Ahead of Australian Healthcare Week 2019 we chat to Jac Mathieson, Chief Nursing Officer at the Peter McCallum Cancer Centre (Peter McC). In this article Jac shares with us insights into Peter MacC’s digitisation journey, which includes the implementation of EMR, and delves into lessons learned and top tips to guarantee an effective future transition to digital.   

Top Tip 1

Don’t overestimate technology’s capabilities

“Healthcare is quite unique in that while our facilities and services are at the cutting edge of technological innovation, our industry as a whole isn’t really up-to-date with the latest technology at all. So there’s a big divide.  

For example we, like most other healthcare providers in Australia, still write notes on paper and receive referrals via a fax machine. I'm pretty sure, without a word of a lie, that the health industry is what is keeping the fax industry alive because we are the only industry still using it!

So stemming from that, one of the key challenges we encountered in our transition to digital was an opposition from our industry as a whole, and that’s not just in terms of receiving referrals and making notes, but in everything from trying to implement EMR and our new nurse call system, to trying to provide more employee friendly flexible working.

Healthcare is traditionally still quite old-fashioned, and while technology is transforming how people work, it certainly hasn’t change the role all that much, and that is something to keep in mind throughout any change management process.”  

Top Tip 2

Change management doesn’t have a clear start and end date

“Our move into a new hospital bought with it a number of new technologies being integrated into workflows, which impacted nurses greatly. We of course had in place a number of training and upskilling strategies in place to prepare for the change, but as we discovered, change management isn’t a clear cut process.   

The key digital changes we brought in include a new patient entertainment terminal, which allows patients to order their food electronically and track their progress, the nurse call system that allows patients to ring nurses directly instead of wandering hallways, and a new completely automated switchboard, instead of the old paper-based directory. The entirety of our new hospital was also designed to work cohesively with EMR and as such is paperless, with very little space for storage.

However adapting to these changes hasn’t been easy. When we moved into the building in 2016 for example we didn’t have EMR – we’re undergoing this transition now – so our workspace was paperless, but our operations weren’t. Additionally, while there’s great WiFi in the hospital, at the end of the day we’re a public hospital, we simply couldn’t justify investing $200,000 towards laptops for staff to work paperless when that money could go towards machinery for patients.

Ultimately what we discovered was that just because we’d trained staff in new ways of working, and introduced new processes in a new facility, our change management journey didn’t end. There was no definitive cut-off point where we literally stop doing everything in one way and transitioned to new ways of working – it’s a continuous process.”

Top Tip 3

Technology requires change management, regardless of workforce age

“At Peter Mac I have a workforce where 50% of us are under the age of 35 - so, we're actually very young; which bucks the trend amongst most other nursing workforces.  

While I don’t have the transition into retirement issue that many other healthcare workforces are facing, and while all of us have grown up in the digital era, we don’t necessarily embrace technology in our workflows as much as people would assume. People see a young workforce and assume that because we’ve grown up surrounded by technology everyone would be automatically onboard with it in their respective roles, but that just isn’t that case.

So despite having a young workforce at Peter Mac, developing comprehensive change management and staff upskilling strategies was still a key component of our overall digitisation project and was integral to the overall success of our transformation.”

Top Tip 4

Change management needs to be fit for purpose

“As I’ve mentioned already, in preparation for our digital transition we developed a comprehensive change management plan that included a number of different strategies that we though would help prepare our workforce for the transition and for more digitally enabled workflows.

We we’re very lucky that the vendors we partnered with worked very closely with us prior to, and throughout the change processes and helped prepare our teams and we also did super user training for a number of systems, which had really positive results.

We did however come across some stumbling blocks too. For example our very first nurse call session was a PowerPoint presentation and automatically the staff came out and said, ‘we know nothing.’ They’re very hands on learners – they need to be able to touch and play with systems to really understand them, and the PowerPoint training didn’t give them that opportunity. So we needed to rework that pretty quickly. 

Secondly, because we had so many staff to get through we needed to start training early in preparation for our move in June. However starting training in March, then reverting back to old systems for a further three months, meant staff we’re forgetting everything from their two hour training session in the interim. So again this was both a challenge and a learning curve for us from a change management perspective.”

Top Tip 5

Patients Need Change Management Too

“The nurse call system, which allows patients to contact nurses directly via a mobile phone instead of wandering through hallways, was a key element of our new hospital, and also one of the biggest points of contention for our staff. There have actually been a number of times were we’ve gotten feedback from staff saying ‘if the windows opened here, I’d throw the phone out the window!’

Thankfully this has settled down now with staff now understanding how to better manage workflows and both staff and patients becoming more accustomed to the system. So what we quickly came to realise when you’re introducing technology is that it’s not just about educating your staff, it's actually about educating the patient too.

We went about educating patients by explaining upon admission that nurses have medication rounds at certain times, so if they could please avoid calling at these times. We also explained that if a nurse has taken your call, they may still be interrupted coming back to you, so to please be patient. This training process with patients was key to getting the nurse call system to work, without driving our staff nuts.

Equally, when things are electronic, certainly not all of our patients are very tech-savvy, so the fact that they can't order their food, or turn on their TV, or use their phone until they've learnt that system, that's an extra half an hour to a nurse's day, trying to explain to the patient how to use the system. I think in our transition we initially overlooked the importance of change management for the patient group, but now, having been through the process already, we understand that patients, like staff, need change management too.”