President Obama's drive to overhaul the healthcare industry through
widespread investment in healthcare IT (HIT) systems has tremendous
implications for training and OD professionals. The good news for
us is that the push for HIT will increase the demand for skilled
training and OD practitioners. The bad news is that we need to
dramatically improve our knowledge, skills, and methodologies to
successfully meet the challenges introduced by HIT systems.
While IT systems have tremendous potential to cut costs and improve
quality, they have a huge failure rate. A recent article in
InfoWorld reports that approximately 70 percent of all IT
projects fail to meet their objectives. It is not uncommon for IT
projects to run late (sometimes years), have exorbitant cost
overruns (think millions or tens of millions of dollars), and
disrupt operations to the point that companies cannot deliver their
product or service. While IT failure in any industry is bad, in
healthcare it is disastrous. Quite simply, with IT failure in
healthcare people can, and do, die.
In fact, this very type of worst-case scenario happened in 1992
when a new information system was introduced to the London
Ambulance Service (LAS) in London, England. This avoidable IT
failure resulted in the deaths of 20 to 30 patients, the shutdown
of the system after only three weeks in service, the resignation of
the chief executive of the LAS, and the commissioning of a very
public government investigation into the system failure. Research
into the LAS tragedy showed that many of the contributing factors
for the system failure were due to human and organizational issues
that were either misunderstood or ignored by the project leaders.
Many of these issues could have been addressed through training and
What causes an IT project to fail?
Many IT systems failures are not caused by technical issues; rather
they are caused by organizational and human performance problems.
IT systems fail or succeed when they are used effectively, or not,
by the people in the organization. It is in this area, the shaping
of user behavior and performance, that training and OD
professionals can be agents of IT success. To do this, many of us
need to increase our own capacity for addressing the complex
challenges encountered when introducing and utilizing information
In addition, IT projects are often focused on developing and
deploying a system on time and on budget. Projects are usually
conceived, structured, and run by people with domain expertise in
technology or project management. A small change management effort,
which typically involves sending out basic communication materials
and providing limited technical training, is delivered at the time
of the initial system deployment. Once a system goes live, the
project is considered complete, and a small team of IT personnel is
left in place to support the system.
The problem is that most traditional approaches to IT systems
include little or no effort to ensure people change their behavior
and actually use the system after it goes live. Most IT project
staff lack the knowledge necessary to address the organizational
and human behavior issues that affect user behavior. Further, after
a system's deployment, it is rare for any action to be taken to
ensure the system is used and is delivering the anticipated
benefits to the organization.
Training and OD can drive success
As training and OD professionals, we have tremendous potential to
help individuals and organizations change behavior and adopt
technology. Many of the tools and approaches we already use are
very applicable to IT projects.
Before the IT project starts:
- Help the organization assign accountability for driving
effective user adoption and for ensuring the system delivers
anticipated benefits. This includes developing metrics for success,
determining when measurements will be taken, and defining the
consequences (positive or negative) that will result from making or
missing performance goals.
- Ensure that the people held accountable for results have the
authority and resources they need to take action and make sure the
system is used.
- Conduct an organizational assessment and identify any existing
organizational issues that will impact the overall success of the
system. OD tools, such as Weisbord's Six-Box Model, can assist in
identifying nontechnical issues that must be addressed.
During IT development:
- Provide leadership development solutions that prepare
executives, managers, and supervisors for the new human performance
challenges they will face once the system goes live.
- Develop the internal policies, processes, support structure,
and communication mechanisms necessary to enable full user adoption
across the organization. For example, organizations need to develop
mechanisms to address problems when poor system use in one
department prevents other departments from using the system.
- Shift the focus from providing training to facilitating
learning and driving desired behavior. This may require going way
beyond the typical point-and-click system training to include other
skill development or behavior change solutions.
- Improve the effectiveness of the IT project team itself through
group development solutions.
After IT deployment:
- Take actions to drive both initial adoption and sustained
long-term system use.
- Identify and share lessons learned and best practices across
- Monitor actual system use and respond as necessary to any
emergent behavior or unintended consequences that result from
implementing the system.
- Conduct periodic assessments and solutions to sustain effective
long-term system use.
We already have important knowledge and skills that can contribute
to successful IT implementations. Still, there are several things
we can do to expand our own capacity for helping organizations
achieve IT success. For example, we can
- increase our knowledge and understanding of IT systems,
development methodologies, and system management issues so we can
better integrate training and OD activities within the IT project
- learn to speak the language of IT and business leaders so we
can show them how we can contribute to their success
- expand our knowledge of socio-technical systems and learn more
about how introducing technology changes social and organizational
- develop new OD solutions for helping people adopt the
Now is the time
The potential for training and OD professionals to drive IT success
is great. The current focus on the widespread introduction of
healthcare IT systems, with all the associated implications for
patient safety and health, means that IT success or failure is
quite literally a matter of life or death. Now is the time to rise
to the challenges before us, increase our own knowledge and skills,
and apply our expertise to help make the potential success of
widespread HIT a reality.