The 4-E Change Management Strategy for Implementing Pathology Workflow Software: Entice, Engage, Enlist, & Enjoy

Michael Riben, MD1 (mriben@mdanderson.org); and Mark J. Routbort, MD, PhD 2, Departments of 1Pathology and 2 Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX

Context: To facilitate the transition from paper-driven to a Pathologist’s care-driven workflow, we developed and are introducing a workflow Integration engine called PathStation, which automates and modifies numerous pathology laboratory processes to  enhance our clinical practice. This software, utilizing barcodes, radically changes the tasks required to accession, dictate, transcribe, and gross cases, as well as patient review, document scanning, surgery schedule review, and information system access/coordination. Historically, technology implementation in our lab has failed to usurp paper-driven tasks. Recognizing this, we crafted a change management strategy as a core component of the project, using it as a guidepost for design, development, and deployment.

Technology: PathStation, a .NET application developed with visual Basic .NET, brings together key applications using common context setting for case and patient. The software coordinates the LIS, the EMR, and the dictation application with single sign-on, and leverages a barcode driven workflow to facilitate grossing and sign-out.

Design: Our 4-E change management strategy derives from the end-user perspective and involves four components: Entice, Engage, Enlist, and Enjoy.  We enticed users with a revolutionary workflow paradigm and “carrot” applications. We engaged users by providing opportunities for decision making ownership (digital dictation software and new peripherals) and soliciting key requirements, current headaches, and preferred workflows, for incorporation into our final design. Features such as hands-free dictation, single sign-on, and application integration, enhanced ability to tract dictations, improved case worksheets, and overall system reliability were directly drawn from end-user input. We enlisted users with a “choose-to-use” adoption strategy, based on perceived benefit. We also developed focused communications and training strategy to widely disperse information, and optionally guide users for successful adoption including email announcements, demonstrations, training manuals, training classes, and quick guides, all engineered to make change enjoyable and easy, rather than stress-inducing, and frustrating.
 
Results: The 4-E strategy has resulted in end-user enthusiasm and quick adoption of the new workflow paradigm. Adoption of available modules (scanning of documents) has been rapidly accepted and end-users are already benefiting. After full implementation in June, we will report the full results of our change management strategy.

Co07/18/2006res thoughtful consideration of a change management strategy to ensure success. Our 4-E strategy is a model that can be used by other pathology groups looking to implement new information systems and drive workflow chang