EP447: Why an “EHR Strategy” Isn’t Enough, With Ashleigh Gunter

Relentless Health Value™

There was a study a few years ago that I was very enamored with. The study found doctors tended to ignore signs (ie, signs hanging on walls) asking them to wash their hands if the messaging on the sign wasn’t right.

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You know what sign message worked the best? When docs were reminded that not washing hands put patients’ health at risk. Did you think I was going to tell you that doctors ignored signs unless they got paid to wash their hands or something to do with some incentive? Well, that’s not what I’m saying.

Whatever was going through the doctors’ minds, an appeal to patient well-being drove them to action much better than alternatives, including when the sign talked about their own personal safety. Soap use rose by over 45% when the sign message resonated with a “why” that many clinicians had, which was patient safety.

Why with this anecdote about handwashing, you may ask? It is so that I can say with evidence that if you want to transform something, anything in healthcare, if you want to get people in healthcare to do something, it is always gonna start with said people—and you have to figure out their “why,” keeping in mind other people’s “why” may or may not be the same as yours, no matter how intuitive you think the “why” is.

For example, “Hey, let’s do value-based care.” Or “Hey, how about we try to get direct contracts with self-insured employers?” Or even, “Hey, let’s make something ‘easy’ for all of our clinicians by sticking it in the EHR system.” These are just three examples I thought of off the top of my head that immediately come to mind where the “why” is not actually self-evident at all for why anybody should be on board for any of these rides.

Karen Simonton and Benjamin Schwartz, MD, MBA, wrote the other day, “It doesn’t matter what area of healthcare you come from, if you can’t see another’s viewpoint, it’s very difficult to motivate them to see yours. This is so true, even in the same tribe—ortho tribe, primary care tribe, payer tribe, [even the RHV tribe]. It is a process.”

So, let’s dig in, because this is really important, actually, to everybody trying to do or sell or transform almost anything in healthcare.

Here’s from Dr. Ben Schwartz. He wrote this on LinkedIn the other day, and I edited it for brevity. He wrote:

“I’m not a big fan of using corporate speak in medicine, but there’s one core theme that comes up over and over and over again when thinking about healthcare innovation: change management.

“The best tech tools, care models, and forward-thinking concepts do not matter if you cannot convince anyone to adopt them. Many great ideas die on the vine because of resistance to change. In healthcare, all it takes is one ounce of resistance in a complicated, multi-layer system to sabotage an entire effort. …

“I’m increasingly convinced that success of any innovative effort in healthcare, from health tech to [value-based care] and beyond, hinges on the ability to manage change.”

And then he writes, “Frontline care delivery experience is too often discounted here, [in my opinion].”

Hmmm … Having spent what amounts to my entire career basically working to change behavior within the healthcare space, I could not agree more with Dr. Ben Schwartz. And may I just say that this, from the nailing of the “why” to the rest of any change management endeavor, is so misunderstood. Like, if you’re from a company trying to change clinician behavior or close a care gap and you come to me as step one asking for an “EHR strategy” or, more usually, an Epic strategy—really dig in on this user experience as step one here—this is why I’m gonna squint at you. It’s like wanting to find new customers and you’re gonna start the new business strategy with a tight focus on credit card swipes.

So, look, frictionless Visa card swiping is gonna be something that, of course, we’d all want to do from an operational excellence standpoint; but it’s only relevant after users decide to buy.

First things first, and first, they gotta have a goal that the thing fulfills. And that goal is going to be some kind of Quadruple or Quintuple Aim kind of goal—a goal that aligns with the “why” of the people that we want to change the behavior of. This is why all change management includes, right up near the front, creating the case for change. What’s the goal? What’s the “why” there? Sidebar, but now my brain is spiraling.

I saw a bar chart by Phil Ballentine the other day in Nikhil Krishnan’s Out-Of-Pocket newsletter that showed, in the USA, in 2024, there are 18,982 live instances of Epic. Each one of those 18,982 live instances are all different: different workflows, separate data, different ways to do the same thing. So, even if having an “Epic strategy” actually was a complete master plan to change behavior in clinic, healthcare has no “nationwide, everywhere it’s all the same, so figure out your thing once and you’re good to go” thing going on.

