Implementing new software, such as electronic field notes or evaluation tools, into residency settings has two overriding challenges:

1. Achieving buy-in from preceptors and residents
2. Ensuring the technology is efficient, and the user experience essentially frictionless

A well-designed change management plan can answer these challenges by demonstrating both the efficiency and ease of use of the technology, which in turn maximizes the potential for buy-in.

The Elements of Change Management

In health care-related change management frameworks[1], successful change hinges on the following four factors.

• Environmental conditions: The external factors giving rise to the need for change.  These include new regulations, technology, economic conditions, and education methods
• Organizational harmony: The alignment of people, plans, and goals with one overall vision
• Power dynamics: Concurrence (or willful participation) from the most influential individuals and teams in an organization
• Organizational capacity: The resources and will required to implement and sustain the change

Accounting for these four factors in your transition plan is step one in the implementation of the software.

The Process of Change

 A successful information technology transition has three stages:  planning, implementation, and sustainment.

• Planning involves making fact-based judgments about the current situation, culture, and attitudes in the organization in order to move from conception to implementation.
• Implementation refers to the multifaceted, customized method of disseminating information, introducing practices, and changing attitudes within a healthcare organization.
• Sustainment means averting the improvement evaporation effect or regression caused by change that is introduced without a robust plan. New methods and their outcomes should be robust enough to withstand periodic challenges to them, and yet be flexible enough to incorporate later innovations.

The Process of Change in Medical Education Settings

Years of experience in introducing software solutions to the medical education setting have elucidated the most critical factors at each stage of implementation.

The Planning Stage:

In the planning stage, a realistic appraisal of the four elements of change management outlined above is essential.  The predominant environmental factor leading to the adoption of software solutions is the mobile-first revolution combined with the shift to competency-based medical education.  The ability to evaluate competency immediately following procedures, and effectively quantify the data, enables medical education institutions to promote competency and identify gaps in learning in optimal and measurable ways.

Communicating clearly how a software tool can facilitate competence and how definitions relate to competency standards are essential to the alignment of people and resources, as well as achieving concurrence from residents and preceptors.

The Implementation Stage:

The main decision in this stage is how the information will be disseminated to preceptors and residents across all sites.

Training the trainer vs. a dedicated change management person

A university may have well over a thousand residents and preceptors spread across a wide geographical area and often without a chief administrator in charge of change management.  In most cases, the university will have an in-house administrator at each residency site.

In a train-the-trainer approach, each of these locations has a person responsible for training everyone there.  Some programs use their assessment or faculty development reps for this task.  Program Directors show the reps how to use the system, and provide them with the training materials so they can in turn train the doctors.

The potential downside to this system is inconsistent training across sites and increasing disengagement between Program Directors and the preceptors administering the program.

An alternative system has a dedicated trainer who is the in-program expert in the software application.  The trainer coaches all of the preceptors in-house at each location.  This system works most efficiently with smaller program populations.

Which system is better will depend on an assessment of each one’s advantages and limitations.

The Sustainment Stage:

Overcoming legacy issues and instilling new habits are perennial challenges.   In the long run, some foreseeable challenges have to be resolved in order to experience the benefits of a sustained software solution. The following is a list of some of the more common ones and their resolutions.

Challenge

• Preceptors may not be inclined to do anything perceived as extra work.

Solutions

• Ensure the technology is efficient and essentially frictionless to use. Eliminate unnecessary logins. Configure the technology to be “one touch” when accessing a field note or evaluation form.  Demonstrate the user-friendly text-to-talk function.
• Encourage preceptors to participate. Explain that the residents are responsible for all the data input; the preceptors are only responsible for offering feedback.

Challenge

• Ensuring the accuracy of the data logged and maintenance of the logging practice

Solutions

• Technical Mirroring: When residents understand that all their data inputs are immediately sent to the preceptor’s device, it encourages them to be timely, detailed and accurate.
• Inactivity reminders are programmed into the system to encourage residents to log their experiences in a timely fashion.

Challenge

• Achieving concurrence

Solution

• Coach Program Directors to:

1)  explain to residents  how the program will benefit them.

2)  regularly examine the data making sure residents are aware  of it.

3)  make decisions which benefit residents, based on the data.

4)  maintain an ongoing dialogue with the residents focusing on insights derived from the data.

Mobile software solutions have several advantages for your program, including more timely communication between preceptors and residents, resolution of preceptors’ time management concerns, more detailed and accurate data entry, as well as more competent residents.   A well-designed change management plan is the key to facilitating the implementation of the software.

[1] Referencing The Canadian Health Services Research Foundation’s Evidence-Informed Change Management Approach, Canada Health Infoway’s Change Management Framework, National Health Service Change Management Guidelines, and Institute for Healthcare Improvement’s Triple Aims Model