitive burden, why fix what’s not broken? These observations are not only characteristics of a changing marketplace and the natural cognitive laziness of the human mind, but a comparison between the two presents an interesting paradox: as much as the power of habit can be a way to increased efficacy, it can also be an impediment to improvement.
As with any sector today, the various industries of healthcare are facing great obstacles in a world of rapidly increasing innovation. While certainly a welcome element for the patients – the companies of the sector face additional challenges in navigating heavy regulations, and the workflow complexities that follow. The level of compliance and the many different categories of staff involved in organizational transformations make the challenge for healthcare quite unique. As the industry is extremely labor-intensive, even the most incremental innovations can disturb workflows far from its original source. Hospital directors, administrative staff, laboratory managers, midwives, nurses and physicians (to name a few) all play an integral part in hospital operations, but to showcase the double-edged sword of habits and their effects on innovation, I’ll use physicians as an example.
The habits of your physician are all wholly accustomed to how operations of his’ or her’s specific hospital or clinic are setup. Because of the nature of the work, habits are even more important in healthcare – the consequences of inefficiencies can be dire. The importance of a habitual mindset for physicians is also more so accentuated by their obligation to endure long, cumbersome hours filled with not only by a heavy cognitive load, but also an accompanying emotional one. Unloading this cognitive burden, and also ensuring speed and efficiency holds great promises for digital innovation in healthcare, but the power of habit that today, form the foundations of functioning healthcare operations are also impeding the adaptation of tools for improvement.
One recent and much scrutinized healthcare innovation is the Electronic Medical Record (EMR). The EMRs are automated and integrated digital patient tracking systems and while EMRs certainly have the potential of greatly increasing the effectiveness in care – the primary users of these systems tell a different story. In a recent Medscape survey, 18,500 physicians were asked about the usability and efficacy of their EMR systems. The results were disheartening: in 2012, nearly a third of the participants of the study said that EMRs had a negative effect on patient care. A problem? Yes. Improvements made? No. Two years later, in 2014, the number of physicians reporting negative impact had instead increased. The reason for these attitudes are many, and while a large amount of physicians cite positive experiences, 16% of participants report that the main reason for not using an EMR is that it they are too complicated to learn or too complex to use. The habits of the physician had not adequately been taken into consideration; the physical workflow had been poorly translated into a digital journey. It is an all too common consequence of a lacking attention to usability. The price of change for the user becomes too heavy, habits of the past trump the opportunity for improvement. Additionally, 8% reported that they were looking to switch EMR systems because of a dislike of how they operate – with 23% of physicians reporting a cost per installation of over $50,000, the commercial viability of attracting the well-meaning of these professionals is certainly sound.
Naturally, it is partly a question of education: proper staff training needs to be included with every EMR implementation. The rationale of a change in process must be emotionally and rationally strengthened through proper change management techniques. It needs to be talked about, explained and showcased. However, regardless of the extents of time and effort put into a digital transformation, it will at the very best be suboptimal if not accurately catering to the users of it. This practically entails that all the necessities of workflows are truly leveraged in making the system effective, but also equally important that the competence-levels of the users are addressed.
If the systems are not optimised for the use of the physician, their ingrained habits and routines will trump the promise of possible future improvements. All potential efficacy gains will be lost. To counteract this, EMR providers must prioritise thorough usability audits and recognise the importance of user experience. Great digital user experiences unburden the cognitive load of the physician, allowing him or her to transition into a more efficient state of operations. It is the only way to break the change paradox: create environments where the modelling of a physical workflow into a digital journey is done with respect and adherence to the users’ habits. Interestingly and obviously enough, the question of usability levels of EMRs is not only in the interest of the physician, but also to patients who want better care, hospital directors who want to cut the costs of implementation and system providers who want to increase sales. In the end, the first frontier of healthcare digitisation will belong to the EMR providers who can best align their solution with the habits of the physicians. In the end, it is best we let the enterprise “scan for disruption”, and leave the physicians to do what they do best – save lives.
[bctt tweet=”While companies are changing, the lives of the people working in them remain the same.”]