There are 18,982 differences of opinion out there, but here’s the actual and big kahuna real reason why I’m leery. An Epic strategy is not equivalent to a change management strategy. That’s the real point that I want to make.

It’s necessary, very necessary even, but not sufficient. You want to make the way as easy as possible once the “why” goes down and the case for change is made, but even if it’s one click and not your usual 14 to 60 clicks, there’s no “why” there. There’s no automatic case for change that slithers out of anybody’s API like a spontaneous miracle.

I said this last week, too. Lots of things are really pretty easy. Lots of things are in Epic. Yet no one uses them. I mean, let’s talk about actually reading most of the best-practice alerts that pop up. How about consistent use of SmartSets in the majority of those 18,982 instances?

Anyway, I couldn’t be more pleased to have learned a thing or two from Ashleigh Gunter about change management and how to do this whole thing right. This conversation happened actually a while ago. It’s re-edited for 2024—call it a supercut—specifically considering change management at hospitals or physician organizations.

Ashleigh Gunther is president of Translucent Healthcare Consulting. She is also an expert in change management and how to align employees and staff so that an organization can move forward together.

One quick spoiler before we proceed: According to Ashleigh, there’s five steps to effective change management that will ensure success:

1. Having great leadership

2. Creating a case for change. This includes the whole “why” thing.

3. Finding champions—engaging people who have to change so that they can contribute and be supportive

4. Overcommunicating

5. Measuring how things are going and also celebrating small triumphs

If you continue to be interested in this topic, do go back and listen to the show with Karen Root (EP381) on shepherding innovation through a large company.

Before we kick in to the show today, let me remind you of a few things. First of all, have you signed up for the weekly newsletter? If you consider yourself part of the Relentless Health Value Tribe and you want to get invited to some of the roundtables that actually we are currently organizing, please sign up for the newsletter.

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Thank you very much. With that, here is Ashleigh Gunter.

Also mentioned in this episode are Translucent Healthcare Consulting; Karen Simonton; Benjamin Schwartz, MD, MBA; Phil Ballentine; Nikhil Krishnan; Karen Root, MBA, CCXP; Rob Marty, DBA, MHA; Geoffrey Moore; and John Kotter.

You can learn more at translucenthc.com and by following Ashleigh on LinkedIn.

Ashleigh Gunter, president of Translucent Healthcare Consulting, combines her experience, an understanding of organizational culture, and a practical mindset to meet her clients’ needs. With over 30 years of management consulting experience, Ashleigh has deep expertise in advising in the dramatically changing healthcare market.

Ashleigh specializes in helping her clients drive change within their health plans, resulting in increased employee engagement, improved human resources experience, and reduced cost for both the employer and the employee. She believes in challenging the status quo by creating direct relationships between employers and providers.

Ashleigh has been a key contributor to several community-owned health plans in states from Washington to Virginia and has been credited with being key to employee participation and support of the plans.

In working for Andersen Consulting/Accenture, Deloitte Consulting, and The Gunter Group, Ashleigh has provided advice and consulting support to Fortune 100 C-suite executives over her career. She has an MBA with a focus in strategic management and organizational change from the University of Texas at Austin and a bachelor’s degree in business administration from the University of Denver with a concentration in finance.

09:22 How does change management go wrong in healthcare?

09:56 “Communication [of change] in and of itself isn’t change management.”

10:53 How does change management work on the provider organization side?

15:33 “You want to ensure you are educating the operational folks.”

16:35 What is change management?

17:36 What does great leadership look like in change management?

18:55 “Leadership sets the tone.”

19:04 What makes change management so hard?

19:31 “What’s the company reason to make this change happen?”

20:51 What are change champions, and why do you need to create them when changing your benefit plan?

21:57 Crossing the Chasm by Geoffrey A. Moore.

23:21 Why is it important to overcommunicate change?

26:47 Why is it important to measure your successes and communicate those after a change?

You can learn more at translucenthc.com and by following Ashleigh on LinkedIn.

Ashleigh Gunter of #TranslucentHealthcareConsulting discusses #changemanagement on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation

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