In order for executives to exhibit strong leadership, they need to have an agenda, which should cover the following four points.
1. Adoption path. In order for hospital executives to lead successfully, they need to outline a clear adoption path. According to Mr. Wivoda, the adoption path should include the following steps:
• Assessment — Assess the preparedness of the hospital to fully adopt an EHR.
• Planning — Develop and prepare the request for proposals from vendors and IT companies.
• Selection — Evaluate vendors and negotiate contracts.
• Evaluation — Review system performance and effectiveness.
• Improvement — Conduct additional training to improve workflows.
2. Total cost of ownership. According to Mr. Wivoda, the total cost of owning an EHR is misunderstood by many executives, but in order to successfully implement an EHR, the cost needs to be clear. "It is easy to understand the licensing costs and the fees, maybe even the computers that the hospital will need. However, people do not go into all the costs that are included," says Mr. Wivoda. There are at least three areas of often overlooked cost:
• Hard costs — licensing costs; implementation fees; hardware expenses
• Recurring costs — annual maintenance fees; periodic computer hardware
• Staff costs — staffing increases; changes in skill sets; loss of productivity during implementation and go live; supplemental staffing for go live
3. Project management. Project management is the discipline of planning, organizing, securing and managing resources for the health IT implementation. According to Mr. Wivoda, project management is a specialized skill, so a hospital needs someone with experience and passion. "Project management can be a significant challenge for rural hospitals and clinics. It can't be left up to the vendor. Leadership must have a major role in supporting project management so that it is successful," says Mr. Wivoda.
4. Project champions. Mr. Wivoda recommends executives choose "champions" for the health IT implementation whose primary responsibility is to be aware of the status of the project and remove any obstacles. "The champion does not need to be actively working on the project but aware and supportive. The champion should understand the project outcomes and be able to spend time on project support as needed," says Mr. Wivoda. He recommends that leadership choose executive, physician and nurse champions.
• Executive champion — The executive champion should be able to walk the floor and casually interact with the staff, to ask what their involvement has been so far and to see what they are excited about.
• Physician champion — The physician selected should be well respected, but he or she does not need to be the most technical. The most important characteristic of the champion is the ability to communicate effectively, according to Mr. Wivoda.
• Nurse champion — The nurse champion should be active with nurse engagement.
When hospital executives make these four elements a part of their agenda for health IT implementation, the process will be more effective. Focusing on these areas will help leadership assist staff, clinicians and patients adjust to and overcome the barriers that typically accompany health IT implementations and impede success.
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